Abstract
ObjectiveTo characterize lymphatic vessel morphology in lower extremity lymphedema using MR lymphography at 3T.Study DesignForty females with lower extremity lymphedema secondary to gynecologic carcinoma treatment underwent MR lymphography (MRL) at 3T. Lymphatic vessel morphology in normal and affected limbs was compared.ResultsThe median diameter of the lymphatic vessels in swollen calf and thigh were significantly larger than that in the contralateral calf and thigh, respectively (p<0.05). The median number of lymphatic vessels visualized in normal calf was less than that in the lymphedematous calf (p<0.01), while no significant difference was found between the normal thigh and swollen thigh. Lymphatic vessel number in the affected calf was significantly greater than that in affected thigh and the mean diameter of affected calf was also significantly wider than that of affected thigh (p<0.01). Mean diameter of lymphatic vessels in the affected calf was significantly different between stage I and stage III (p<0.05), but not significantly different between stages I and II, and between stages II and III (p>0.05). The median number of lymphatic vessels for affected calf showed significant difference between stage I and stage III, and between stage II and stage III (p<0.05), but no significant difference between stage I and stage II (p>0.05). There was no significant difference in mean diameter or median number of lymphatic vessels in the affected thigh found between different stages (p>0.05).ConclusionThere are significant differences in the number or diameter of lymphatic vessels between normal and affected limbs and there are significant differences for affected calf between early and late stages of lymphedema; therefore, MR lymphography can be helpful in diagnosis or clinical staging for lower extremity with gynecologic oncology-related lymphedema.
Highlights
Lower extremity lymphedema (LEL) secondary to gynecologic tumor treatment is the result of abnormal accumulation of fluid in the interstitial tissues [1,2,3,4,5,6]
The majority of Magnetic resonance lymphangiography (MRL) research has been confined to primary lymphedema which may have different MRL characteristics from secondary LEL because of etiological differences [16]
The few existing studies with MRL do not evaluate the morphology of lymphatic vessels in normal lower extremities, or study the relationship between abnormal lymphatic vessels and the severity of lymphedema [17,18,19]
Summary
Lymphatic vessels in the 32 normal lower extremities showed an intermittent, low signal intensity line on MRL and rendered illdefined outlines on MIPs (Figure 1, 2). The mean diameters of lymphatic vessels for each clinical stages showed significant differences using ANOVA (F = 3.898, p = 0.027) Further intra-stage comparison produced p-values of 0.365 for stages between I and II, 0.367 for stages between II and III, and 0.024 for stages between I and III. No significant difference was found for inter-stage comparisons of mean transversal lymphatic vessel diameter visualized for the affected thigh (F = 2.093, P = 0.135). ANOVA variance analysis was applied to make comparisons between the median numbers of lymphatic vessels visualized in various clinical stages for the affected calf, which showed a significant difference (F = 5.115, P = 0.010). The patterns of dermal back-flow appeared as an irregular, patchy shaped, high signal intensity area on MRL
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