Single- and double-lumen silicone breast implant integrity: Prospective evaluation of MR and US criteria

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) and ultrasound (US) criteria for breast implant integrity. MATERIALS AND METHODS: One hundred twenty-two single-lumen silicone breast implants and 22 bilumen implants were evaluated with surface coil MR imaging and US and surgically removed. MR criteria for implant failure were a collapsed implant shell ('linguine sign'), foci of silicone outside the shell ('noose sign'), and extracapsular gel. US criteria were a collapsed shell, low-level echoes within the gel, and 'snowstorm' echoes of extracapsular silicone. RESULTS: Among single-lumen implants, MR imaging depicted 39 of 40 ruptures, 14 of 28 with minimal leakage; 49 of 54 intact implants were correctly interpreted. US depicted 26 of 40 ruptured implants, four of 28 with minimal leakage, and 30 of 54 intact implants. Among bilumen implants, MR imaging depicted four of five implants with rupture of both lumina and nine of 10 as intact; US depicted one rupture and helped identify two of 10 as intact. Mammography accurately depicted the status of 29 of 30 bilumen implants with MR imaging correlation. CONCLUSION: MR imaging depicts implant integrity more accurately than US; neither method reliably depicts minimal leakage with shell collapse. Mammography is useful in screening bilumen implant integrity.