Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan; Department of Emergency and Critical Care Medicine, Saitama Medical Center, Saitama, Japan.
Research Administration Center, Saitama Medical University, Saitama, Japan.
J Plast Reconstr Aesthet Surg. 2024 May;92:225-236. doi: 10.1016/j.bjps.2024.03.016. Epub 2024 Mar 24.
Non-contrast magnetic resonance imaging (NMRI) has been reported as valuable for the assessment of lymphedema. However, the correlation between NMRI findings and indocyanine green lymphography (ICG-L) findings remains elusive.
This single-center retrospective study included 26 patients diagnosed with breast cancer-related lymphedema. We examined the prevalence of fluid infiltration in eight regions of the upper extremity, the type of fluid distribution, and the dominant segment of edema on NMRI in comparison to the ICG-L stage. Statistical analysis was performed using the Cochran-Armitage trend test, Spearman's rank correlation test, and Fisher's exact test.
The regional fluid infiltration significantly increased with the progression of the ICG-L stage (hand, forearm, elbow, and upper arm: p = 0.003, <0.001, <0.001, and <0.001, respectively). The fluid distribution significantly advanced with the progression of the ICG-L stage as follows (r = 0.80; p < 0.001): no edema in ICG-L stage 0, edema in either the hand or elbow in ICG-L stage I, edemas in both the elbow and hand in ICG-L stage II, three segmental edemas centered on the forearm or elbow in ICG-L stage III, and edema encompassing the entire upper limb in ICG-L stage IV-V. Additionally, the dominant segment of edema tended to shift from the hand to the elbow and further to the forearm as the ICG-L stage progressed (p < 0.001).
Fluid infiltration observed on NMRI exhibited distinct patterns with the progression of the ICG-L stage. We believe that anatomical information regarding fluid distribution would potentially contribute to optimizing surgical efficacy.
磁共振成像（MRI）不增强对比剂已被报道可用于评估淋巴水肿。然而，MRI 检查结果与吲哚菁绿淋巴造影（ICG-L）检查结果之间的相关性仍不清楚。
本单中心回顾性研究纳入了 26 例诊断为乳腺癌相关淋巴水肿的患者。我们在 MRI 上检查了上肢 8 个区域的液体浸润程度、液体分布类型和水肿优势节段，并与 ICG-L 分期进行了比较。使用 Cochran-Armitage 趋势检验、Spearman 秩相关检验和 Fisher 确切检验进行了统计学分析。
上肢各区域的液体浸润程度随 ICG-L 分期的进展而显著增加（手部、前臂、肘部和上臂：p = 0.003、<0.001、<0.001 和 <0.001）。液体分布随 ICG-L 分期的进展显著进展（r = 0.80；p < 0.001）：ICG-L 分期 0 期无水肿，ICG-L 分期 I 期手部或肘部水肿，ICG-L 分期 II 期肘部和手部均水肿，ICG-L 分期 III 期以肘部或前臂为中心的 3 个节段性水肿，ICG-L 分期 IV-V 期水肿累及整个上肢。此外，随着 ICG-L 分期的进展，水肿的优势节段从手部向肘部、再向前臂转移（p < 0.001）。
MRI 上观察到的液体浸润表现出与 ICG-L 分期进展相关的特定模式。我们认为，有关液体分布的解剖学信息可能有助于优化手术疗效。
