title: Appropriate use of magnetic resonance imaging and ultrasound to detect early silicone gel breast implant rupture in postmastectomy reconstruction.
abstract: BACKGROUND
  Implant rupture is one of the most important sequelae of breast reconstruction after mastectomy. The primary aim of this study was to compare magnetic resonance imaging and ultrasound evaluation with intraoperative findings and provide a reliable description of the occurrence of each radiological sign.
  
  
  METHODS
  The authors prospectively recruited a consecutive series of 102 postmastectomy patients requiring implant change for aesthetic purposes. Magnetic resonance imaging and ultrasound evaluation results were compared with intraoperative findings. Sensitivity, specificity, positive predictive value, negative predictive value, and the overall accuracy of magnetic resonance imaging and ultrasound in detecting ruptured implants were calculated, along with their corresponding 95 percent confidence intervals.
  
  
  RESULTS
  Magnetic resonance imaging performs better than ultrasound for diagnosis of breast implant rupture, with overall accuracies of 94 and 72 percent, respectively. The negative predictive value of ultrasound was 85 percent, meaning that in the case of negative ultrasound findings, magnetic resonance imaging may be avoided. Teardrop sign and water droplets are the most common findings on magnetic resonance imaging.
  
  
  CONCLUSIONS
  Magnetic resonance imaging should be considered the method of choice for investigating silicone gel implant rupture in postmastectomy patients, and the standardization of magnetic resonance imaging criteria may improve magnetic resonance imaging accuracy. The authors therefore suggest a strategy of screening asymptomatic women with ultrasound every year and with magnetic resonance imaging every 5 years.
  
  
  METHODS
  Diagnostic, II.
authors.affiliation: Milan, Italy; and Barretos, Brazil From the Departments of Plastic and Reconstructive Surgery, Radiology, and Breast Surgery, and the Division of Epidemiology and Biostatistics, European Institute of Oncology; and the Department of Breast and Reconstructive Surgery, Barretos Cancer Hospital.
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
authors.forename: Gaetano
authors.initials: G
authors.lastname: Villa
authors.forename: Antonio
authors.initials: A
authors.lastname: Toesca
authors.forename: Stefania
authors.initials: S
authors.lastname: Rizzo
authors.forename: Sara
authors.initials: S
authors.lastname: Raimondi
authors.forename: Fabio
authors.initials: F
authors.lastname: Rossetto
authors.forename: Claudia
authors.initials: C
authors.lastname: Sangalli
authors.forename: Francesca
authors.initials: F
authors.lastname: De Lorenzi
authors.forename: Andrea
authors.initials: A
authors.lastname: Manconi
authors.forename: Angelo Gustavo Zucca
authors.initials: AGZ
authors.lastname: Matthes
authors.forename: Badir
authors.initials: B
authors.lastname: Chahuan
authors.forename: Fabricio
authors.initials: F
authors.lastname: Brenelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Petit
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation; D018427:Breast Implants; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology; D011446:Prospective Studies; D011475:Prosthesis Failure; D020034:Silicone Gels; D014463:Ultrasonography
chemical_list: D020034:Silicone Gels