Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Department of Radiology, Atrius Health, Boston, Massachusetts, USA.
Lymphat Res Biol. 2023 Apr;21(2):111-117. doi: 10.1089/lrb.2021.0022. Epub 2022 Aug 1.
Secondary upper extremity lymphedema occurs after an insult such as surgery. One theory suggests underlying lymphatic dysfunction predisposing certain patients into developing secondary lymphedema. We aim to determine the rate of incidental edema in the contralateral upper extremity of patients with secondary unilateral lymphedema. MRI of the upper extremities were obtained in patients with lymphedema who were referred by a lymphedema clinic from 2017 to 2019. Axial short-tau inversion recovery MR images of the symptomatic and contralateral arms were retrospectively reviewed and edema severity was graded. Interobserver agreement was calculated. Indocyanine green (ICG) lymphography was compared against MRI stage in symptomatic and contralateral. Age, symptom duration, body mass index (BMI), and history of chemotherapy were compared between patients with and without contralateral limb lymphedema. ICG severity was compared against MRI stage. Seventy-eight patients were analyzed. The MRI stages of symptomatic versus contralateral arms were 1.7 ± 1.1 versus 0.1 ± 0.4 ( < 0.00001). Interobserver agreement was 0.86 (0.79-0.94). Of the patients with MRI Stage 1 or above in the symptomatic arm ( = 64), 55 (82.1%) patients demonstrated no abnormality in the contralateral arm. Nine patients (14.1%) demonstrated asymptomatic edema (MRI Stage 1). The mean ICG lymphography stage of symptomatic versus contralateral arms was 1.83 ± 0.96 versus 0.04 ± 0.25 ( < 0.00001). There was no difference in the age, symptom duration, BMI, or history of chemotherapy between patients with or without edema in the contralateral arm. Asymptomatic contralateral edema was detected in 14.1% of patients with unilateral secondary upper extremity lymphedema using MRI modality.
继发性上肢淋巴水肿发生于创伤后，如手术。一种理论认为，潜在的淋巴功能障碍使某些患者易患继发性淋巴水肿。我们旨在确定继发性单侧淋巴水肿患者对侧上肢偶然水肿的发生率。2017 年至 2019 年，我们对由淋巴水肿诊所转诊的淋巴水肿患者进行了上肢 MRI 检查。回顾性分析了症状性和对侧手臂的轴向短 tau 反转恢复 MR 图像，并对水肿严重程度进行分级。计算了观察者间的一致性。比较了吲哚菁绿（ICG）淋巴造影术与症状性和对侧的 MRI 分期。比较了有和无对侧肢体淋巴水肿患者的年龄、症状持续时间、体重指数（BMI）和化疗史。ICG 严重程度与 MRI 分期进行比较。共分析了 78 例患者。症状性手臂与对侧手臂的 MRI 分期分别为 1.7±1.1 与 0.1±0.4（ < 0.00001）。观察者间的一致性为 0.86（0.79-0.94）。在症状性手臂 MRI 分期为 1 期或以上的患者（ = 64）中，55 例（82.1%）患者对侧手臂无异常。9 例（14.1%）患者无症状性水肿（MRI 分期 1 期）。症状性手臂与对侧手臂的平均 ICG 淋巴造影分期分别为 1.83±0.96 与 0.04±0.25（ < 0.00001）。有和无对侧手臂水肿的患者在年龄、症状持续时间、BMI 或化疗史方面无差异。使用 MRI 方法，在 14.1%的单侧继发性上肢淋巴水肿患者中发现了无症状的对侧水肿。
