Joseph H Dayan1, Itay Wiser1, Richa Verma1, Jody Shen1, Nishi Talati1, Debra Goldman1, Babak J Mehrara1, Mark L Smith1, Erez Dayan M D2,1, Michelle Coriddi M D2,1, Alexander Kagan1. 1. From the Plastic and Reconstructive Surgery Service and the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center; Weill Cornell Medicine; the Department of Radiology, Mt. Sinai Health System; the Division of Plastic Surgery, Northwell Health System and Cancer Institute; and the Division of Plastic Surgery, Massachusetts General Hospital/Harvard Medical School. 2. New York and Lake Success, N.Y.; and Boston, Mass.
Abstract
BACKGROUND: Fat accumulation is frequently observed in patients with lymphedema but is not accounted for in existing staging systems. In addition, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical intervention. The purpose of this study was to evaluate fluid and fat distribution in patients with lower extremity lymphedema using magnetic resonance angiography. METHODS: Magnetic resonance angiographic examinations of patients with lower extremity lymphedema were reviewed. Fluid-fat grade and location were assessed by three observers. Three-point scales were developed to grade fluid (0 = no fluid, 1 = reticular pattern of fluid, and 2 = continuous stripe of subcutaneous fluid) and fat (0 = normal, 1 = subcutaneous thickness less than twice that of the unaffected side, and 2 = subcutaneous thickness greater than twice that of the unaffected side) accumulation. RESULTS: In total, 76 magnetic resonance angiographic examinations were evaluated. Using the proposed grading system, there was good interobserver agreement for fat and fluid accumulation location (91.5 percent; κ = 0.9), fluid accumulation grade (95.7 percent; κ = 0.95), and fat accumulation grade (87.2 percent; κ = 0.86). Patients with International Society of Lymphology stage 2 lymphedema had a wide range of fluid and fat grades (normal to severe). The most common location of fluid accumulation was the lateral lower leg, whereas the most common location of fat accumulation was the medial and lateral lower leg. CONCLUSION: The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
BACKGROUND: Fat accumulation is frequently observed in patients with lymphedema but is not accounted for in existing staging systems. In addition, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical intervention. The purpose of this study was to evaluate fluid and fat distribution in patients with lower extremity lymphedema using magnetic resonance angiography. METHODS: Magnetic resonance angiographic examinations of patients with lower extremity lymphedema were reviewed. Fluid-fat grade and location were assessed by three observers. Three-point scales were developed to grade fluid (0 = no fluid, 1 = reticular pattern of fluid, and 2 = continuous stripe of subcutaneous fluid) and fat (0 = normal, 1 = subcutaneous thickness less than twice that of the unaffected side, and 2 = subcutaneous thickness greater than twice that of the unaffected side) accumulation. RESULTS: In total, 76 magnetic resonance angiographic examinations were evaluated. Using the proposed grading system, there was good interobserver agreement for fat and fluid accumulation location (91.5 percent; κ = 0.9), fluid accumulation grade (95.7 percent; κ = 0.95), and fat accumulation grade (87.2 percent; κ = 0.86). Patients with International Society of Lymphology stage 2 lymphedema had a wide range of fluid and fat grades (normal to severe). The most common location of fluid accumulation was the lateral lower leg, whereas the most common location of fat accumulation was the medial and lateral lower leg. CONCLUSION: The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
Authors: M R Fu; C M Cleland; A A Guth; M Kayal; J Haber; F Cartwright; R Kleinman; Y Kang; J Scagliola; D Axelrod Journal: Lymphology Date: 2013-06 Impact factor: 1.286
Authors: Mike Notohamiprodjo; Mayo Weiss; Ruediger G Baumeister; Wieland H Sommer; Andreas Helck; Alexander Crispin; Maximilian F Reiser; Karin A Herrmann Journal: Radiology Date: 2012-04-20 Impact factor: 11.105
Authors: Ming-Huei Cheng; Jung-Ju Huang; Ju-Jung Huang; Dung H Nguyen; Michel Saint-Cyr; Michael R Zenn; Bien Keem Tan; Chyi-Long Lee Journal: Gynecol Oncol Date: 2012-04-17 Impact factor: 5.482