Ability of dual-energy CT to detect silicone gel breast implant rupture and nodal silicone spread

Katrina Nesta Glazebrook, Stefan Doerge, Shuai Leng, Tammy A. Drees, Katie N. Hunt, Shannon N. Zingula, Sandhya Pruthi, Jennifer R. Geske, Rickey E. Carter, Cynthia H McCollough, Joel Garland Fletcher

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of this study is to compare the performance of dual-energy CT (DECT) with that of breast MRI for detection of silicone gel breast implant rupture and nodal spread of silicone. SUBJECTS AND METHODS. This prospective study enrolled consecutive patients with current or prior silicone gel implants and clinical suspicion of implant rupture or extracapsular silicone. All patients underwent MRI followed by unenhanced DECT. A breast radiologist not participating in image evaluation established reference standards for implant rupture (intra- or extracapsular) and regional nodal silicone spread (to axillary nodes and internal mammary [IM] and mediastinal nodes) using MRI, surgical findings, and medical records. After undergoing reader training, two radiologists who were blinded to all medical records interpreted randomized images in two sessions, indicating confidence in diagnosis using a 100-point visual scale. RESULTS. A total of 46 patients who had a subpectoral silicone gel implant (n = 31), a subglandular silicone gel implant (n = 14), or a silicone gel implant that was removed (n = 1) underwent MRI and DECT (mean [± SD] volume CT dose index, 8.2 ± 2.0 mGy). Nineteen patients had implant rupture, and 13 of these patients had silicone within the IM or axillary nodes. Pooled data showed no significant difference between MRI and DECT interpretation of intra- or extracapsular rupture of implants (AUC value for intracapsular rupture, 0.958 [for MRI] vs 0.989 [for DECT]; p = 0.28; AUC value for extracapsular rupture, 0.864 [for MRI] vs 0.878 [for DECT]; p = 0.78). No difference was noted in the AUC value for silicone spread to regional lymph nodes: 0.823–0.866 [for MRI] vs 0.892–0.906 [for DECT]; p = 0.34–0.54). CONCLUSION. DECT performs similar to MRI for the detection of silicone gel implant rupture and the presence of silicone in regional lymph nodes, and it may be an alternative for patients who are unable or unwilling to undergo MRI.

Original languageEnglish (US)
Pages (from-to)933-942
Number of pages10
JournalAmerican Journal of Roentgenology
Volume212
Issue number4
DOIs
StatePublished - Apr 1 2019

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Silicone Gels
Breast Implants
Silicones
Rupture
Breast
Area Under Curve
Medical Records
Lymph Nodes
Cone-Beam Computed Tomography
Prospective Studies

Keywords

  • Breast implant
  • Dual-energy CT
  • Implant rupture
  • MRI
  • Silicone

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Ability of dual-energy CT to detect silicone gel breast implant rupture and nodal silicone spread. / Glazebrook, Katrina Nesta; Doerge, Stefan; Leng, Shuai; Drees, Tammy A.; Hunt, Katie N.; Zingula, Shannon N.; Pruthi, Sandhya; Geske, Jennifer R.; Carter, Rickey E.; McCollough, Cynthia H; Fletcher, Joel Garland.

In: American Journal of Roentgenology, Vol. 212, No. 4, 01.04.2019, p. 933-942.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The purpose of this study is to compare the performance of dual-energy CT (DECT) with that of breast MRI for detection of silicone gel breast implant rupture and nodal spread of silicone. SUBJECTS AND METHODS. This prospective study enrolled consecutive patients with current or prior silicone gel implants and clinical suspicion of implant rupture or extracapsular silicone. All patients underwent MRI followed by unenhanced DECT. A breast radiologist not participating in image evaluation established reference standards for implant rupture (intra- or extracapsular) and regional nodal silicone spread (to axillary nodes and internal mammary [IM] and mediastinal nodes) using MRI, surgical findings, and medical records. After undergoing reader training, two radiologists who were blinded to all medical records interpreted randomized images in two sessions, indicating confidence in diagnosis using a 100-point visual scale. RESULTS. A total of 46 patients who had a subpectoral silicone gel implant (n = 31), a subglandular silicone gel implant (n = 14), or a silicone gel implant that was removed (n = 1) underwent MRI and DECT (mean [± SD] volume CT dose index, 8.2 ± 2.0 mGy). Nineteen patients had implant rupture, and 13 of these patients had silicone within the IM or axillary nodes. Pooled data showed no significant difference between MRI and DECT interpretation of intra- or extracapsular rupture of implants (AUC value for intracapsular rupture, 0.958 [for MRI] vs 0.989 [for DECT]; p = 0.28; AUC value for extracapsular rupture, 0.864 [for MRI] vs 0.878 [for DECT]; p = 0.78). No difference was noted in the AUC value for silicone spread to regional lymph nodes: 0.823–0.866 [for MRI] vs 0.892–0.906 [for DECT]; p = 0.34–0.54). CONCLUSION. DECT performs similar to MRI for the detection of silicone gel implant rupture and the presence of silicone in regional lymph nodes, and it may be an alternative for patients who are unable or unwilling to undergo MRI.",
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T1 - Ability of dual-energy CT to detect silicone gel breast implant rupture and nodal silicone spread

AU - Glazebrook, Katrina Nesta

AU - Doerge, Stefan

AU - Leng, Shuai

AU - Drees, Tammy A.

AU - Hunt, Katie N.

AU - Zingula, Shannon N.

AU - Pruthi, Sandhya

AU - Geske, Jennifer R.

AU - Carter, Rickey E.

AU - McCollough, Cynthia H

AU - Fletcher, Joel Garland

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N2 - OBJECTIVE. The purpose of this study is to compare the performance of dual-energy CT (DECT) with that of breast MRI for detection of silicone gel breast implant rupture and nodal spread of silicone. SUBJECTS AND METHODS. This prospective study enrolled consecutive patients with current or prior silicone gel implants and clinical suspicion of implant rupture or extracapsular silicone. All patients underwent MRI followed by unenhanced DECT. A breast radiologist not participating in image evaluation established reference standards for implant rupture (intra- or extracapsular) and regional nodal silicone spread (to axillary nodes and internal mammary [IM] and mediastinal nodes) using MRI, surgical findings, and medical records. After undergoing reader training, two radiologists who were blinded to all medical records interpreted randomized images in two sessions, indicating confidence in diagnosis using a 100-point visual scale. RESULTS. A total of 46 patients who had a subpectoral silicone gel implant (n = 31), a subglandular silicone gel implant (n = 14), or a silicone gel implant that was removed (n = 1) underwent MRI and DECT (mean [± SD] volume CT dose index, 8.2 ± 2.0 mGy). Nineteen patients had implant rupture, and 13 of these patients had silicone within the IM or axillary nodes. Pooled data showed no significant difference between MRI and DECT interpretation of intra- or extracapsular rupture of implants (AUC value for intracapsular rupture, 0.958 [for MRI] vs 0.989 [for DECT]; p = 0.28; AUC value for extracapsular rupture, 0.864 [for MRI] vs 0.878 [for DECT]; p = 0.78). No difference was noted in the AUC value for silicone spread to regional lymph nodes: 0.823–0.866 [for MRI] vs 0.892–0.906 [for DECT]; p = 0.34–0.54). CONCLUSION. DECT performs similar to MRI for the detection of silicone gel implant rupture and the presence of silicone in regional lymph nodes, and it may be an alternative for patients who are unable or unwilling to undergo MRI.

AB - OBJECTIVE. The purpose of this study is to compare the performance of dual-energy CT (DECT) with that of breast MRI for detection of silicone gel breast implant rupture and nodal spread of silicone. SUBJECTS AND METHODS. This prospective study enrolled consecutive patients with current or prior silicone gel implants and clinical suspicion of implant rupture or extracapsular silicone. All patients underwent MRI followed by unenhanced DECT. A breast radiologist not participating in image evaluation established reference standards for implant rupture (intra- or extracapsular) and regional nodal silicone spread (to axillary nodes and internal mammary [IM] and mediastinal nodes) using MRI, surgical findings, and medical records. After undergoing reader training, two radiologists who were blinded to all medical records interpreted randomized images in two sessions, indicating confidence in diagnosis using a 100-point visual scale. RESULTS. A total of 46 patients who had a subpectoral silicone gel implant (n = 31), a subglandular silicone gel implant (n = 14), or a silicone gel implant that was removed (n = 1) underwent MRI and DECT (mean [± SD] volume CT dose index, 8.2 ± 2.0 mGy). Nineteen patients had implant rupture, and 13 of these patients had silicone within the IM or axillary nodes. Pooled data showed no significant difference between MRI and DECT interpretation of intra- or extracapsular rupture of implants (AUC value for intracapsular rupture, 0.958 [for MRI] vs 0.989 [for DECT]; p = 0.28; AUC value for extracapsular rupture, 0.864 [for MRI] vs 0.878 [for DECT]; p = 0.78). No difference was noted in the AUC value for silicone spread to regional lymph nodes: 0.823–0.866 [for MRI] vs 0.892–0.906 [for DECT]; p = 0.34–0.54). CONCLUSION. DECT performs similar to MRI for the detection of silicone gel implant rupture and the presence of silicone in regional lymph nodes, and it may be an alternative for patients who are unable or unwilling to undergo MRI.

KW - Breast implant

KW - Dual-energy CT

KW - Implant rupture

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