Silicone Implant Breast MRI Step by Step

Silicone Implant Breast MRI  Sequence usage: Turbo Spin Echo T2-weighted images, short-time inversion recovery silicone excited (silicone hyperintense, water suppressed), and silicone- saturated (water hyperintense, silicone suppressed) are the most common and most important sequences in silicone breast implant assessment. Protocol specifics will be determined by the Radiologist. Typically, saline implant rupture is not recom- mended for MRI due to the fact the implant will deflate and can be diagnosed with a physical examination. Suppression Techniques: 1. Bright Silicone: A. Inversion Recovery (STIR) i. STIR - Fat will be suppressed with TI and both water and silicone will be bright. Gives good overall impression of breast tissue. Center frequency should be set to water. ii. STIR with Water Saturation - Fat will be suppressed with TI and water saturation pulse (centered on water peak) will suppress water signal from breast tissue and blood vessels. The only bright signal will be from silicone. This sequence is very sensitive for free silicone that may have leaked outside the implant. Axial STIR Fluid Axial STIR + WS Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Job Aid | Silicone Implant Breast MRI Effective Date: 5/13/2020 | HOOD 05162003086676 2. T2 Turbo Spin Echo (TSE): A. T2 TSE – Useful to give general anatomy overview and evaluate the integrity of the implant lumen. B. T2 TSE with Fat Sat – Due to relative closeness of frequency peaks, silicone and fat share there can be differing results with this technique. Fat suppression is gener- ally not needed to evaluate implant leaks versus folds. 3. Silicone Suppression: A. Water Saturation – Offers no information for implant itself but is very useful in problem solving in situations such as with a double lumen. 720 3/20 Silicone- T2 Silicone Sat Sag (Water Saturation with manual frequency T2 Sagittal centered on silicone peak) B. Stir with TI 400 - Gray silicone with bright fluid and bright fat. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 2 of 6 Job Aid | Silicone Implant Breast MRI Effective Date: 5/13/2020 | HOOD 05162003086676 C. BLADE – very useful in Sagittal imaging to reduce artifacts caused by the inherent motion of the implant itself. There tends to be more ghosting from saline than silicone. D. Note: The fill valve is visible in the image example on the Right – which is present only in saline implants. Center Frequency Adjustments: Fat and water need to be suppressed to evaluate implant for rupture or linguine sign 1. Fat-Sat, Bright Silicone and Standard: A. Most all imaging is done with a centered frequency to Water. B. Under the System>>Adjustments tab Confirm freq. adjustment must be marked in order to see the pop-up prior to starting the scan. C. Note: Slight differences between software versions exist. Please refer to your manual. Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 3 of 6 Job Aid | Silicone Implant Breast MRI Effective Date: 5/13/2020 | HOOD 05162003086676 D. With assume Silicone checked, System will automatically tune to water accordingly it’s then the technologist role to confirm it is accurate. Routine Contrast Resolution Geometry System Physio Inline Sequence Coils Miscellaneous Adjustments Adjust Volume Tx/Rx Adjustment Strategy Standard Adjustment Tolerance Auto BO Shim Standard Adjust with Body Coil Confirm Frequency Always Assume Silicone V (1) (3) (2) (4) (5) Display of MR spectra: The frequency of spectra (silicone, fat, and water) runs from left to right. Normally, the fat line somewhat overlays the silicone line. (1) Amplitude (2) Frequency (3) Silicone (4) Fat (5) Water E. Three peaks will be displayed for Silicone, Fat then Water (Lt to Rt) F. Fat - Water is about 220Hz at 1.5T and 440Hz at 3T G. Silicone - Water is about 300Hz at 1.5T / 600Hz at 3T Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 4 of 6 Job Aid | Silicone Implant Breast MRI Effective Date: 5/13/2020 | HOOD 05162003086676 H. Note: To visualize peaks better, right click in the window and zoom spectrum. Can also separate the signals seen by each independent coil which is helpful if one breast has a different implant type. 2. Water Saturation: Used to suppress water or silicone signals by suppressing whichever peak you are centered on A. Centering on Water - suppresses water signal from breast parenchyma and blood vessels |Max| 8, 192 FWHM [Hz] 122.9 Mag f [Hz] 63.678.103 63.680.657 Coil Combined AD Frequency (sys) [Hz] 63679380 Frequency (temp) [Hz] 63679380 Apply B. Centering on Silicone - suppresses the silicone signal only C. When the frequency window pops up, simply left mouse click on the frequency peak you wish to suppress, click on Apply to save the frequency change D. Note: The white tick mark is where the system tuned, the Red line is only shown once you hit the Apply button Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 5 of 6 Job Aid | Silicone Implant Breast MRI Effective Date: 5/13/2020 | HOOD 05162003086676 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information. The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages. All names and data of patients, parameters and configuration dependent designations are fictional and examples only. All rights, including rights created by patent grant or registration of a utility model or design, are reserved. Copyright © Siemens Healthcare GmbH 2020 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 Unrestricted 0 Published by Siemens Healthcare GmbH © Siemens Healthcare GmbH, 2020 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: XX/XX/XXXX | HOOD/HILS Healthineers Page 6 of 6