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European Radiology
Published in: European Radiology 1/2018

01-01-2018 | Vascular-Interventional

Primary lower limb lymphoedema: classification with non-contrast MR lymphography

Authors: Lionel Arrivé, S. Derhy, B. Dahan, S. El Mouhadi, L. Monnier-Cholley, Y. Menu, C. Becker

Published in: European Radiology | Issue 1/2018

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Abstract

Purpose

The purpose of the present study was to analyse the performance of non-contrast MR lymphography for the classification of primary lower limb lymphoedema in 121 consecutive patients with 187 primary lower limb lymphoedemas.

Materials and methods

121 consecutive patients with clinically diagnosed primary lower limb lymphoedema underwent non-contrast MR lymphography with a free-breathing 3D fast spin-echo sequence with a very long TR/TE (4000/884 ms). MR examinations were retrospectively reviewed for severity of lymphoedema (absent, mild, moderate, severe) and characteristics of inguinal lymph nodes and iliac and inguinal lymphatic trunks graded as aplasic (no lymph nodes or lymphatic trunks), hypoplasic (less lymph nodes or lymphatic trunks), normal and hyperplasic (more lymph nodes or more and/or dilated trunks).

Results

There was an excellent correlation between clinical stage and severity of lymphoedema (Cramer’s V of 0,73 (p < 0.001)). Differentiation was feasible between inguinal lymphatic vessel aplasia (21%), hypoplasia (15%), normal pattern (53%) and hyperplasia (11%).
Severe lymphoedema was observed in 46% of aplasic patterns and in 37% of hyperplasic patterns, but in only 15% of hypoplasic patterns and never observed in normal patterns (p < 0.001).

Conclusion

Non-contrast MR lymphography is able to classify primary lower limb lymphoedemas into hyperplasic, aplasic, hypoplasic and normal patterns.

Key Points

• Non-contrast MR lymphography is able to classify primary lower limb lymphoedemas.
• Lymphoedema can be classified in hyperplasic, aplasic, hypoplasic and normal patterns.
• Non-contrast MR lymphography can optimize clinical management of primary lower limb lymphoedemas.
Literature
1.
2.
Allen EV (1934) Lymphedema of the extremities. Classification, etiology and differential diagnosis: a study of three hundred cases. Arch Intern Med 54:606–624CrossRef
3.
Petrek JA, Pressman PI, Smith RA (2000) Lymphedema: current issues in research and management. CA Cancer J Clin 50:292–307CrossRefPubMed
4.
Kinmonth JB (1957) Primary lymphoedema. Clinical and lymphangiographic studies of a series of 107 patients in which the lower limbs were affected. Br J Surg 189:1–9CrossRef
5.
Campisi C, Davini D, Bellini C et al (2006) Lymphatic microsurgery for the treatment of lymphedema. Microsurgery 26:65–69CrossRefPubMed
6.
Becker C, Assouad J, Riquet M, Hidden G (2006) Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg 243:313–315CrossRefPubMedPubMedCentral
7.
Olszewski WL (2013) Lymphovenous microsurgical shunts in treatment of lymphedema of lower limbs: a 45-year experience of One surgeon/One center. Eur J Vasc Endovasc Surg 45:282–290CrossRefPubMed
8.
Tammela T, Saaristo A, Holopainen T et al (2007) Therapeutic differentiation and maturation of lymphatic vessels after lymph node dissection and transplantation. Nat Med 13:1458–1466CrossRefPubMed
9.
Lähteenvuo M, Honkonen K, Tervala T et al (2011) Growth factor therapy and autologous lymph node transfer in lymphedema. Circulation 123:613–620CrossRefPubMed
10.
Witte CL, Witte MH, Unger EC (2000) Advances in imaging of lymph flow disorders. RadioGraphics 20:1697–1719CrossRefPubMed
11.
Weissleder H, Weissleder R (1988) Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology 167:729–735CrossRefPubMed
12.
Ruehm SG, Schroeder T, Debatin JF (2001) Interstitial MR lymphography with gadoterate meglumine: initial experience in humans. Radiology 220:816–821CrossRefPubMed
13.
Lohrmann C, Foeldi E, Speck O, Langer M (2006) High-resolution MR lymphangiography in patients with primary and secondary lymphedema. AJR Am J Roentgenol 187:556–561CrossRefPubMed
14.
Mitsumori LM, McDonald ES, Wilson GJ, Neligan PC, Minoshima S, Maki HM (2015) MR lymphangiography: How I do it. J Magn Reson Imaging 42:1465–1477CrossRefPubMed
15.
Lu Q, Delproposto Z, Hu A et al (2012) MR lymphography of lymphatic vessels in lower extremity with gynecologic oncology-related lymphedema. PLoS One 7:e50319CrossRefPubMedPubMedCentral
16.
Liu NF, Lu Q, Jiang ZH, Wang CG (2009) Anatomic and functional evaluation of the lymphatic and lymph nodes in diagnosis of lymphatic circulation disorders with contrast magnetic resonance lymphangiography. J Vasc Surg 49:980–987CrossRefPubMed
17.
Case TC, Witte CL, Witte MH, Unger EC, Williams WH (1992) Magnetic resonance imaging in human lymphedema: comparison with lymphangioscintigraphy. Magn Reson Imaging 10:549–558CrossRefPubMed
18.
Liu NF, Wang CG (1998) The role of magnetic resonance imaging in diagnosis of peripheral lymphatic disorders. Lymphology 31:119–127PubMed
19.
Aström KGO, Abdsaleh S, Brenning GC, Ahlström KH (2001) MR imaging of primary, secondary, and mixed forms of lymphedema. Acta Radiol 42:409–416CrossRefPubMed
20.
Consensus Document of the International Society of Lymphology (2009) The diagnosis and treatment of peripheral lymphedema. Lymphology 42:51–60
21.
Hadjis NS, Carr DH, Banks L, Pflug JJ (1985) The role of CT in the diagnosis of primary lymphedema of the lower limb. AJR 144:361–364CrossRefPubMed
22.
Witte CL, Witte MH (1998) Physiology and imaging of the peripheral lymphatic system. In: Moore WS (ed) Vascular surgery, 5th edn. Saunders, Philadelphia, pp 808–828
23.
Witte MH, Witte CL (1992) Massive obesity simulating lymphedema. N Engl J Med 327:1927CrossRef
24.
Duewell S, Hagspiel KD, Zuber J, von Schulthess GK, Bollinger A, Fuchs WA (1992) Swollen lower extremity: role of MR imaging. Radiology 184:227–231CrossRefPubMed
25.
Mihara M, Hara H, Hayashi Y et al (2012) Pathological steps of cancer related lymphedema histological changes in the collecting lymphatic vessels after lymphadenectomy. PLoS ONE 7:e41126CrossRefPubMedPubMedCentral
26.
Vaqueiro M, Gloviczki P, Fisher J, Hollier LH, Schirger A, Wahner HW (1986) Lymphoscintigraphy in lymphedema: an aid to microsurgery. J Nucl Med 27:1125–1130PubMed
27.
Maegawa J, Mikami T, Yamamoto Y, Satake T, Kobayashi S (2010) Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis. Microsurgery 30:437–442CrossRefPubMed
28.
Koehler PR (1968) Complications of lymphography. Lymphology 1:116–120PubMed
29.
Notohamiprodjo M, Weiss M, Baumeister RG et al (2012) MR lymphangiography at 3.0T: correlation with lymphoscintigraphy. Radiology 264:78–87
30.
Olszewski WL, Liu NF (2013) Magnetic resonance lymphography (MRL). Point and counter point. Lymphology 46:202–207PubMed
31.
Lu Q, Xu J, Liu N (2010) Chronic lower extremity lymphedema: a comparative study of high-resolution interstitial MR lymphangiography and heavily T2-weighted MRI. Eur J Radiol 73:365–373CrossRefPubMed
32.
Liu N, Wang C, Sun M (2005) Noncontrast three-dimensional magnetic resonance imaging vs lymphoscintigraphy in the evaluation of lymph circulation disorders: a comparative study. J Vasc Surg 41:69–75CrossRefPubMed
33.
Takahashi H, Kuboyama S, Abe H, Aoki T, Miyazaki M, Nakata H (2003) Clinical feasibility of non-contrast enhanced magnetic resonance lymphography of the thoracic duct. Chest 124:2136–2142CrossRefPubMed
34.
Arrivé L, Azizi L, Lewin M et al (2007) MR lymphography of abdominal and retroperitoneal lymphatic vessels. AJR Am J Roentgenol 189:1051–1058CrossRefPubMed
35.
Derhy S, El Mouhadi S, Ruiz A, Azizi L, Menu Y, Arrivé L (2013) Non-contrast 3D MR lymphography of retroperitoneal lymphatic aneurysmal dilatation: a continuous spectrum of change from normal variants to cystic lymphangioma. Insights Imaging 4:753–758CrossRefPubMedPubMedCentral
36.
Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Hayashi A, Koshima I (2015) Indocyanine Green Lymphography findings in primary leg lymphedema. Eur J Vasc Endovasc Surg 49:95–102CrossRefPubMed
Metadata
Title
Primary lower limb lymphoedema: classification with non-contrast MR lymphography
Authors
Lionel Arrivé
S. Derhy
B. Dahan
S. El Mouhadi
L. Monnier-Cholley
Y. Menu
C. Becker
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-4948-z

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