From the Plastic and Reconstructive Surgery Service and the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center; Weill Cornell Medicine; the Department of Radiology, Mt. Sinai Health System; the Division of Plastic Surgery, Northwell Health System and Cancer Institute; and the Division of Plastic Surgery, Massachusetts General Hospital/Harvard Medical School.
New York and Lake Success, N.Y.; and Boston, Mass.
Plast Reconstr Surg. 2020 Feb;145(2):555-563. doi: 10.1097/PRS.0000000000006520.
Fat accumulation is frequently observed in patients with lymphedema but is not accounted for in existing staging systems. In addition, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical intervention. The purpose of this study was to evaluate fluid and fat distribution in patients with lower extremity lymphedema using magnetic resonance angiography.
Magnetic resonance angiographic examinations of patients with lower extremity lymphedema were reviewed. Fluid-fat grade and location were assessed by three observers. Three-point scales were developed to grade fluid (0 = no fluid, 1 = reticular pattern of fluid, and 2 = continuous stripe of subcutaneous fluid) and fat (0 = normal, 1 = subcutaneous thickness less than twice that of the unaffected side, and 2 = subcutaneous thickness greater than twice that of the unaffected side) accumulation.
In total, 76 magnetic resonance angiographic examinations were evaluated. Using the proposed grading system, there was good interobserver agreement for fat and fluid accumulation location (91.5 percent; κ = 0.9), fluid accumulation grade (95.7 percent; κ = 0.95), and fat accumulation grade (87.2 percent; κ = 0.86). Patients with International Society of Lymphology stage 2 lymphedema had a wide range of fluid and fat grades (normal to severe). The most common location of fluid accumulation was the lateral lower leg, whereas the most common location of fat accumulation was the medial and lateral lower leg.
The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
脂肪堆积在淋巴水肿患者中很常见，但在现有的分期系统中并未得到体现。此外，特定的脂肪和液体蓄积的区域性模式仍然未知，并且可能会影响到医疗或手术干预后的结果。本研究旨在使用磁共振血管造影评估下肢淋巴水肿患者的液体和脂肪分布。
对下肢淋巴水肿患者的磁共振血管造影检查进行了回顾性分析。三位观察者评估了液体-脂肪分级和位置。开发了三点量表来分级液体（0 = 无液体，1 = 网状液体模式，2 = 连续条状皮下液体）和脂肪（0 = 正常，1 = 皮下厚度小于未受影响侧的两倍，2 = 皮下厚度大于未受影响侧的两倍）蓄积。
共评估了 76 次磁共振血管造影检查。使用提出的分级系统，脂肪和液体蓄积位置（91.5%；κ=0.9）、液体蓄积分级（95.7%；κ=0.95）和脂肪蓄积分级（87.2%；κ=0.86）具有良好的观察者间一致性。国际淋巴学会（International Society of Lymphology）2 期淋巴水肿患者的液体和脂肪分级范围很广（从正常到严重）。液体蓄积最常见的位置是小腿外侧，而脂肪蓄积最常见的位置是小腿内外侧。
提出的磁共振血管造影分级系统可以根据组织成分帮助对国际淋巴学会 2 期淋巴水肿患者进行分层。
临床问题/证据水平：诊断，IV。
