Impaired myocardial SPECT imaging secondary to silicon- and saline-containing breast implants

Stinis, Curtiss T.; Lizotte, Paul; Movahed, Mohammad Reza

doi:10.1007/s10554-005-9068-1

Cited by 13 publications

(11 citation statements)

References 12 publications

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“…The usage of echocardiography is another commonly performed diagnostic procedure in cardiology for the assessment of heart structures and function. Additionally, stress echocardiography is another frequently performed procedure for the evaluation of ischemia (9).…”

Section: Introductionmentioning

confidence: 99%

Women with breast implants have a higher rate of cardiac catheterization but a lower rate of percutaneous coronary intervention suggesting breast implant interference leads to higher false positive rates of cardiac stress imaging

Movahed,

Irannejad,

Venard

et al. 2023

Preprint

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BackgroundBreast implants cause attenuation during myocardial perfusion imaging (SPECT) and interfere with echocardiographic acoustic windows, which may cause false positive results. We hypothesized that false positive cardiac testing would lead to a lower rate of percutaneous intervention (PCI) in patients with breast implants who underwent cardiac catheterization.MethodsUsing ICD 10 codes for breast implants, cardiac catheterization, and percutaneous coronary interventions, we evaluated any association between these cardiac procedures and older adult women with breast implants.ResultsA total of 1,681,135 women 50 or older underwent cardiac catheterization and 792,760 of them underwent PCI. The total number of patients with breast implants who underwent cardiac catheterization was 1,980 (1.99%). The rate of cardiac catheterization was similar (2.99% vs 3.30%, p= 0.06). However, after multivariate adjustment, women with breast implants had a significantly higher rate of cardiac catheterization (OR: 1.12, CI: 1.00-1.25, P=0.05). Furthermore, women after undergoing cardiac catheterization had a lower unadjusted and adjusted rate of PCI (36.93% vs 47.08%, <0.001, unadjusted OR: 0.66, CI: 0.54-0.80, adjusted OR:0.79, CI: 0.64-0.97, p=0.02). Sensitivity analyses using different age cutoffs showed a similar pattern of findings.ConclusionsWomen with breast implants who underwent cardiac catheterization had significantly lower adjusted rates for PCI consistent with our hypothesis that breast implants may lead to higher false positive rates during cardiac ischemia testing. Therefore, women who consider breast implants should be informed about interference with cardiac diagnostic procedures.

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Section: Introductionmentioning

confidence: 99%

Women with breast implants have a higher rate of cardiac catheterization but a lower rate of percutaneous coronary intervention suggesting breast implant interference leads to higher false positive rates of cardiac stress imaging

Movahed,

Irannejad,

Venard

et al. 2023

Preprint

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“…In a case series of 3 patients with breast cancer and left-sided implants, acoustic window limitations were noted with echocardiography, and visualization artifacts obscuring ventricular and valve structures were reported . Significant attenuation artifacts were also described with single-photon emission computed tomography myocardial perfusion imaging in women with silicone- or saline-containing breast implants …”

mentioning

confidence: 99%

Addressing Imaging Pitfalls to Reduce Cardiovascular Disease Misdiagnosis in Patients With Breast Cancer Following Reconstruction

2022

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“…Alternative imaging modalities are therefore commonly required to ensure accurate diagnosis and appropriate clinical decision-making. Investigation and monitoring of incident CV toxic effects also requires optimal CV noninvasive imaging, and the spectrum of disease demands a multimodality approach, with false-positive results reported in this patient group with both electrocardiography and nuclear (single-photon emission computed tomography) imaging …”

mentioning

confidence: 99%

No Diagnostic Concerns With Cardiovascular Magnetic Resonance Imaging in Patients With Breast Cancer and Breast Implants

Manisty

Barac

Lenihan³

2022

JAMA Cardiol

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To the Editor We welcome the Viewpoint from Oren et al 1 highlighting the importance of ensuring high-quality cardiovascular (CV) imaging for patients living with (or survivors of) breast cancer with breast implants. Patients commonly require functional CV imaging to establish CV safety during or after receiving cancer treatment for screening for cancer treatment-related cardiac dysfunction (CTRCD) in line with available guidelines and consensus statements. 2 Echocardiography has long been known to be challenging in patients with breast implants, 3 and inaccurate imaging risks not only late detection of potentially life-threatening cardiotoxic effects but also inappropriate withholding of cancer treatments. Alternative imaging modalities are therefore commonly required to ensure accurate diagnosis and appropriate clinical decisionmaking. Investigation and monitoring of incident CV toxic effects also requires optimal CV noninvasive imaging, and the spectrum of disease demands a multimodality approach, with false-positive results reported in this patient group with both electrocardiography 4 and nuclear (single-photon emission computed tomography) imaging. 5 The authors state that the diagnostic performance of cardiovascular magnetic resonance imaging (CMR) may be impaired by the presence of breast prostheses. They propose that formal evaluation of the sensitivity and specificity of CMR in patients with breast cancer and implants is required, notably for investigation of immune checkpoint inhibitor-related myocarditis.We strongly refute that suggestion. There is no evidence to suggest that the presence of a breast implant should impact tissue characterization-either for late gadolinium enhancement fibrosis imaging or for parametric mapping for measurement of T1, T2, or T2*. The constituent components of the implants (silicone, saline) are nonferromagnetic and have no impact on relaxometry. Many thousands of patients globally have undergone CMR with breast implants, and there are no published or anecdotal reports of artifacts.The only area where care should be taken with patients with breast cancer undergoing CMR is for patients with some tissue expanders with MAGNA-SITE injection ports, which are labelled as MR-Unsafe. Tissue expanders are temporary devices used prior to breast implantation following mastectomy. All breast implants are labelled as MR-Safe and many new tissue expanders are labelled MR-Conditional.Options for quality diagnostic CV imaging in patients with breast cancer with implants may be limited, and for these specific patients, the impact of not evaluating for CTRCD or other cardiotoxic effects is high. Suggesting that either CMR or computed tomography be inaccurate is not only incorrect but also potentially harmful to patients. On behalf of the cardiooncology community and patients, we would strongly advocate that this Viewpoint article be amended to correct this statement.

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Impaired myocardial SPECT imaging secondary to silicon- and saline-containing breast implants

Cited by 13 publications

References 12 publications

Women with breast implants have a higher rate of cardiac catheterization but a lower rate of percutaneous coronary intervention suggesting breast implant interference leads to higher false positive rates of cardiac stress imaging

Women with breast implants have a higher rate of cardiac catheterization but a lower rate of percutaneous coronary intervention suggesting breast implant interference leads to higher false positive rates of cardiac stress imaging

Addressing Imaging Pitfalls to Reduce Cardiovascular Disease Misdiagnosis in Patients With Breast Cancer Following Reconstruction

No Diagnostic Concerns With Cardiovascular Magnetic Resonance Imaging in Patients With Breast Cancer and Breast Implants

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