Regional Patterns of Fluid and Fat Accumulation in Patients with Lower Extremity Lymphedema Using Magnetic Resonance Angiography
Regional Patterns of Fluid and Fat Accumulation in Patients with Lower Extremity Lymphedema Using Magnetic Resonance Angiography
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DOI：
10.1097/prs.0000000000006520
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发表时间：
2020-02-01
影响因子：
3.6
通讯作者：
Kagan, Alexander
中科院分区：
文献类型：
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作者：
Dayan, Joseph H.;Wiser, Itay;Kagan, Alexander
背景：脂肪堆积经常在水肿患者中观察到，但在现有的分期系统中没有考虑到。此外，脂肪和液体积聚的特定区域模式仍然未知，可能会影响药物或手术干预后的结果。本研究的目的是评估液体和脂肪分布的患者下肢水肿使用磁共振血管造影。方法：磁共振血管造影检查患者下肢水肿进行了审查。由三名观察员评估液体脂肪等级和位置。三点量表被开发来分级流体（0 =无流体，1 =流体的网状图案，和2 =皮下流体的连续条纹）和脂肪（0 =正常，1 =皮下厚度小于2倍的未受影响的一方，和2 =皮下厚度大于2倍的未受影响的一方）accumulation.Results：在总共，76磁共振血管造影检查进行了评价。使用所提出的分级系统，观察者之间在脂肪和液体积聚位置（91.5%; kappa = 0.9）、液体积聚等级（95.7%; kappa = 0.95）和脂肪积聚等级（87.2%; kappa = 0.86）方面具有良好的一致性。国际淋巴学学会2期水肿患者的液体和脂肪分级范围广泛（正常至重度）。最常见的液体积聚的位置是外侧小腿，而脂肪积聚的最常见的位置是内侧和外侧小腿。结论：建议的磁共振血管造影分级系统可能有助于分层的基础上，组织成分的国际淋巴学学会2期水肿患者。
Background:Fat accumulation is frequently observed in patients with lymphedema but is not accounted for in existing staging systems. In addition, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical intervention. The purpose of this study was to evaluate fluid and fat distribution in patients with lower extremity lymphedema using magnetic resonance angiography.Methods:Magnetic resonance angiographic examinations of patients with lower extremity lymphedema were reviewed. Fluid-fat grade and location were assessed by three observers. Three-point scales were developed to grade fluid (0 = no fluid, 1 = reticular pattern of fluid, and 2 = continuous stripe of subcutaneous fluid) and fat (0 = normal, 1 = subcutaneous thickness less than twice that of the unaffected side, and 2 = subcutaneous thickness greater than twice that of the unaffected side) accumulation.Results:In total, 76 magnetic resonance angiographic examinations were evaluated. Using the proposed grading system, there was good interobserver agreement for fat and fluid accumulation location (91.5 percent; kappa = 0.9), fluid accumulation grade (95.7 percent; kappa = 0.95), and fat accumulation grade (87.2 percent; kappa = 0.86). Patients with International Society of Lymphology stage 2 lymphedema had a wide range of fluid and fat grades (normal to severe). The most common location of fluid accumulation was the lateral lower leg, whereas the most common location of fat accumulation was the medial and lateral lower leg.Conclusion:The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition.