Does breast implant damage require MRI with or without contrast?

From the Guidelines

Breast implant damage can be effectively evaluated with MRI without IV contrast, as it is particularly helpful in identifying intracapsular ruptures. When evaluating breast implant integrity, the primary goal is to accurately diagnose any potential damage or rupture, which can significantly impact patient morbidity, mortality, and quality of life. According to the most recent guidelines from the American College of Radiology 1, MRI without IV contrast is recommended for symptomatic patients with silicone breast implants or patients with equivocal US results for rupture at any time postoperatively. The use of MRI without contrast has been shown to have a high sensitivity and specificity for detecting intracapsular ruptures, with pooled data from a meta-analysis showing a sensitivity of 87% and a specificity of 89.9% 1. Some key points to consider when using MRI for breast implant evaluation include:

• The ability to detect intracapsular ruptures, which are not evident on mammography and can be difficult to diagnose by US
• The use of specialized sequences, such as silicone-specific sequences, to detect small amounts of silicone that may have leaked outside the implant shell
• The importance of interpreting the MRI at a facility with experience in breast imaging and by radiologists familiar with the appearance of normal and damaged breast implants
• The potential for MRI to evaluate the surrounding breast tissue for any complications or abnormalities associated with implant damage. Overall, the use of MRI without IV contrast is a valuable tool for evaluating breast implant integrity and can help guide clinical decision-making to improve patient outcomes.

From the Research

Breast Implant Damage Evaluation

• The evaluation of breast implant integrity can be done using various imaging modalities, including magnetic resonance imaging (MRI), mammography, and ultrasonography 2, 3, 4.
• MRI is considered the most useful imaging modality for characterizing breast implants due to its high spatial resolution and contrast between implants and soft tissues 3.
• The use of MRI with or without contrast for evaluating breast implant damage is supported by several studies, with some indicating that noncontrast breast MRI is the imaging modality of choice for evaluating implant integrity 5.

Comparison of Imaging Modalities

• A study comparing mammography, sonography, and MRI found that MRI had the highest sensitivity and specificity for detecting implant rupture, followed by sonography, and then mammography 4.
• Another study found that physical examination with or without mammography was as accurate as MRI in determining implant integrity in the setting of capsular contracture 2.
• However, a study evaluating the usefulness of clinical examination in diagnosing silicone breast-implant rupture found that the sensitivity and specificity of clinical examination were not acceptable, and that MRI was a more reliable diagnostic tool 6.

Use of Contrast in MRI

• According to a study, breast MRI for evaluation of implant integrity does not require intravenous contrast material, but the use of MRI contrast material is indicated when infection or malignancy is suspected 5.
• Silicone- and water-selective sequences can provide useful supplemental information to confirm intracapsular and extracapsular rupture, and can be used without contrast 5.