CAJ | 학술논문

目的分析聚丙烯酰胺水凝胶(polyamide hydrogel, PAMHG)注射隆乳后取出术前行磁共振成像(MRI)检查的意义.方法采用Philips 3.0T磁共振仪及4通道乳腺相控阵线圈,对20例共40只乳房曾注射PAMHG隆乳后取出术前的行双侧横轴位T1WI、T2WI-脂肪抑制(fat satura-tion,FS)及矢状位T2WI-FS平扫,其中8例用磁显葡胺(Gd-DTPA,0.1 mmol/kg,2.0 ml/s静脉团注)行THRIVE动态增强.对MRI表现与手术、病理结果对照分析.结果 PAMHG于T1WI表现为与腺体相等信号,T2WI表现为明显高信号.PAMHG内见不同程度低信号间隔100%(40/40),与周围组织相间分布,无光滑囊壁90%(36/40),见T1WI及T2WI低信号、光滑均匀囊壁10%(4/40).MRI发现PAMHG皮下硬结70%(28/40),腺体内硬结20%(8/40),胸大肌下条带状弥散硬结100%(40/40),乳腺肋间肌肌间隙出现PAMHG游走10 0A(4/40).所有PAMHG隆乳材料均无对比增强,1例于乳腺腺体内发现不规则结节状增强.T2WI上所见PAMHG范围、表现与手术所见一致.结论 PAMHG取出术前T2WI-FS可以准确评价其分布范围及并发症,MRI平扫同时进行动态增强扫描可以鉴别腺体内的硬结并及时发现伴发的乳腺癌,对临床取出PAMHG具有重要的指导意义.
목적 분석취병희선알수응효(polyamide hydrogel, PAMHG)주사륭유후취출술전행자공진성상(MRI)검사적의의.방법 채용Philips 3.0T자공진의급4통도유선상공진선권,대20례공40지유방증주사PAMHG륭유후취출술전적행쌍측횡축위T1WI、T2WI-지방억제(fat satura-tion,FS)급시상위T2WI-FS평소,기중8례용자현포알(Gd-DTPA,0.1 mmol/kg,2.0 ml/s정맥단주)행THRIVE동태증강.대MRI표현여수술、병리결과 대조분석.결과 PAMHG우T1WI표현위여선체상등신호,T2WI표현위명현고신호.PAMHG내견불동정도저신호간격100%(40/40),여주위조직상간분포,무광활낭벽90%(36/40),견T1WI급T2WI저신호、광활균균낭벽10%(4/40).MRI발현PAMHG피하경결70%(28/40),선체내경결20%(8/40),흉대기하조대상미산경결100%(40/40),유선륵간기기간극출현PAMHG유주10 0A(4/40).소유PAMHG륭유재료균무대비증강,1례우유선선체내발현불규칙결절상증강.T2WI상소견PAMHG범위、표현여수술소견일치.결론 PAMHG취출술전T2WI-FS가이준학평개기분포범위급병발증,MRI평소동시진행동태증강소묘가이감별선체내적경결병급시발현반발적유선암,대림상취출PAMHG구유중요적지도의의.
Objective To evaluate the significance of MRI before surgery to remove polyaeryl-amide hydrogel (PAMHG) which has been used for augmentation mammaplasty. Methods Twenty female patients with 40 breasts, having been injected PAMHG as augmentation mammaplasty, under-went bilateral breast axial T1WI, T2WI-fat saturation (FS) and sagittal T2WI-FS by 4-channal phased-assay breast coil at 3.0T (Philips) before removal surgery, in which 8 patients underwent axial multiphase contrast-enhanced MRI with THRIVE after Gd-DTPA (2.0 ml/s, 0.1 mmol/kg) adminis- tration. The results of MRI were compared with that of operation and pathology. Results PAMHG showed iso-intensity compared with breast gland on T1WI and hyperintensity on T2WI-FS. Low signal septa were noted within PAMHG in 40 breasts (20 patients), 90% (36/40) PAMHG without capsule, 10 % (4/40) with smooth capsule which showing homogenous low signal on T1WI and T2WI-FS. Subcutaneous lump of PAMHG was 70 % (28/40), lump of that in breast gland was 20% (8/40). Diffuse gel along spatium intermusculare of pectoralis major was 100 % (40/40), that along spatium intermusculare of intercostal muscle was 10 % (4/40). All PAMHG in breast of the 8 patients showed no enhancement, an irregular enhanced mass was found in gland of 1 patient. All distributions of PAMHG and appearances of its complications on T2WI-FS were consistent with the results of operation. Conclusions T2WI-FS can accurately display the distribution of PAMHG and its complication before removal surgery. MRI plane scan combined with muhiphase contrast-enhanced MRI can differentiate PAMHG from the lesions in the gland and find the breast carcinoma, so that it can guide clinicians before surgery to remove PAMHG used for augmentation mammaplasty.