 Next we will discuss implant rupture on MRI. This is one of the best modalities for evaluating silicone implant rupture. The sensitivity can be upwards of 94% and with specificity of almost 100%. Classic signs of intracapsular rupture on MRI for silicone implants are the linguine sign, the teardrop sign, the keyhole sign, and the subcapsular line sign. Please remember, we only do MRI for silicone implant rupture, not saline. Saline implant rupture is a clinical diagnosis. So let's talk more about extra capsule rupture signs on MRI. We can see free silicone separate from the implant. We can see ISO to low signal intensity on the T1 fat set images outside of the capsules. We see high intensity on water suppressed T2 images outside of the capsules as well. What is the typical MRI protocol for implant rupture? We want a nice T1 image so that we can visualize the fibers capsule which will be black on T1 images. We want to do T2 fat set and or T2 non-fat set for an overall picture of the implants on the breast. Then most importantly, we want a silicone only also known as a silicone bright sequence as well as a silicone suppressed or silicone black sequence to evaluate for extra capsule rupture. So if you see something bright outside of both the fibers and the polymer capsule on MRI, then it should be dark on the silicone suppressed sequence. If it's bright on the silicone bright sequence and that will be confirmatory that what you're seeing is definitely extra capsular silicone. If it is not following silicone's intensity on both sequences, then it is not likely extra capsular silicone. It's important to remember that the silicone polymer implant capsule is dark on T1 but not as dark as the fibers capsule. So here are some examples of intercapsule rupture on MRI. This is a classic linguine sign where we see these strips of the intercapsular polymer floating like pasta floating in water or linguine floating in water on the MRI and these tend to settle dependently. This is the subcapsular line sign. We have the dark T1 fibers capsule here and the lighter black silicone polymer capsule here and we can see silicone on both sides of it and that is the subcapsular line sign. We can also see that down here smaller and more subtle. The key hole or new sign is where we see this kind of loop or noose of the silicone polymer capsule and instead of the sides of it being adherent to each other with no brightness in between it as we'd see on a normal radial fold, we do see this bright silicone in between these two layers of the polymer capsule suggesting intercapsular rupture and then here we see the teardrop sign again, this teardrop dot of silicone in between the silicone polymer capsule. We also see a subcapsular line sign here as well and as well as multiple subcapsular line signs and these are all consistent with intercapsular rupture of silicone implant on MRI. Extracapsular rupture on MRI, you need an intercapsular rupture to have an extra capsule rupture and as you can see here we have a linguine sign suggesting an intercapsular rupture but also outside of the fibrous capsule which is this dark, if you guys look here it's dark, very dark fibrous capsule, we see bright silicone outside of that that also was dark on silicone suppressed sequences. So this is an example of an intra and extracapsular silicone implant rupture on MRI and that is all for evaluating implant rupture on MRI.