From the Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Institute for Radiological Research, College of Medicine, Chang Gung University, 5 Fuxing St, Guishan Dist, Taoyuan 33305, Taiwan (W.H.C., Y.L.H., S.Y.C.); Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.L.); and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan (C.Y.L., M.H.C.).
Radiology. 2018 Dec;289(3):759-765. doi: 10.1148/radiol.2018172869. Epub 2018 Aug 14.
Purpose To evaluate the feasibility of cutaneous and subcutaneous limb tissue elasticity measurement in participants with limb lymphedema by using acoustic radiation force impulse (ARFI) elastography. Materials and Methods From July 2015 to June 2017, ARFI elastography was performed in 64 participants with lymphedema (seven men and 57 women; age range, 23-85 years) by using a US system. Tissue stiffness quantification with shear-wave velocity (SWV) was obtained in the cutaneous and subcutaneous limb tissues. Lymphoscintigraphy was the reference standard. Results SWV was significantly higher in limbs with lymphatic obstruction than in unaffected limbs (cutaneous tissue: 2.75 m/sec vs 1.74 m/sec, respectively; subcutaneous tissue: 1.90 m/sec vs 1.35 m/sec, respectively; P < .001). SWV was significantly different among limbs without lymphatic drainage obstruction, with partial obstruction, and with total obstruction (cutaneous tissue: 1.74 m/sec vs 2.75 m/sec vs 2.77 m/sec; subcutaneous tissue: 1.35 m/sec vs 1.90 m/sec vs 1.90 m/sec, respectively; P < .001). By using a cut-off value of 2.10 m/sec and 1.43 m/sec for cutaneous and subcutaneous tissue, respectively, sensitivity was 83.1% (59 of 71) and 80.3% (57 of 71), and specificity was 86.0% (49 of 57) and 70.2% (40 of 57) for manifestation of lymphatic obstruction. The corresponding areas under the receiver operating characteristic curve were 0.91 and 0.83, respectively. Conclusion Acoustic radiation force impulse elastography showed that cutaneous and subcutaneous tissues are stiffer in lymphedematous limbs than in unaffected limbs. Acoustic radiation force impulse elastography is a feasible imaging modality for noninvasive tissue stiffness quantification in limb lymphedema. © RSNA, 2018 Online supplemental material is available for this article.
目的 利用声辐射力脉冲（ARFI）弹性成像评价四肢淋巴水肿患者皮肤和皮下组织弹性测量的可行性。
材料与方法 本研究回顾性分析 2015 年 7 月至 2017 年 6 月期间 64 例淋巴水肿患者（男 7 例，女 57 例；年龄 23~85 岁）的资料，采用超声系统行 ARFI 弹性成像检查。获得皮肤和皮下组织的剪切波速度（SWV）组织硬度定量值。淋巴闪烁显像为参考标准。
结果 与无淋巴引流阻塞的肢体相比，有淋巴阻塞的肢体的 SWV 显著更高（皮肤组织：分别为 2.75 m/sec 比 1.74 m/sec；皮下组织：分别为 1.90 m/sec 比 1.35 m/sec；P <.001）。无淋巴引流阻塞、部分阻塞和完全阻塞的肢体之间的 SWV 差异有统计学意义（皮肤组织：1.74 m/sec 比 2.75 m/sec 比 2.77 m/sec；皮下组织：1.35 m/sec 比 1.90 m/sec 比 1.90 m/sec；P <.001）。当皮肤和皮下组织的截断值分别为 2.10 m/sec 和 1.43 m/sec 时，SWV 对淋巴阻塞的敏感性分别为 83.1%（59/71）和 80.3%（57/71），特异性分别为 86.0%（49/57）和 70.2%（40/57）。相应的受试者工作特征曲线下面积分别为 0.91 和 0.83。
结论 ARFI 弹性成像显示，淋巴水肿肢体的皮肤和皮下组织比无淋巴水肿肢体更硬。ARFI 弹性成像可作为一种无创性肢体淋巴水肿组织硬度定量成像方法。
© 2018 RSNA，在线补充材料可供本文参考。
