{'fraction_non_alphanumeric': 0.023103340618170466, 'fraction_numerical': 0.0034342803621604744, 'mean_word_length': 5.420841683366733, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Is It Possible To Differentiate Types Of Breast Implants By Imaging In The Era Of Implant Associated Lymphoma?

Objectives Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) has been recognised in the latest years and there is an ongoing extensive research. Although the exact mechanism and cause are still not clear, we now know that the disease is more associated with textured implants. To the best of our knowledge, no previous study investigating the radiological differential of various implants has been conducted. In this essay, we aimed to demonstrate dicriminating in vitro and in vivo imaging features, if any, of variuos types of breast implant devices using mammography, ultrasound, and Magnetic Resonance Imaging (MRI). METHODS Five different implant devices from various manufacturers with different surface materials which are smooth, microtextured, regular macrotextured, lightweight macrotextured, polyurethane coated were involved. In vitro mammography was performed with a digital mammogram (Amulet Innovality, Fuji, Japan) and in vitro and in vivo sonography was performed with Esaote MyLab9 using a 7.5 MHz linear probe. In vitro MRI was performed with 1.5T magnet (Symphony TIM upgrade and Aera, Siemens Healthcare, Erlangen, Germany), with 7 channel breast coil (Sense coil, Innova, Germany). MRI studies included fat sat T2 weighted sequences (T2WS), non-fat sat T2WS and silicone only sequences. Results Each imaging technique had different contributions for dealing with this challenge. Mammography and MRI were limited on identifying the double bands of the capsule. On mammogram, we could only differentiate the lightweight macrotextured implant as the borosilicate microspheres were represented by tiny, round lucencies within the gel. Ultrasound imaging with the proper technique was very helpful for identfying the surface. On in vitro sonogram, the inner capsule (implant shell) was identified as parallel double echogenic bands. Bands of the smooth implant were better delineated compared to the textured implants. The double echogenic bands of the polyurethane coated implant were not even identified separetely. Reverberation artefact caused by the smooth implant was the main discriminating in vivo sonographic feature of smooth implants. On in vitro MRI, we could identify the hyperintense polyurethane coated capsule on fat sat T2WS and non-fat sat T2WS. The tiny hypointense microspheres of the lightweight implant was also identified on the silicone only sequence of the in vitro MRI. Conclusion In this study, we have showed that breast implant material and type may be differed by the help of in vitro and in vivo imaging characteristics on different radiological modalities. These different imaging features could be used for recognising and labelling the implant type, especially macro textured implants which are reported to be more associated with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) compared to other types. We believe evaluating these imaging characteristics during daily practice will help radiologists to become aware of the implant type and possible complications or diseases associated with that type.