Postmastectomy lymphoedema: different patterns of fluid distribution visualised by ultrasound imaging compared with magnetic resonance imaging
Postmastectomy lymphoedema: different patterns of fluid distribution visualised by ultrasound imaging compared with magnetic resonance imaging
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DOI：
10.1016/j.physio.2010.08.003
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发表时间：
2011-09-01
期刊：
影响因子：
3.3
通讯作者：
Lievens, Pierre
中科院分区：
文献类型：
--
作者：
Tassenoy, An;De Mey, Johan;Lievens, Pierre
目的 乳房切除术后淋巴水肿仍然是乳腺癌治疗引起的致残并发症。真皮层厚度的增加和皮下组织体积的增加是对手臂总肿胀的最重要贡献。皮下层的超声成像会产生不同的反射超声波模式，具体取决于由于淋巴引流受损而发生的形态变化。本研究的目的是将这些回波描记图像与使用磁共振成像获得的图像进行比较，以解释形态变化的性质。设计观察性研究。背景从布鲁塞尔大学医院乳腺诊所招募患者。参与者七名患有单侧乳腺癌的女性（平均年龄 60 岁），随后出现淋巴水肿。主要结果指标应用排水技术来确定手臂 使用体积、回波描记图和磁共振图像来评估组织结构的变化。 结果 手臂的体积测量（平均受影响手臂 3241 毫升与未受影响手臂 2538 毫升）显示总手臂体积显着增加 703 毫升（95% 置信区间为 324 至 1084 毫升）。使用回波描记术，真皮层和皮下层的厚度平均分别增加了 0.2 至 0.8 毫米和 3.9 至 7.2 毫米。对于所有上臂和下臂测量（即体积、真皮和皮下厚度），受影响的手臂和未受影响的手臂之间的差异均显着，但手部测量没有显着差异。超声检查显示，由于水流入，真皮显示出均匀的变化，与对侧相比具有均匀的低回声外观。皮下组织内可以看到不同模式的结构变化：（1）由于水通过皮下组织的扩散而均匀地低回声； (2) 被低回声条纹包围的高回声区域，在磁共振成像上可视化为被纤维组织中嵌入的液体包围的脂肪组织； (3) 由于脂肪组织在极少量的水下过度生长而导致均匀的高回声。结论回波图像可以帮助确定复杂的物理治疗减少淋巴水肿的可能性，并通过测量组织厚度和评估组织一致性来评估治疗结果。 (C) 2010 年特许物理治疗学会。由爱思唯尔有限公司出版。保留所有权利。
Objectives Postmastectomy lymphoedema remains a disabling complication caused by treatment for breast cancer. The increased thickness of the dermal layer and the increased volume of the subcutis represent the most important contributions to the total swelling of the arm. Ultrasound imaging of the subcutaneous layer results in different patterns of reflected ultrasound waves depending on the morphological alternations that occurred due to impaired lymphatic drainage. The aim of this study was to compare these echographic images with those obtained using magnetic resonance imaging to explain the nature of the morphological changes.Design Observational study.Setting Patients were recruited from the Breast Clinic at the University Hospital Brussels.Participants Seven women (mean age 60 years) with unilateral breast cancer who subsequently developed lymphoedema.Main outcome measures The water displacement technique was applied to determine arm volumes, and echographic and magnetic resonance images were used to evaluate changes in tissue structures.Results Volumetric measurements of the arm (mean affected arm 3241 ml vs unaffected arm 2538 ml) showed a significant increase in total arm volume of 703 ml (95% confidence interval 324 to 1084 ml). Using echography, the thickness of the dermal and subcutaneous layers showed an average increase of 0.2 to 0.8 mm and 3.9 to 7.2 mm, respectively. The differences between the affected arm and the unaffected arm for all upper and lower arm measurements (i.e. volumetry, dermal and subcutaneous thickness) were significant, but no significant differences were registered for hand measurements. On echography, the dermis showed uniform changes, with a homogenous hypo-echogenic appearance compared with the contralateral side due to water influx. Different patterns of structural changes could be visualised within the subcutis: (1) uniformly hypo-echogenic due to the diffuse spread of water through the subcutis; (2) hyperechogenic areas surrounded by hypo-echogenic streaks visualised on magnetic resonance imaging as adipose tissue surrounded by fluid embedded in fibrous tissue; and (3) homogenously hyperechogenic due to the overgrowth of adipose tissue with a minimal amount of water.Conclusions Echographic images can help to determine the likelihood that complex physical therapy will reduce lymphoedema, and evaluate treatment results by measuring tissue thickness and evaluating tissue consistency. (C) 2010 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.