title: Imaging of idle breast implants with ultrasound-strain elastography- A first experimental study to establish criteria for accurate imaging of idle implants via ultrasound-strain elastography.
abstract: OBJECTIVE
  To investigate whether there are fundamental sonographic and elastographic criteria to precisely assess different surfaces and fillings of idle breast implants and to determine their most distinctive parameters. This was a comparative study of different unused breast implant materials, neighter in animals nor in humans. This knowledge should be transferred in vivo to develop an objective measurement tool.
  
  
  METHODS
  Nine idle breast implants-silicone and polyurethane (PU)-were examined in an experimental study by using ultrasound B-mode with tissue harmonic imaging (THI), speckle reduction imaging (SRI, level 0-4), cross-beam (CB, low, medium, high), photopic and the colour coded ultrasound-strain elastography with a multifrequency probe (9-15 MHz).Using a standardised protocol the implants' centre as well as the edge were analysed by one experienced examiner. Two independent readers performed analysis and evaluation. For image interpretation a score was created (score 0:inadequate image, score 5:best image quality).
  
  
  RESULTS
  The highest score result for the centre was achieved by using ultrasound with B-mode in addition with CB level medium, SRI level 2, THI and photopic (mean:3.22±SD:1.56), but without any statistic significant difference (t-value = 0.71). With elastography the implants' edge in general was represented without disruptive artefacts (3.89±0.60) with statistic significant difference (t-value = 5.29). Implants filled with inner cohesive silicone gel II° showed best imaging conditions for their centre via ultrasound (5±0) as well as for their edge via elastography (4.50±0.71).
  
  
  CONCLUSIONS
  Ultrasound-strain elastography and high resolution ultrasound represent a valuable measurement tool to evaluate different properties of idle breast implants. These modified ultrasound examinations could be an additional help for clinical investigations and be correlated with Baker's Classification.
authors.affiliation: Center for Plastic, Aesthetic, Hand &Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Kuehlmann
authors.affiliation: Center for Plastic, Aesthetic, Hand &Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Prantl
authors.affiliation: Department of DiagnosticRadiology and Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Michael Jung
mesh_terms: D018427:Breast Implants; D001943:Breast Neoplasms / Q000532:radiotherapy*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D016217:Ultrasonography, Mammary / Q000379:methods*
keywords: Baker’s Classification; Breast implants; elastography