Magnetic resonance lymphography findings across different clinical stages of lower limb lymphedema

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ObjectiveTo investigate the imaging findings of lower limb lymphedema using magnetic resonance lymphography (MRL). MethodsMRL was used to record the lymphatic vessel morphology, distribution of lymphatic vessels, dermal backflow (DBF), and morphology of inguinal lymph nodes in 112 patients (175 affected limbs) with the lower limb lymphedema at different clinical stages (according to the International Society of Lymphology staging criteria 2020). ResultsThe lymphatic vessel morphology significantly differed in different clinical stages (X2=59.306; P=0.000). ISL stage I is dominated by ‘scattered beads’ and ‘branch-like’ distribution, ISL stage Ⅱ has tree branch or ‘capillary-like’ distribution, and ISL stage Ⅲ primarily has a capillary pattern and contrast agent accumulation in the foot. There were statistically significant differences in the distribution of lymphatic vessels and DBF in different clinical stages. The distribution of enhanced lymphatic vessels was distal to the knee in ISL stage I, involved areas below the knee joint or involving the whole limb in ISL stage II, and Involving the whole limb in ISL stage III (X2=44.591; P=0.000). With the progression of edema, DFB severity increased (X2=76.416; P=0.000). ConclusionMRL revealed the morphology and distribution of lymphatic vessels and detected abnormal inguinal lymph nodes in patients at different stages of lymphedema, which can provide reference information for surgical treatment.