Sanderson Jennifer, Tuttle Neil, Laakso Liisa
School of Allied Health and Social Work, Griffith University, Gold Coast, QLD 4215, Australia.
School of Health Sciences, University of Tasmania, Newham, TAS 7005, Australia.
Cancers (Basel). 2022 Oct 27;14(21):5281. doi: 10.3390/cancers14215281.
Palpation remains essential for evaluating lymphoedema to detect subtle changes that may indicate progression. As palpation sense is not quantifiable, this study investigates the utility of ultrasound elastography to quantify stiffness of lymphoedema tissue and explore the influence of the pitting test on tissue stiffness. Fifteen women with unilateral arm lymphoedema were scanned using a Siemens S3000 Acuson ultrasound (Siemens, Germany) with 18 MHz and 9 MHz linear transducers to assess tissue structure and tissue stiffness with Acoustic Radiation Force Impulse elastography. Ninety sites were assessed, three on each of the lymphoedema-affected and contralateral unaffected arms. A subgroup of seven lymphoedema-affected sites included additional elastography imaging after a 60-s pitting test. Dermal tissue stiffness was greater than subcutaneous tissue stiffness regardless of the presence of pathology (p < 0.001). Lymphoedematous tissue exhibited a higher dermal to subcutaneous tissue stiffness ratio than contralateral sites (p = 0.005). Subgroup analysis indicated that the pitting test reduces dermal tissue stiffness (p = 0.018) and may alter the stiffness of the subcutaneous tissue layer. Elastography demonstrates potential as a complement to lymphoedema palpation assessment. The novel pre-test and post-pitting elastography imaging protocol yielded information representative of lymphoedema tissue characteristics that could not be ascertained from pre-test elastography images alone.
触诊对于评估淋巴水肿以发现可能提示病情进展的细微变化仍然至关重要。由于触诊感觉无法量化，本研究调查了超声弹性成像在量化淋巴水肿组织硬度方面的效用，并探讨了点压试验对组织硬度的影响。使用西门子S3000 Acuson超声（德国西门子）和18 MHz及9 MHz线性换能器对15名单侧手臂淋巴水肿的女性进行扫描，以通过声辐射力脉冲弹性成像评估组织结构和组织硬度。共评估了90个部位，在受淋巴水肿影响的手臂和对侧未受影响的手臂上各评估3个部位。在7个受淋巴水肿影响的部位的亚组中，在进行60秒点压试验后进行了额外的弹性成像。无论是否存在病变，真皮组织硬度均大于皮下组织硬度（p < 0.001）。淋巴水肿组织的真皮与皮下组织硬度比高于对侧部位（p = 0.005）。亚组分析表明，点压试验可降低真皮组织硬度（p = 0.018），并可能改变皮下组织层的硬度。弹性成像显示出作为淋巴水肿触诊评估补充手段的潜力。新的试验前和点压后弹性成像方案产生了代表淋巴水肿组织特征的信息，这些信息无法仅从试验前弹性成像图像中确定。
