Zusammenfassung.
In dieser Übersicht wird die Evaluation der weiblichen Brust nach Aufbau mit Silikonmammaprothesen
mittels MR-Techniken vorgestellt. Ein Schwerpunkt liegt dabei auf der Defektdiagnostik,
d. h. dem Nachweis des so genannten „Gelblutens”, der intra- und der extrakapsulären
Ruptur. Daneben wird auf die MR-Detektion von Silikonomen (abgekapseltes Silikon)
und deren Abgrenzung von einem Malignom eingegangen und das typische MR-Erscheinungsbild
von chronischer Fremdkörperreaktion vorgestellt. „Gelbluten” ist mittels MR-Bildgebung
(MRT) allein nicht zuverlässig zu diagnostizieren. Für die intrakapsuläre Ruptur ist
das so genannte „Linguini-Zeichen” das einzig verlässliche Zeichen. Der Nachweis von
Silikon außerhalb der Prothesenkapsel beweist eine extrakapsuläre Ruptur. Der MR-spektroskopische
Nachweis von Silikon im Lebergewebe stützt bei kurzer Implantationszeit und unauffälliger
MRT die Diagnose eines ausgedehnten „Gelblutens” und bei langer Implantationszeit
von mehr als 10 Jahren und fehlendem „Linguini-Zeichen” die Diagnose einer Ruptur
durch eine aufgelöste Implantathülle. Die MR hat im Vergleich zu anderen Bildgebungsmodalitäten
die höchste Sensitivität und Spezifität in der Diagnostik von Implantatdefekten. Aus
Kostengründen sollte die MR allerdings nicht als Screeningmethode, sondern vor allem
bei sonographischem Verdacht auf Ruptur oder bei Zustand nach radikaler Mastektomie
und Aufbauplastik zum Einsatz kommen. In diesen Fällen stellt die MRT die Untersuchungsmodalität
der Wahl dar.
MRI and MRS in patients with silicon implants of the breast.
This paper reviews the evaluation of the breast of women by MR-techniques after implantation
with silicon gel protheses. The main topics are the diagnosis of implant defects such
as extensive “gel bleed” and intra- and extracapsular ruptures. Moreover, the MR-detection
of siliconomas (encapsulated silicone) and differentiation from malignomas as well
as MR-features of chronic foreign body reactions are presented. “Gel bleed” is difficult
to diagnose unambiguously by MRI alone. The “linguini” sign is the only reliable mans
to diagnose intracapsular ruptures. The presence of silicone outside the implant capsule
indicates extracapsular rupture. The MR-spectroscopic detection of silicone in the
liver suggests after short implantation times and a normal MR scan the diagnosis “gel
bleed”, and after longer implantation times of more than 10 years and missing “linguini”
sign the diagnosis of ruptures due to a dissolved shell of the implant. MRI, in comparison
to other imaging modalities, has the highest specificity and sensitivity in the diagnosis
of implant defects. Due to its high costs, however, MR is not suitable as a screening
tool and should only be used in cases of sonographic suspected rupture or after radical
mastectomy. In these cases MRI is the method of choice.
Schlüsselwörter:
MR-Tomographie - Mamma - Silikonmammaprothesen - Mammatumor - MR-Protonen-Spektroskopie
- Leber
Key words:
MR-Imaging - Breast - Silicone breast protheses - Breast tumour - MR-Proton spectroscopy
- Liver
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Priv. Doz. Dr. Bettina Pfleiderer
Institut für Klinische Radiologie
Universität Münster
Albert-Schweitzer-Straße 33
48129 Münster
Phone: 0251-83-56153
Fax: 0251-83-56145
Email: pfleide@uni-muenster.de
