Linguine Sign PDF

Signs in Imaging
Amjad Safvi, MS, MD
Linguine Sign1
APPEARANCE
The linguine sign is seen at magnetic resonance (MR) imaging

of silicone breast implants by using T2-weighted spin-echo or
fast spin-echo methods with or without water suppression. The
breast implant contains multiple curvilinear low-signal-inten-
sity lines within the high-signal-intensity silicone gel. The
lines are usually scattered diffusely and appear as long strands
of decreased signal intensity curved on top of each other.
EXPLANATION
The linguine sign indicates intracapsular rupture of the sili-

cone breast implant (1). The breast implant is made of a Silastic
elastomeric shell containing silicone. The elastomeric shell
breaks, which releases the silicone inside. A fibrous capsule
(scar tissue) forms around the breast implant after it is placed
into the breast. The fibrous capsule usually contains the sili-
cone as the shell collapses. The serpentine lines represent lay-
ers of collapsed elastomeric shell floating in the silicone gel
within the fibrous capsule.
The Silastic elastomeric shell appears as low-signal-intensity
lines, and the silicone gel appears as high signal intensity on Sagittal T2-weighted short-T1 inversion-recov-
ery MR image (3,000/60 [repetition time msec/
T2-weighted images. Medical-grade silicone is composed of
echo time msec]) obtained with fat suppres-
dimethyl siloxane, a silicon molecule with two methyl groups sion shows intracapsular rupture of a silicone
linked to each other by oxygen molecules in a polymer chain. breast implant, as demonstrated by the lin-
The MR signal intensity is derived from the protons of the guine sign (arrow).
methyl groups. The Silastic elastomeric shell is also composed
of the same polymer but has increased cross-linkage of the
methyl groups, which results in an elastic solid. This linked
DISCUSSION
polymer produces a lower MR imaging signal intensity than
the unlinked silicone gel polymer (2).
There are several types of breast implants. Most are single-
lumen silicone prostheses containing silicone gel within an
outer elastomeric silicone shell. Implants can also contain
saline or be made of a combination of saline and silicone in
different encapsulated shells. The surface can be smooth or
Index terms:
textured; the latter is thought to decrease the formation of
Breast, MR, 00.121411
Breast, prostheses, 00.4543, 00.91 capsular contractures, which is a fairly common complication.
Signs in Imaging Gel bleeding indicates microscopic leakage of silicone
Silicone, 00.4543 through the shell. There almost always is some degree of leak-
age of silicone gel from the implant. In intracapsular implant
Radiology 2000; 216:838 839
1
From the Department of Radiology, Northwestern Memorial Hospi-
tal, Chicago, Ill. Received March 3, 1998; revision requested April 29;
final revision received April 26, 1999; accepted August 30. Address A trainee (resident or fellow) wishing to submit a manuscript
correspondence to the author, 296 Hawkeye Court, Iowa City, IA for Signs in Imaging should first write to the Editor for approval
52242. of the sign to be prepared, to avoid duplicate preparation of the
RSNA, 2000 same sign.
838
rupture, the fibrous capsule contains the silicone. In extracap- cm seen on multiple consecutive images indicate a ruptured
sular rupture, the silicone breaks free from the ruptured fibrous implant (5). There usually is some undulation of these lines,
capsule and the ruptured implant and leaks into the breast which indicates a free-floating elastomeric shell. Intracapsular
parenchyma. rupture of breast implants can be easily and confidently de-
The linguine sign (Figure) indicates intracapsular rupture of tected with the presence of the linguine sign.
the breast implant. This MR imaging sign is the most sensitive
among all the signs of intracapsular rupture from other imag-
ing modalities, with a sensitivity of 96% and a specificity of References
94% (3). The wavy lines on MR images represent the collapsed 1. Gorczyca D, Sinha S, Ahn C, et al. Silicone breast implants in vivo:
shell floating in the silicone. Although the linguine sign is MR Imaging. Radiology 1992; 185:407 410.
fairly easy to detect, the signs of early intracapsular rupture (4) 2. Gorczyca D. MR imaging of breast implants. Magn Reson Imaging
Clin N Am 1994; 2:659 672.
(tear drop sign, keyhole sign, subcapsular line sign) were more
3. Samuels JB, Rohrich R, Weatherall P, et al. Radiographic diagnosis
common than the linguine sign in a study of 86 breast im- of breast implant rupture: current status and comparison of tech-
plants (5). niques. Plast Reconstr Surg 1995; 96:865 877.
The Silastic elastomeric shell by design is not wrapped tautly 4. Soo MS, Kornguth P, Walsh R, et al. Complex radial folds versus
around the silicone gel. There is room left for the implant to be subtle signs of intracapsular rupture of breast implants: MR find-
ings with surgical correlation. AJR Am J Roentgenol 1996; 166:
molded and be pliable. There is a small amount of natural
14211427.
infolding of the implant shell seen on MR images obtained in 5. Soo MS, Kornguth PJ, Walsh R, et al. Intracapsular implant rupture:
women with intact, normal implants. This may produce cur- MR finding of incomplete shell collapse. J Magn Reson Imaging
vilinear lines similar to the linguine sign. Lines longer than 3 1997; 7:724 730.
Volume 216 Number 3 Linguine Sign 839

Linguine Sign PDF

Uploaded by

Copyright:

Available Formats

Linguine Sign PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Linguine Sign PDF

Uploaded by

Copyright:

Available Formats

Signs in Imaging

Amjad Safvi, MS, MD

The linguine sign is seen at magnetic resonance (MR) imaging

The linguine sign indicates intracapsular rupture of the sili-

Volume 216 Number 3 Linguine Sign 839

You might also like