Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy.
Department of Radiology, IRCCS Policlinico San Matteo Foundation, Viale Camillo Golgi 19, 27100 Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy.
Magn Reson Imaging. 2020 May;68:158-166. doi: 10.1016/j.mri.2020.02.004. Epub 2020 Feb 10.
To assess the ability and reproducibility of Non-contrast Magnetic Resonance Lymphography (NMRL) in detecting and quantify lymphedema, using a semiquantitative scoring system.
This is a monocentric retrospective study of 134 consecutive patients with a clinical diagnosis of limb lymphedema who performed a Non-contrast Magnetic Resonance Lymphography (NMRL) at our Institution between November 2014 and February 2017. Lymphedema was classified based both on clinical and radiologic evaluation. An NMRL total score was obtained for each limb's segment and compared to the clinical grade, used as reference standard. NMRL intra-observer, inter-observer variability and intraclass correlation were calculated. NMRL sensitivity, specificity, and accuracy in identifying lymphedema were provided. Based on score distribution an NMRL four-stage system was developed.
NMRL showed 92% sensitivity, 77% specificity and 82% accuracy in identifying lymphedema. An almost perfect agreement was obtained by expert operators, while substantial agreement was obtained by non-expert operators. Substantial agreement resulted also for the inter-observer variability (Cohen's Kappa K = 0.73, CI 95% [0.69-0.78]). The intra-class correlation showed an almost perfect relationship both by expert and non-expert operators. Excellent correlation between clinical grade and NMRL score and between clinical grade and NMRL stage were found for each segment.
NMRL is a confident and reproducible exam with high sensitivity, good specificity and high accuracy in lymphedema detection; the semiquantitative NMRL score resulted a reliable and reproducible tool able to quantify lymphedema severity.
使用半定量评分系统评估非增强磁共振淋巴成像（NMRL）检测和定量淋巴水肿的能力和可重复性。
这是一项单中心回顾性研究，纳入了 2014 年 11 月至 2017 年 2 月在我院接受非增强磁共振淋巴成像（NMRL）检查的 134 例连续临床诊断为肢体淋巴水肿的患者。根据临床和影像学评估对淋巴水肿进行分类。获得每个肢体节段的 NMRL 总分，并与作为参考标准的临床分级进行比较。计算 NMRL 观察者内、观察者间变异性和组内相关系数。提供 NMRL 识别淋巴水肿的敏感性、特异性和准确性。根据评分分布，建立了 NMRL 四阶段系统。
NMRL 对淋巴水肿的诊断具有 92%的敏感性、77%的特异性和 82%的准确性。专家操作者获得了近乎完美的一致性，而非专家操作者获得了实质性的一致性。观察者间的变异性也得到了实质性的一致性（Cohen's Kappa K=0.73，95%CI [0.69-0.78]）。组内相关显示专家和非专家操作者均具有近乎完美的关系。每个节段均发现临床分级与 NMRL 评分之间以及临床分级与 NMRL 分期之间存在极好的相关性。
NMRL 是一种可靠且可重复的检查，在检测淋巴水肿方面具有高敏感性、良好的特异性和高准确性；半定量 NMRL 评分是一种可靠且可重复的工具，可量化淋巴水肿的严重程度。
