Cellina Michaela, Martinenghi Carlo, Panzeri Marta, Soresina Massimo, Menozzi Andrea, Daniele Gibelli, Oliva Giancarlo
Radiology Department, Fatebenefratelli Hospital, Milan, Italy.
Radiology Department, San Raffaele Hospital, Milan, Italy.
J Magn Reson Imaging. 2021 Feb;53(2):458-466. doi: 10.1002/jmri.27328. Epub 2020 Aug 14.
Invasive imaging techniques have been applied for lymphedema (LE) assessment; noncontrast MR lymphography (NCMLR) has potential as an alternative, but its performance is not known in secondary lower limb LE.
To assess the role of NCMRL for the classification and characterization of secondary lower limb LE.
Retrospective.
Fifty adults with clinically diagnosed secondary LE.
FIELD STRENGTH/SEQUENCE: 1.5T, 3D T -weighted turbo spin-echo, 3D T -weighted turbo spin-echo short tau inversion recovery.
Three radiologists assessed the following characteristics on NCMRL: honeycomb pattern, dermal thickening, muscular abnormalities, distal dilated lymphatics, inguinal lymph node number, appearance of iliac lymphatic trunks. An LE grading based on the MR images was assigned. The relationship between imaging findings and clinical staging was evaluated, as well as between dermal backflow at lymphoscintigraphy and MR staging, and between the limb swelling duration and peripheral lymphatics dilatation.
Pearson's correlation test and Cramer's V coefficient were computed to measure the strength of association. The Mann-Whitney test was used to compare the limb swelling duration between patients with and without dilated distal vessels. Agreement among raters was assessed through Kendall's W coefficient of correlation.
Clinical stage and the MR grading were correlated, with Cramer's V coefficient of 1 for reader 1 (P < 0.05), 0.846 for reader 2 (P < 0.05), and 0.912 (P < 0.05) for reader 3; agreement between interraters was very good (W = 0.0.75; P = 0.05). A honeycomb pattern (P < 0.05), dermal thickening (P < 0.001), muscular abnormalities (P < 0.05), iliac lymphatic trunks appearance (P < 0.05), distal dilated vessels (P < 0.05), and lymph nodes number (P < 0.05) were significantly correlated with LE clinical stage. Dermal backflow at lymphoscintigraphy was described in 10 (20%) patients and showed a significant correlation with the MR grading (P < 0.05).
These preliminary results suggest that NCMRL may provide information useful for the staging and management of patients affected by secondary lower limb LE. Level of Evidence 4 Technical Efficacy Stage 2 J. MAGN. RESON. IMAGING 2021;53:458-466.
侵入性成像技术已应用于淋巴水肿（LE）评估；非增强磁共振淋巴造影（NCMLR）有作为替代方法的潜力，但其在继发性下肢淋巴水肿中的表现尚不清楚。
评估NCMLR在继发性下肢淋巴水肿的分类和特征描述中的作用。
回顾性研究。
50例临床诊断为继发性淋巴水肿的成年人。
场强/序列：1.5T，三维T加权快速自旋回波序列，三维T加权快速自旋回波短tau反转恢复序列。
三名放射科医生在NCMLR上评估以下特征：蜂窝状模式、皮肤增厚、肌肉异常、远端扩张淋巴管、腹股沟淋巴结数量、髂淋巴干外观。根据磁共振图像进行淋巴水肿分级。评估影像学表现与临床分期之间的关系，以及淋巴闪烁造影时的皮肤逆流与磁共振分期之间的关系，以及肢体肿胀持续时间与外周淋巴管扩张之间的关系。
计算Pearson相关检验和Cramer's V系数以测量关联强度。采用Mann-Whitney检验比较有和没有扩张远端血管的患者之间的肢体肿胀持续时间。通过Kendall's W相关系数评估评估者之间的一致性。
临床分期与磁共振分级相关，评估者1的Cramer's V系数为1（P<0.05），评估者2为0.846（P<0.05），评估者3为0.912（P<0.05）；评估者之间的一致性非常好（W = 0.75；P = 0.05）。蜂窝状模式（P<0.05）、皮肤增厚（P<0.001）、肌肉异常（P<0.05）、髂淋巴干外观（P<0.05）、远端扩张血管（P<0.05）和淋巴结数量（P<0.05）与淋巴水肿临床分期显著相关。10例（20%）患者在淋巴闪烁造影时有皮肤逆流，且与磁共振分级显著相关（P<0.05）。
这些初步结果表明，NCMLR可能为受继发性下肢淋巴水肿影响的患者的分期和管理提供有用信息。证据水平4 技术效能2级 J.MAGN.RESON.IMAGING 2021;53:458 - 466。
