期刊
CLINICAL IMAGING
卷 80, 期 -, 页码 400-405出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.clinimag.2021.08.018
关键词
Lymphedema; MRI; Lymphoscintigraphy; Dermal backflow
资金
- RSNA R&E Resident Grant [RR1820]
The study indicates that the DRS observed on non-contrast MRI can be used to diagnose dermal backflow in patients with secondary upper extremity lymphedema, and it correlates with the severity of lymphedema.
Purpose: The purpose of the study is to determine if a combination of dermal thickening and subcutaneous fluid honeycombing on non-contrast MRI, termed the dermal rim sign (DRS), can be diagnostically analogous to dermal backflow seen on lymphoscintigraphy in patients with secondary upper extremity lymphedema. Materials and methods: Upper extremity MRI and lymphoscintigraphy were performed on patients referred to a multidisciplinary lymphedema clinic for suspicion of secondary lymphedema. Sensitivity, specificity, and positive and negative predictive values of DRS on MRI in detecting dermal backflow on lymphoscintigraphy and the correlation between DRS, Indocyanine Green (ICG) lymphography, bioimpedence L-Dex (R) ratio and MRI Lymphedema Staging were calculated. Weighted interobserver agreements on the presence and location of DRS on MRI were calculated. Results: Of the 45 patients in the study, 91.1% (41/45) of patients had history of breast cancer. The average age was 58.4 +/- 10.5 years, with a mean symptom duration of 4.7 +/- 4.4 years. The mean BMI was 30.5 +/- 7.0 kg/m2. Interobserver agreement on the presence and the extent of DRS on MRI was 0.93 [95% confidence-interval: 0.80-1]. DRS was present in 97% (32/33) of patients who demonstrated dermal backflow on lymphoscintigraphy. Sensitivity, specificity, PPV, and NPV of DRS were 96.6% [81.7%-99.9%], and 75.0% [47.6%-92.7%], 87.5% [74.9%-94.3%], and 92.3% [63.1%-98.8%]. DRS was associated with severity on ICG lymphography and bioimpedance (both p < 0.001). Conclusions: DRS on non-contrast MRI is highly predictive of dermal backflow and correlates with clinical measures of lymphedema severity. DRS may be used as an independent diagnostic biomarker to identify patients who would benefit from dedicated exams.
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