上肢继发性淋巴水肿淋巴手术后非对比 MRI 上的变化。

IF 2.8 2区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Sara Babapour, Clarissa Lee, Erin Kim, JacqueLyn R Kinney, James Fanning, Dhruv Singhal, Leo L Tsai
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引用次数: 0

摘要

目的:评估上肢淋巴水肿手术后非对比 MRI 生物标志物的变化:评估上肢淋巴水肿手术后基于非对比核磁共振成像的生物标志物的变化:我们回顾性地确定了接受血管化淋巴结移植(VLNT)、剥脱性淋巴结切除术或先行剥脱性淋巴结移植(单独进行)的继发性上肢淋巴水肿患者。所有患者的手术前和手术后核磁共振成像结果都进行了比较。采用基于 MRI 的水肿评分系统:0(无水肿)、1(从肌筋膜到真皮层的液体少于 50%)和 2(从肌筋膜到真皮层的液体达到或超过 50%)。对手臂和前臂上下三分之一处的四个象限(共 16 个解剖位置)分别进行水肿评分和皮下厚度(ST)测量,并对手术前后进行比较。然后将水肿评分和 ST 的净变化与 LYMPH-Q(生活质量)评分、L-Dex(生物阻抗)和周径测量法得出的肢体体积差值相关联:纳入2017年1月至2022年12月期间接受淋巴手术并成功完成术前和术后磁共振成像的患者,共33例单侧继发性上肢淋巴水肿患者(年龄63±14岁,女性32例)。VLNT术后随访时间的中位数范围为12.5 [6-19]个月,去势术后随访时间的中位数范围为13.5 [12-40]个月,去势术后接受VLNT的患者随访时间的中位数范围为12.0 [12-24]个月。上肢16个解剖节段中,有15个节段的平均皮下厚度(ST)在剥脱术后有所下降(p 结论:皮下厚度的下降与上肢的解剖节段有关:大部分解剖节段的皮下厚度在吸脂去骨赘手术后都有所减少,而水肿阶段则有所增加。VLNT术后的变化较小,这可能反映了在较短的随访期内变化更为渐进,前臂桡侧可能最早出现反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Changes on noncontrast magnetic resonance imaging following lymphatic surgery for upper extremity secondary lymphedema.

Objective: To assess changes in noncontrast magnetic resonance imaging (MRI)-based biomarkers after upper extremity lymphedema surgery.

Methods: We retrospectively identified secondary upper extremity lymphedema patients who underwent vascularized lymph node transplant (VLNT), debulking lipectomy, or VLNT with a prior debulking (performed separately). All patients with both preoperative and postoperative MRIs were compared. An MRI-based edema scoring system was used: 0 (no edema), 1 (<50% fluid from myofascial to dermis), and 2 (≥50% fluid from myofascial to dermis). Edema scores and subcutaneous thickness (ST) were obtained along four quadrants across the upper and lower third of the arm and forearm each-for a total of 16 anatomical locations-and compared before and after surgery. Net changes in edema scores and ST were then correlated with Lymphoedema Quality-of-Life Questionnaire scores, L-Dex (bioimpedance), and limb volume difference by perometry.

Results: Patients who underwent lymphatic surgeries between January 2017 and December 2022 and successfully completed preoperative and postoperative MRI were included, resulting in a total of 33 unilateral secondary upper extremity lymphedema patients m(mean age, 63 ± 14 years; 32 female). The median postoperative follow-up times were 12.5 months (range, 6-19 months) for VLNT, 13.5 months (range, 12-40 months) for debulking, and 12.0 months (range, 12-24 months) for patients who underwent VLNT after debulking surgery. There was a decrease in mean ST in 15 of 16 anatomical segments of the upper extremity after debulking (P < .001), and the edema score increased in 7 of 16 segments (P ≤ .001-.020). Edema stage did not change in patients who underwent VLNT only or VLNT after debulking. ST decreased only along the radial forearm in patients who underwent VLNT after debulking despite an improvement in the Lymphoedema Quality-of-Life Questionnaire score in the former group. There was correlation between a decrease in ST with a decrease in volume within the debulking group (r = 0.79; P < .001). A decrease in ST also correlated with improved lymphedema quality of life questionnaires in the debulking group (r = 0.49; P = .04).

Conclusions: A decrease in ST was demonstrated in most anatomical segments after liposuction debulking, whereas edema stage was increased. Fewer changes were seen with VLNT, possibly a reflection of more gradual changes within this short follow-up period, with the radial forearm potentially revealing the earliest response.

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来源期刊
Journal of vascular surgery. Venous and lymphatic disorders
Journal of vascular surgery. Venous and lymphatic disorders SURGERYPERIPHERAL VASCULAR DISEASE&n-PERIPHERAL VASCULAR DISEASE
CiteScore
6.30
自引率
18.80%
发文量
328
审稿时长
71 days
期刊介绍: Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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