Ruptures of Single-Lumen Silicone Breast Implants

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 2.25
Patient Care: 1.25
Patient Interactions and Management: 1.25
Procedures: 1.00
Breast Interventions: 1.00

Mammography: 2.25
Procedures: 2.25
Mammographic Positioning, Special Needs, and Imaging Procedures: 2.25

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Body: 1.50

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Thoracic Section: 2.25

Sonography: 1.00
Procedures: 1.00
Superficial Structures and Other Sonographic Procedures: 1.00

Outline

1. Introduction
2. Mammography
3. Ultrasonography
   1. Technical Considerations
   2. Normal Appearance
   3. Capsule-Shell Complex
   4. Intracapsular Rupture
   5. Intracapsular Rupture Mimics
   6. Extracapsular Rupture
4. MR Imaging
   1. Technical Considerations
   2. Determining Implant Type
   3. Normal Appearance
   4. Contour Abnormalities
   5. Intracapsular Rupture
   6. Intracapsular Rupture Mimics
   7. Extracapsular Rupture
   8. MR Imaging with Intravenous Contrast Agent
5. Cohesive Implants
6. Conclusion

Objectives

Upon completion of this course, students will:

1. know the number of breast augmentation procedures performed in the U.S. annually
2. recognize the most common type of breast implant used today
3. identify the improvements made in fourth- and fifth-generation implants
4. realize the average lifespan of a silicone-gel filled implant
5. define intracapsular rupture
6. define extracapsular rupture
7. know the type of rupture mammography is useful for detecting
8. know the sensitivity of mammography, US, and MR imaging for the detection of silicone implant rupture
9. identify the imaging modality suggested for use in initial evaluation of suspected rupture
10. describe the speed of sound through a silicone implant compared to that of a saline implant
11. recognize the normal appearance of a single-lumen silicone implant at US
12. notice bulges and herniations of the implant’s elastomer shell at US
13. name the classic US signs of intracapsular rupture
14. realize which US sign of intracapsular rupture is the equivalent to the MRI “linguine” sign
15. identify a reverberation artifact
16. identify an echogenic noise artifact
17. know what an echogenic noise artifact signifies
18. be aware of the artifact that may result at US when imaging cohesive implants
19. cite the stance of the U.S. FDA with regard to surveillance screening with MRI of silicone implants
20. recognize for what types of breast implants MR imaging should be used for rupture assessment
21. be familiar with the appearance of the images from a silicone-only pulse sequence
22. realize the image acquisition method used to differentiate early intracapsular rupture from complex radial folds
23. know the type of MRI pulse sequence used to distinguish the fill materials of a breast implant
24. describe how both silicone and saline appear on T2-weighted images
25. describe how both silicone and saline appear on T1-weighted images
26. know which implants have fill valves
27. recognize the normal appearance of the fibrous capsule on a T2-weighted image
28. name the MR imaging sign of an uncollapsed rupture
29. name the degree of collapse when the extruded silicone separates the implant elastomer shell from the fibrous capsule
30. identify the MR imaging sign of a partial to full collapse
31. recognize MR imaging artifacts that mimic intracapsular rupture
32. state the MR imaging pulse sequence that’s particularly useful and sensitive for identifying extracapsular free silicone gel
33. know for what MR imaging breast studies a BI-RADS score is required
34. identify the other name for cohesive breast implants
35. describe the design of cohesive breast implants