Kempa S, Tessmann V, Prantl L, Schmid S, Müller M, Jung E-M, Tews H C
Department for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2024;86(1-2):99-108. doi: 10.3233/CH-238103.
Lipedema is a chronic disease marked by symmetric enlargement of painful nodular and fibrotic adipose tissue, predominantly affecting the limbs. Since there is no specific test or biomarker for this condition, years often pass before the diagnosis of lipedema is established for the first time, thereby causing psychosocial distress, including depression, eating disorders, and social isolation. Over the last few years several advanced Doppler-based technologies have been developed to visualize slow flow blood vessels and superficial microvascular architecture undetectable by traditional color Doppler flow imaging (CDFI).
The aim of this study was to evaluate the superficial microvascular anatomy in lipedema patients compared to healthy controls and investigate the clinical significance of the Ultra Micro Angiography (UMA) technology in the diagnosis of lipedema. This new technique may contribute to reduce the diagnostic delay and, eventually, establish and guide treatment strategies toward a better therapeutic outcome in lipedema patients.
25 patients with lipedema and ten healthy controls with no history of lipedema were included in this study. All ultrasound examinations were performed on a novel high-performance ultrasound system (Resona R9/Mindray) using CDFI and the UMA technique.
In all of the patients, Ultra Micro Angiography achieved the excellent visualization of microvascular structures, revealing that most lipedema patients showed grade 3 (n = 13) or grade 2 (n = 8) flow. UMA was superior to CDFI for depicting the microvascular structures.
Here we show that UMA imaging characterizes the subcutaneous microvasculature with an unprecedented accuracy. The method has the advantage of being sensitive to small, slow-flowing vessels. This allows for the assessment of the course of vessels and vascular pathologies in great detail. Thus, UMA as a non-invasive diagnostic method can improve diagnostic accuracy in lipedema.
脂肪性水肿是一种慢性疾病，其特征为疼痛性结节状和纤维化脂肪组织对称性增大，主要累及四肢。由于针对这种病症尚无特异性检测方法或生物标志物，往往在数年之后才首次确诊脂肪性水肿，从而导致心理社会困扰，包括抑郁、饮食失调和社会隔离。在过去几年中，已开发出几种基于先进多普勒的技术，以可视化传统彩色多普勒血流成像（CDFI）无法检测到的缓慢血流血管和浅表微血管结构。
本研究的目的是评估脂肪性水肿患者与健康对照者的浅表微血管解剖结构，并研究超微血管造影（UMA）技术在脂肪性水肿诊断中的临床意义。这项新技术可能有助于减少诊断延迟，并最终制定和指导治疗策略，以改善脂肪性水肿患者的治疗效果。
本研究纳入了25例脂肪性水肿患者和10例无脂肪性水肿病史的健康对照者。所有超声检查均采用CDFI和UMA技术，在新型高性能超声系统（迈瑞Resona R9）上进行。
在所有患者中，超微血管造影均实现了微血管结构的出色可视化，显示大多数脂肪性水肿患者表现为3级（n = 13）或2级（n = 8）血流。在描绘微血管结构方面，UMA优于CDFI。
我们在此表明，UMA成像以前所未有的准确性描绘了皮下微血管系统。该方法的优点是对细小、缓慢流动的血管敏感。这使得能够非常详细地评估血管的走行和血管病变。因此，UMA作为一种非侵入性诊断方法可提高脂肪性水肿的诊断准确性。
