Regional patterns of fluid and fat accumulation in patients with lower extremity lymphedema using magnetic resonance angiography Journal Article


Authors: Dayan, J. H.; Wiser, I.; Verma, R.; Shen, J.; Talati, N.; Goldman, D.; Mehrara, B. J.; Smith, M. L.; Dayan, E.; Coriddi, M.; Kagan, A.
Article Title: Regional patterns of fluid and fat accumulation in patients with lower extremity lymphedema using magnetic resonance angiography
Abstract: BACKGROUND: Fat accumulation is frequently observed in patients with lymphedema but is not accounted for in existing staging systems. In addition, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical intervention. The purpose of this study was to evaluate fluid and fat distribution in patients with lower extremity lymphedema using magnetic resonance angiography. METHODS: Magnetic resonance angiographic examinations of patients with lower extremity lymphedema were reviewed. Fluid-fat grade and location were assessed by three observers. Three-point scales were developed to grade fluid (0 = no fluid, 1 = reticular pattern of fluid, and 2 = continuous stripe of subcutaneous fluid) and fat (0 = normal, 1 = subcutaneous thickness less than twice that of the unaffected side, and 2 = subcutaneous thickness greater than twice that of the unaffected side) accumulation. RESULTS: In total, 76 magnetic resonance angiographic examinations were evaluated. Using the proposed grading system, there was good interobserver agreement for fat and fluid accumulation location (91.5 percent; κ = 0.9), fluid accumulation grade (95.7 percent; κ = 0.95), and fat accumulation grade (87.2 percent; κ = 0.86). Patients with International Society of Lymphology stage 2 lymphedema had a wide range of fluid and fat grades (normal to severe). The most common location of fluid accumulation was the lateral lower leg, whereas the most common location of fat accumulation was the medial and lateral lower leg. CONCLUSION: The proposed magnetic resonance angiographic grading system may help stratify patients with International Society of Lymphology stage 2 lymphedema on the basis of tissue composition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
Keywords: adolescent; adult; child; aged; middle aged; retrospective studies; young adult; prospective study; prospective studies; observer variation; pathology; retrospective study; lymphedema; body fluids; body fluid; magnetic resonance angiography; leg; body fat distribution; subcutaneous fat; humans; human; male; female
Journal Title: Plastic and Reconstructive Surgery
Volume: 145
Issue: 2
ISSN: 0032-1052
Publisher: Lippincott Williams & Wilkins  
Date Published: 2020-02-01
Start Page: 555
End Page: 563
Language: English
DOI: 10.1097/prs.0000000000006520
PUBMED: 31985658
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
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Citation Impact
MSK Authors
  1. Babak Mehrara
    289 Mehrara
  2. Debra Alyssa Goldman
    118 Goldman
  3. Joseph Henry Dayan
    31 Dayan
  4. Erica Simone Dayan
    6 Dayan
  5. Richa Verma
    3 Verma
  6. Itay Wiser
    4 Wiser