What causes the linguine sign in the breast on magnetic resonance imaging (MRI)?
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Answer:
The linguine sign is caused by intracapsular rupture of a silicone breast implant. On MRI, this appears as multiple curvilinear lines of decreased density (the silicone implant shell) floating within the hyperintense silicone gel, all contained within the surrounding fibrous capsule. The presence of these lines is the most reliable MRI indicator of intracapsular rupture. The clinical condition associated is silicone breast implant rupture, which may be asymptomatic or present with palpable mass, capsular contracture, or implant deformity[1][3][4].
Why is it called so?:
The sign is named for its resemblance to linguine pasta, as the collapsed, wavy appearance of the implant shell within the silicone gel mimics the thin, elongated strands of the pasta[1][3][4].
Pathophysiology:
Intracapsular rupture occurs when the elastomeric shell of the silicone implant breaks but remains contained within the surrounding fibrous capsule. The released gel fills the space between the collapsed shell and the capsule, while the shell fragments appear as curvilinear, hypodense lines on T2-weighted MRI. These represent the disrupted, folded, and freely floating segments of the implant membrane within the viscous silicone gel[1][2][3].
Alternative names:
None widely used.
Other associated named signs:
Teardrop sign, keyhole or noose sign, subcapsular line (all indicate varying presentations of intracapsular rupture)[4].
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