title: Magnetic resonance imaging appearances in the postoperative breast: the clinical target volume-tumor and its relationship to the chest wall.
abstract: OBJECTIVE
  To describe and measure the postoperative complexes and their relationship to the chest wall in 100 randomly chosen MRI breast scans, to attempt a better understanding of the changes taking place in the postoperative breast.
  
  
  METHODS
  Appearances and measurements of MRI postoperative cavities were analyzed in a cohort of 100 randomly selected patients who underwent a single open MRI scan in the conventional breast radiotherapy treatment position before routine two-dimensional simulation.
  
  
  RESULTS
  Magnetic resonance imaging appearances of postoperative cavities seem to differ qualitatively from descriptions of CT and ultrasound cavities in the literature. Rather than being principally homogeneous, heterogeneous cavities were seen in 85%, irregular in 51%. The size of cavity was inversely related to the time elapsed since surgery. Cavities directly touched the chest wall in 53% of cases; 89% lay within 10 mm of the chest wall. Regular, annular concentric rings of differing signal were seen in 32% of cases; such appearances have not been previously described. These patterns suggest that seromas may not shrink entirely as a result of simple serous fluid absorption; instead, new tissue may be being laid down. Because large, regular spheroidal/ellipsoidal cavities with crisp margins may be seromas under pressure, greater target shifts during radiation may need to be anticipated in such cases.
  
  
  CONCLUSIONS
  Postsurgical cavities in the conserved breast on MRI are commonly heterogeneous, irregular, and lie close to the chest wall. Magnetic resonance imaging studies may help in better understanding the natural history of postoperative cavities.
authors.affiliation: Bristol Haematology and Oncology Centre, United Bristol Healthcare Trust, Bristol, United Kingdom. liz@lizwhipp.com
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: Whipp
authors.forename: Michael
authors.initials: M
authors.lastname: Halliwell
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011184:Postoperative Period; D049291:Seroma / Q000473:pathology*; D035441:Thoracic Wall / Q000473:pathology*; D013997:Time Factors; D047368:Tumor Burden