Department of Biomedical Engineering, School of Electrical Engineering, University of Ulsan, Ulsan, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School and Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk, Republic of Korea.
PLoS One. 2019 Dec 10;14(12):e0224457. doi: 10.1371/journal.pone.0224457. eCollection 2019.
No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients.
目前尚无方法可在淋巴水肿纤维化进展前对其进行检测。本研究旨在评估基于计算机断层扫描（CT）的纤维化估计的可行性。本研究为观察性、横断面研究，共纳入了 326 例单肢淋巴水肿患者。使用吸收值从横轴图像上对 CT 网状指数的 3 种类型（最大、平均和最小）进行数字计算，并将 CT 网状指数与临床量表和测量值进行比较。在接受至少一项淋巴闪烁成像、生物电阻抗和 CT 检查的 326 例患者中，有 24 例接受了所有三种检查。这些患者的 CT 扫描平均次数为 109 次。16 例患者患有乳腺癌，7 例患者患有妇科癌症，1 例患者患有原发性淋巴水肿。平均 CT 网状指数（r = 0.52，p < 0.01）和最大 CT 网状指数（r = 0.45，p < 0.05）与从初始肢体肿胀到 CT 检查的时间显著相关。平均 CT 网状指数（r = 0.86，p < 0.01）、最小 CT 网状指数（r = 0.79，p < 0.01）和最大 CT 网状指数（r = 0.68，p < 0.01）与国际淋巴学会分期显著相关。最小 CT 网状指数与基于 1 kHz 的生物电阻抗比（r = -0.46，p < 0.05）和双侧标准化近端肢体周径差比（r = 0.45，p < 0.05）显著相关。最大 CT 网状指数检测淋巴闪烁成像Ⅳ期的敏感度为 0.78，特异度为 0.60，曲线下面积为 0.66。利用筋膜外纤维化的三维 CT 图像的算法可作为淋巴水肿持续时间、肢体肿胀、国际淋巴学会分期和淋巴水肿间质液的标志物。目前的方法有望提供一种额外的方法来协助对淋巴水肿患者进行特征描述和监测。
