ISSN 1004-4140
CN 11-3017/P
Volume 31 Issue 4
Jul.  2022
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Abstract
References
LIU M K, LI X P, ZHANG Y N, et al. Study on the staging of primary lower extremity lymphedema based on calf soft-tissue thickness measurement by MRI[J]. CT Theory and Applications, 2022, 31(4): 479-487. DOI: 10.15953/j.ctta.2022.100. (in Chinese).
Citation: LIU M K, LI X P, ZHANG Y N, et al. Study on the staging of primary lower extremity lymphedema based on calf soft-tissue thickness measurement by MRI[J]. CT Theory and Applications, 2022, 31(4): 479-487. DOI: 10.15953/j.ctta.2022.100. (in Chinese).
shu

Study on the Staging of Primary Lower Extremity Lymphedema Based on Calf Soft-tissue Thickness Measurement by MRI

  • 1.

    Capital Medical University, Beijing 100038, China Department of Radiology

  • 2.

    Capital Medical University, Beijing 100038, China Department of MR, Affiliated Beijing Shijitan Hospital

  • 2.

    Department of Radiology, The Ninth Clinical Medical College of Peking University, Beijing 100038,China

More Information
  • Received Date: May 25, 2022
  • Revised Date: June 30, 2022
  • Accepted Date: July 05, 2022
  • Available Online: July 12, 2022
  • Published Date: July 31, 2022
    Graphical Abstract
    • Abstract
  • Objective: To investigate the value of MRI-based measurement of calf soft-tissue thickness in assessing the clinical staging of primary lower extremity lymphedema (PLEL). Methods: The clinical and MR imaging data of 90 patients diagnosed with PLEL in our hospital were retrospectively collected, and all patients underwent bilateral lower limb MR examinations. Short Time Inversion Recovery (STIR) sequence was used to measure the total soft tissue thickness (T), musculoskeletal thickness (M) and subcutaneous soft tissue thickness (S) of bilateral lower legs, and the difference between T and S of bilateral lower legs (DT, DS) was calculated respectively. Patients were classified into stages Ⅰ, Ⅱ and Ⅲ with reference to the clinical staging criteria of the International Lymphatic Association 2020 and our lymphatic surgery department for lower limb lymphedema, excluding stage 0. One-way ANOVA was used to compare calf soft tissue thickness among different clinical stages, Spearman correlation was used to analyze the correlation between calf soft tissue thickness and clinical stage, and ROC curves were used to evaluate the efficacy of calf soft tissue thickness in discriminating clinical stage. Results: The differences among T, S, DT and DS of the three stages were statistically significant, while there was no statistical difference among M; when comparing two by two in each subperiod, T, S, DT and DS were statistically different between stage Ⅰ and Ⅱ and stage Ⅰ and Ⅲ, while there was no statistical difference between stage II and III. The correlation between DT (r=0.750) and DS (r=0.772) and clinical stage was significantly greater than that between T (r=0.669) and S (r=0.734), with DS showing the highest correlation with clinical stage; there was no significant correlation between M and clinical stage. ROC curves showed that the AUC values for each parameter to identify stage Ⅰ and Ⅱ were greater than those to identify stage Ⅱ and Ⅲ. The AUC value of DS (AUC=0.945) demonstrated the highest area under the curve (AUC) among all parameters to identify stage Ⅰ and stage Ⅱ. Conclusion: MRI soft-tissue thickness measurement of calf can be used as a quantitative adjunct in the clinical staging of unilateral PLEL, and for patients with unilateral PLEL, we recommend DS as the best thickness index to differentiate stage Ⅰ from Ⅱ lymphedema.
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    • References (15)
  • [1]
    VIGNES S. Lymphedema: From diagnosis to treatment[J]. La Revue de Medecine Interne, 2017, 38(2): 97−105. doi: 10.1016/j.revmed.2016.07.005
    [2]
    王鹤玮, 贾杰. 乳腺癌术后上肢淋巴水肿的检查与评估研究进展[J]. 中国康复理论与实践, 2017,23(9): 1001−1006. doi: 10.3969/j.issn.1006-9771.2017.09.003

    WANG H W, JIA J. Advance in examination and evaluation of upper limb lymphedema after breast cancer surgery (review)[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017, 23(9): 1001−1006. (in Chinese). doi: 10.3969/j.issn.1006-9771.2017.09.003
    [3]
    TASSENOY A, de STRIJCKER D, ADRIAENSSENS N, et al. The use of noninvasive imaging techniques in the assessment of secondary lymphedema tissue changes as part of staging lymphedema[J]. Lymphatic Research and Biology, 2016, 14(3): 127−133. doi: 10.1089/lrb.2016.0011
    [4]
    LIU N F, YAN Z X, WU X F, et al. Magnetic resonance lymphography demonstrates spontaneous lymphatic disruption and regeneration in obstructive lymphedema[J]. Lymphology, 2013, 46(2): 56−63.
    [5]
    Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology[J]. Lymphology, 2020, 53(1): 3−19.
    [6]
    BRUNELLE C L, TAGHIAN A G. Lymphoedema screening: Setting the standard[J]. British Journal of Cancer, 2020, 123(1): 1−2. doi: 10.1038/s41416-020-0848-0
    [7]
    CELLINA M, MARTINENGHI C, PANZERI M, et al. Noncontrast MR lymphography in secondary lower limb lymphedema[J]. Journal of Magnetic Resonance Imaging, 2021, 53(2): 458−466. doi: 10.1002/jmri.27328
    [8]
    王丽, 李苏芹, 华小兰, 等. 妇科恶性肿瘤术后下肢淋巴水肿MRI分期研究[J]. 实用放射学杂志, 2017,33(3): 343−348. doi: 10.3969/j.issn.1002-1671.2017.03.006

    WANG L, LI S Q, HUA X L, et al. Cross-sectional areas of calf soft tissue measured with MRI as a new method for staging gynecologic oncology-related extremity lymphedema[J]. Journal of Practical Radiology, 2017, 33(3): 343−348. (in Chinese). doi: 10.3969/j.issn.1002-1671.2017.03.006
    [9]
    ARRIVÉ L, DERHY S, DAHAN B, et al. Primary lower limb lymphoedema: Classification with non-contrast MR lymphography[J]. European Radiology, 2018, 28(1): 291−300. doi: 10.1007/s00330-017-4948-z
    [10]
    KIM G, SMITH M P, DONOHOE K J, et al. MRI staging of upper extremity secondary lymphedema: Correlation with clinical measurements[J]. European Radiology, 2020, 30(8): 4686−4694. doi: 10.1007/s00330-020-06790-0
    [11]
    GRADA A A, PHILLIPS T J. Lymphedema: Pathophysiology and clinical manifestations[J]. Journal of the American Academy of Dermatology, 2017, 77(6): 1009−1020. doi: 10.1016/j.jaad.2017.03.022
    [12]
    DAYAN J H, WISER I, VERMA R, et al. Regional patterns of fluid and fat accumulation in patients with lower extremity lymphedema using magnetic resonance angiography[J]. Plastic and Reconstructive Surgery, 2020, 145(2): 555−563. doi: 10.1097/PRS.0000000000006520
    [13]
    ZARRAD M, DUFLOS C, MARIN G, et al. Skin layer thickness and shear wave elastography changes induced by intensive decongestive treatment of lower limb lymphedema[J]. Lymphatic Research and Biology, 2022, 20(1): 17−25.
    [14]
    LU Q, LI Y, CHEN T W, et al. Validity of soft-tissue thickness of calf measured using MRI for assessing unilateral lower extremity lymphoedema secondary to cervical and endometrial cancer treatments[J]. Clinical Radiology, 2014, 69(12): 1287−1294. doi: 10.1016/j.crad.2014.08.011
    [15]
    TASSENOY A, de MEY J, de RIDDER F, et al. Postmastectomy lymphoedema: Different patterns of fluid distribution visualised by ultrasound imaging compared with magnetic resonance imaging[J]. Physiotherapy, 2011, 97: 234−243. doi: 10.1016/j.physio.2010.08.003
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