Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
J Vasc Surg Venous Lymphat Disord. 2024 Sep;12(5):101890. doi: 10.1016/j.jvsv.2024.101890. Epub 2024 Apr 16.
The dermal rim sign (DRS) on nonenhanced magnetic resonance imaging has been shown to predict dermal backflow (DBF) in patients with secondary upper limb lymphedema. However, whether the DRS has the same effects on primary lower extremity lymphedema (PLEL) has not been clearly reported. Therefore, this study aimed to explore whether the DRS can be used to diagnose DBF on lymphoscintigraphy in patients with PLEL.
A total of 94 patients who were diagnosed with PLEL were recruited for this retrospective study from January 2022 to December 2023. All the patients were divided into two groups according to the lymphoscintigraphy findings: no DBF and DBF. The magnetic resonance imaging data of the two groups were recorded and statistically compared for the following indicators: range of lymphedema involvement (left, right, whole lower limbs, only thigh, only calf and ankle), signs of lymphedema (notable thickening of skin, parallel line sign, grid sign, honeycomb sign, band sign, lymph lake sign, crescent sign, DRS), and lymphedema measurement (skin thickness, band width). The DRS is characterized by notable thickening of the skin plus the grid sign and/or honeycomb sign, plus the band sign.
The following statistically significant differences in the following indicators were found between the two groups (P < .05): notable skin thickening, parallel line sign, grid sign, honeycomb sign, band sign, DRS, skin thickness, and band width. The sensitivity, specificity, and accuracy for predicting for DBF with the DRS was 82%, 64%, and 77%, respectively.
This study confirmed good consistency between the DRS and DBF from the perspective of imaging. This tool is suitable for children, adolescents, and patients with contraindications to lymphoscintigraphy. The DRS has important value in assessing the severity of PLEL. The DRS is suggested for the clinical use of combined surgical treatment of PLEL.
磁共振成像（MRI）增强前的真皮边缘征（DRS）已被证明可预测继发性上肢淋巴水肿患者的真皮回流（DBF）。然而，DRS 对原发性下肢淋巴水肿（PLEL）是否有相同的效果尚未明确报道。因此，本研究旨在探讨 DRS 是否可用于诊断 PLEL 患者淋巴闪烁显像中的 DBF。
回顾性分析 2022 年 1 月至 2023 年 12 月期间因 PLEL 就诊的 94 例患者，根据淋巴闪烁显像结果将所有患者分为两组：无 DBF 组和 DBF 组。记录两组患者的 MRI 数据，并对以下指标进行统计比较：淋巴水肿受累范围（左侧、右侧、整个下肢、仅大腿、仅小腿和踝关节）、淋巴水肿征象（皮肤显著增厚、平行线征、网格征、蜂窝征、条带征、淋巴湖征、新月征、DRS）和淋巴水肿测量（皮肤厚度、条带宽）。DRS 的特征是皮肤显著增厚，伴网格征和/或蜂窝征，伴条带征。
两组间以下指标存在统计学差异（P<.05）：显著皮肤增厚、平行线征、网格征、蜂窝征、条带征、DRS、皮肤厚度和条带宽。DRS 预测 DBF 的灵敏度、特异度和准确率分别为 82%、64%和 77%。
从影像学角度证实了 DRS 与 DBF 之间具有良好的一致性。该工具适用于儿童、青少年和对淋巴闪烁显像有禁忌证的患者。DRS 对评估 PLEL 的严重程度具有重要价值。建议在 PLEL 的联合手术治疗中应用 DRS。
