使用无创 3T MR 淋巴造影术评估淋巴水肿。
Lymphedema evaluation using noninvasive 3T MR lymphangiography.
机构信息
Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
出版信息
J Magn Reson Imaging. 2017 Nov;46(5):1349-1360. doi: 10.1002/jmri.25670. Epub 2017 Feb 28.
PURPOSE
To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema.
MATERIALS AND METHODS
A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TE = 600 msec; shot-duration = 13.2 msec) and TSE-factor (TSE-factor = 90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n = 11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n = 25), with a subgroup (n = 5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five-point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided P < 0.05).
RESULTS
Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm = 12.9 ± 6.3 mm ; torso = 17.2 ± 15.6 mm ) vs. contralateral (arm = 9.4 ± 3.9 mm ; torso = 9.1 ± 4.6 mm ) side; this difference was significant both for the arm (P = 0.014) and torso (P = 0.025). Affected (arm: P = 0.010; torso: P = 0.016) but not contralateral (arm: P = 0.42; torso: P = 0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm = 8.8 ± 1.8 mm ; torso = 31.4 ± 26.0 mm ; post-MLD: arm = 6.6 ± 1.8 mm ; torso = 23.1 ± 24.3 mm ). This change was significant in the torso (P = 0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas.
CONCLUSION
A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in ∼10 minutes without exogenous contrast agents.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1349-1360.
目的
利用淋巴液的长 3.0T 弛豫时间和低流速开发一种非侵入性的 3.0T 淋巴管造影序列，并评估其在淋巴水肿患者中的相关性。
材料与方法
开发了一种长回波时间（TE = 600 msec；激发时长 = 13.2 msec）和 TSE 因子（TSE-factor = 90）的 3.0T 涡轮自旋回波（TSE）脉冲序列，并对信号演化进行了模拟。该方法在健康成年人（n = 11）和单侧乳腺癌治疗相关淋巴水肿（BCRL；n = 25）患者中进行了评估，其中 BCRL 患者的一个亚组（n = 5）在接受手动淋巴引流（MLD）治疗前后进行了扫描。记录了最大淋巴管横截面积、信噪比（SNR）和五点分类评分系统的结果。应用非参数检验评估对照组和患者、患者患侧和健侧之间的研究参数差异（双侧 P < 0.05）。
结果
患者志愿者在患侧（手臂 = 12.9 ± 6.3 mm；躯干 = 17.2 ± 15.6 mm）和健侧（手臂 = 9.4 ± 3.9 mm；躯干 = 9.1 ± 4.6 mm）的淋巴管横截面积均大于健侧；手臂（P = 0.014）和躯干（P = 0.025）均有统计学差异。患侧（手臂：P = 0.010；躯干：P = 0.016）但非患侧（手臂：P = 0.42；躯干：P = 0.71）的血管面积均显著高于对照组。接受 MLD 治疗后，患侧的淋巴管横截面积减小（MLD 前：手臂 = 8.8 ± 1.8 mm；躯干 = 31.4 ± 26.0 mm；MLD 后：手臂 = 6.6 ± 1.8 mm；躯干 = 23.1 ± 24.3 mm）。这一变化在躯干上有统计学意义（P = 0.036）。与淋巴管面积相比，分类评分在检测侧支疾病方面特异性较低。
结论
提出了一种 3.0T 淋巴管造影序列，可在 10 分钟内无需外源性对比剂即可检测上肢淋巴淤滞。
证据水平
1 技术功效：第 3 阶段 J. Magn. Reson. Imaging 2017；46：1349-1360.
Zotero 插件