MR imaging of the lymphatic system in patients with lipedema and lipo-lymphedema
MR imaging of the lymphatic system in patients with lipedema and lipo-lymphedema
复制标题
DOI：
10.1016/j.mvr.2009.01.005
复制
发表时间：
2009-05-01
影响因子：
3.1
通讯作者：
Langer, Mathias
中科院分区：
文献类型：
--
作者：
Lohrmann, Christian;Foeldi, Etelka;Langer, Mathias
目的：首次应用MR淋巴管造影对下肢脂肪水肿和脂肪水肿患者的淋巴管形态进行了研究，材料与方法：对13例患者（5例脂肪水肿，8例脂肪水肿）的26条下肢进行了MR淋巴管造影检查。将18 mL钆特醇和1 mL 1%盐酸甲哌卡因细分为10份，并在前足皮内注射。使用配备高性能梯度的1.5 T系统进行MR成像。对于MR淋巴管造影，使用3D扰相梯度回波序列。结果：在所有16条下肢（100%）的脂肪性水肿，高信号区的筋膜上区可以检测到的3D-TSE序列的重T2加权序列的水肿进行评估。在检查的16条患有脂肪淋巴水肿的下肢中，8条小腿和3条大腿显示淋巴管肿大，直径达3 mm。在两条患有脂肪淋巴水肿的小腿中，可见真皮回流区，表明淋巴流出受阻。在10例临床上单纯脂肪水肿的下肢中，4例下肢和2例上肢显示直径达2 mm的淋巴管增大，表明亚临床水肿状态。在所有检查的四肢，腹股沟淋巴结表现出对比剂增强，在第一次图像采集后15分钟injection.Conclusion：MR淋巴管造影是一种安全，准确的微创成像方式，用于评价患者的淋巴循环与脂肪水肿和脂水肿的下肢。如果在最初的临床检查中淋巴管受累的程度不清楚，或者需要更好的定义以制定最佳的治疗计划，MR淋巴管造影能够识别解剖和生理紊乱，并建立客观的基线。(C)2009爱思唯尔公司All rights reserved.
Objective: To assess for the first time the morphology of the lymphatic system in patients with lipedema and lipo-lymphedema of the lower extremities by MR lymphangiography.Materials and methods: 26 lower extremities in 13 consecutive patients (5 lipedema, 8 lipo-lymphedema) were examined by MR lymphangiography. 18 mL of gadoteridol and 1 mL of mepivacainhydrochloride 1% were subdivided into 10 portions and injected intracutaneously in the forefoot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For MR lymphangiography, a 3D-spoiled gradient-echo sequence was used. For evaluation of the lymphedema a heavily T2-weighted 3D-TSE sequence was performed.Results: In all 16 lower extremities (100%) with lipo-lymphedema, high signal intensity areas in the epifascial region could be detected on the 3D-TSE sequence. In the 16 examined lower extremities with lipo-lymphedema, 8 lower legs and 3 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 3 mm. In two lower legs with lipo-lymphedema, an area of dermal back-flow was seen, indicating lymphatic outflow obstruction. In the 10 examined lower extremities with clinically pure lipedema, 4 lower legs and 2 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 2 mm, indicating a subclinical status of lymphedema. In all examined extremities, the inguinal lymph nodes demonstrated a contrast material enhancement in the first image acquisition 15 min after injection.Conclusion: MR lymphangiography is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic circulation in patients with lipedema and lipo-lymphedema of the lower extremities. If the extent of lymphatic involvement is unclear at the initial clinical examination or requires a better definition for optimal therapeutic planning, MR lymphangiography is able to identify the anatomic and physiological derangements and to establish an objective baseline. (C) 2009 Elsevier Inc. All rights reserved.