Aström K G, Abdsaleh S, Brenning G C, Ahlström K H
Department of Radiology, University Hospital, Uppsala, Sweden.
Acta Radiol. 2001 Jul;42(4):409-16. doi: 10.1080/028418501127346909.
To describe the pathological features and assess the diagnostic information of different MR sequences in patients with primary, secondary, and mixed (phlebo-, lipophlebo-, or lipolymphedema) forms of lymphedema of the lower leg.
In 26 patients with clinical diagnoses of primary (n=10), pure secondary (n=4), mixed (n=9) and combined secondary and mixed forms of lymphedema (n=3), MR imaging was performed with coronal and axial T1 SE, T2 TSE, fat-suppressed (SPIR) T2 sequences and axial T1 SE after i.v. injection of Gd-DTPA.
In 24 patients there was a honeycomb pattern in the subcutis with a signal intensity corresponding to fluid (n=11), fibrosis (n=3), or both (n=10). Five patients with primary lymphedema showed subfascial fluid accumulation. Dermal edema was noted in 23 patients. Fat or edema components in the muscles were mostly seen in patients with phlebolymphedema. The honeycomb pattern was best seen on coronal T1 images, and fluid accumulations on axial SPIR-T2 images. Fibrosis was only assessible from the T2 TSE sequence. Gd-DTPA did not improve the diagnostic information.
For evaluation of lymphedema and its mixed forms, an axial T2-weighted SPIR sequence in conjunction with a coronal T1 SE sequence are sufficient.
描述小腿原发性、继发性及混合性（静脉性、脂肪静脉性或脂肪淋巴性水肿）淋巴水肿患者的病理特征，并评估不同磁共振序列的诊断信息。
对26例临床诊断为原发性淋巴水肿（n = 10）、单纯继发性淋巴水肿（n = 4）、混合性淋巴水肿（n = 9）以及继发性与混合性淋巴水肿合并存在（n = 3）的患者进行磁共振成像检查，采用冠状位和轴位T1加权自旋回波（SE）序列、T2加权快速自旋回波（TSE）序列、脂肪抑制（短反转恢复，SPIR）T2序列以及静脉注射钆喷酸葡胺（Gd-DTPA）后的轴位T1加权SE序列。
24例患者皮下出现蜂窝状表现，信号强度与液体（n = 11）、纤维化（n = 3）或两者均有（n = 10）相对应。5例原发性淋巴水肿患者出现筋膜下液体聚集。23例患者存在真皮水肿。静脉淋巴水肿患者的肌肉中大多可见脂肪或水肿成分。蜂窝状表现以冠状位T1图像显示最佳，液体聚集以轴位SPIR-T2图像显示最佳。纤维化仅能从T2加权TSE序列进行评估。Gd-DTPA并未改善诊断信息。
对于评估淋巴水肿及其混合形式，轴位T2加权SPIR序列联合冠状位T1加权SE序列就足够了。
