Li Jiaping, Luo Jia, Li Manying, Lin Manxia, Liu Yingli, Zhong Jiaqian, Wei Laina, Qi Jian, Li Ping, Xie Xiaoyan, Zheng Yanling
Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Department of Microsurgery, Trauma and Hand Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Quant Imaging Med Surg. 2024 Jul 1;14(7):4965-4971. doi: 10.21037/qims-24-300. Epub 2024 Jun 18.
The diagnosis of lymphedema primarily relies on the clinical symptoms, signs, medical history and imaging. Objective lymphatic imaging helps improving the diagnosis of lymphedema. This study aimed to develop an effective imaging tool to diagnose lymphedema.
This is a single-center retrospective study. From September 2022 to November 2023, we enrolled thirty-two patients, involving 40 lower extremities who underwent lymphatic contrast-enhanced ultrasound (CEUS) following a subcutaneous injection of contrast agent at four points in the First Affiliated Hospital of Sun Yat-sen University. Cohen's kappa value, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. Lymphoscintigraphy was the reference standard.
Successful lymphatic-CEUS detection was defined as the situation that lymphatic drainage of medial or lateral lower limbs were observed. The successful detection rate was 100% (40 of 40). The diagnosis of lymphedema was based on the presence of either medial or lateral lymphatic obstructions, or subcutaneous lymphatic enhancement. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for diagnosing lymphedema by lymphatic-CEUS were as follows: 91.2% (31 of 34), 100% (6 of 6), 100% (31 of 31), 66.7% (6 of 9) and 92.5% (37 of 40), respectively. The Cohen's Kappa value was 0.756. The area under the receiver operating characteristic curve (AUC) for the subcutaneous injection of four-point lymphatic-CEUS was 0.956.
This study put forward a novel four-point lymphatic-CEUS method to detect the functions of the lymphatics of lower extremities and established a lymphatic-CEUS standard for diagnosing lymphedema of lower extremities. Four-point lymphatic-CEUS is a considerable option for diagnosing lymphedema of lower extremities.
淋巴水肿的诊断主要依赖于临床症状、体征、病史及影像学检查。客观的淋巴成像有助于提高淋巴水肿的诊断水平。本研究旨在开发一种有效的成像工具用于诊断淋巴水肿。
这是一项单中心回顾性研究。2022年9月至2023年11月，我们纳入了32例患者，共40条下肢，这些患者在中山大学附属第一医院于四个点皮下注射造影剂后接受了淋巴造影增强超声（CEUS）检查。计算了Cohen's kappa值、灵敏度、特异度、阳性预测值、阴性预测值及准确率。淋巴闪烁造影为参考标准。
成功的淋巴CEUS检测定义为观察到下肢内侧或外侧淋巴管引流的情况。成功检测率为100%（40条中的40条）。淋巴水肿的诊断基于内侧或外侧淋巴管阻塞或皮下淋巴管增强的存在。淋巴CEUS诊断淋巴水肿的灵敏度、特异度、阳性预测值、阴性预测值及准确率分别如下：91.2%（34条中的31条）、100%（6条中的6条）、100%（31条中的31条）、66.7%（9条中的6条）及92.5%（40条中的37条）。Cohen's Kappa值为0.756。四点皮下注射淋巴CEUS的受试者工作特征曲线（AUC）下面积为0.956。
本研究提出了一种新型的四点淋巴CEUS方法来检测下肢淋巴管功能，并建立了诊断下肢淋巴水肿的淋巴CEUS标准。四点淋巴CEUS是诊断下肢淋巴水肿的一个相当不错的选择。
