Lower limb lymphedema staging based on magnetic resonance lymphangiography
Lower limb lymphedema staging based on magnetic resonance lymphangiography
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DOI：
10.1016/j.jvsv.2021.06.006
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发表时间：
2022-02-15
影响因子：
3.2
通讯作者：
Shinmoto, Hiroshi
中科院分区：
文献类型：
--
作者：
Soga, Shigeyoshi;Onishi, Fumio;Shinmoto, Hiroshi
目的：皮肤返流（DBF）和淋巴管显影减少是水肿的常见影像学表现。然而，目前还缺乏关于这些发现如何随着解剖位置和水肿严重程度而变化的知识，并且先前使用吲哚菁绿色淋巴造影或淋巴结造影的报告显示了可变的结果。磁共振淋巴管造影术（MRL）由于其上级淋巴可视化能力，有望澄清这一临床问题。本回顾性研究的目的是探讨以下问题：（1）DBF和血管造影的可视化是否存在任何特征性模式，取决于下肢内的解剖位置和水肿的严重程度？(2)是否有可能根据MRL结果对水肿的严重程度进行分类？方法：两名放射科医师对56例（112条肢体）下肢水肿患者的MRL进行一致性检查。在每个下肢的六个区域中分析可视化DBF和反射的频率。并与国际淋巴学学会水肿的临床分期和病因学进行比较。结果：DBF和水肿在下肢远端较近端多见。DBF的发生率随临床分期的增加而增加，0期和I期与II期之间差异有统计学意义（P < 10-3）。早期（0和I期）膝关节以上DBF少见（0.48%），而II期多见（13.5%，P < 10-5）。随着分期的进展，淋巴管出现的频率降低，I期和II期之间以及II期和III期之间存在显著差异（P <0.05）。随着分期的进展，I期和II期之间以及II期和III期之间膝关节以上关节炎的频率显著降低（P <0.05），在III期达到0%。提出了一个MRL分期，并显示出显着的正相关性与临床分期（r = 0.79，P <0.01）和水肿持续时间（r = 0.57，P <0.01）。DBF模式与其他成像技术在以前的研究中观察到的不同。基于这些特征性发现提出的MRL分期允许对水肿患者进行新的分层。结合其出色的可视化淋巴解剖结构的能力，MRL可以更详细地了解个体患者的病理，有助于确定最合适的治疗方法。
Objective: Dermal backflow (DBF) and reduced lymphatic visualization are common findings of lymphedema on various imaging modalities. However, there is a lack of knowledge about how these findings vary with the anatomic location and severity of lymphedema, and previous reports using indocyanine green lymphography or lymphoscintigraphy show variable results. Magnetic resonance lymphangiography (MRL) is expected to clarify this clinical question due to its superior ability for lymphatic visualization. This retrospective study aimed to investigate the following: (1) Are there any characteristic patterns for DBF and lymphatics' visualization, depending on the anatomic location within lower limbs and severity of lymphedema? (2) Is it possible to classify the severity of lymphedema based on MRL findings?Methods: Two radiologists performed consensus readings of MRL of 56 patients (112 limbs) with lower-limb lymphedema. The frequency of visualized DBF and lymphatics was analyzed in six regions in each lower limb. The results were compared with the International Society of Lymphology clinical stages and etiology of lymphedema. Characteristic findings were categorized and compared with the clinical stage and duration of lymphedema.Results: DBF and lymphatics were observed more frequently in the distal regions than the proximal regions of lower limbs. DBF appeared more frequently as the clinical stage increased, reaching statistical significance (P < 10-3) between stages 0 or I and II. DBF above the knee joint was rarely observed (0.48%) in early stages (0 and I) but appeared more frequently (13.5%, P < 10-5) in stage II. Lymphatics appeared less frequently as the stage progressed, with significant differences (P < .05) between stages I and II and between II and III. The frequency of lymphatics above the knee joint decreased significantly (P < .05) between stages I and II and between II and III as the stage progressed, reaching 0% in stage III. An MRL staging was proposed and showed significant positive correlations with the clinical stage (r = 0.79, P < .01) and the duration of lymphedema (r = 0.57, P < .01).Conclusions: MRL-specific patterns of DBF and lymphatics that depended on the site within the lower limb and clinical stage were shown. The DBF pattern differed from those observed in previous studies with other imaging techniques. The proposed MRL staging based on these characteristic findings allows new stratification of patients with lymphedema. Combined with its excellent ability to visualize lymphatic anatomy, MRL could enable a more detailed understanding of individual patient's pathology, useful for determining the most appropriate treatment.