Use of non-contrast MR in diagnosing secondary lymphedema of the upper extremities

The purpose of the study is to determine if a combination of dermal thickening and subcutaneous fluid honeycombing on non-contrast MRI, termed the dermal rim sign (DRS), can be diagnostically analogous to dermal backflow seen on lymphoscintigraphy in patients with secondary upper extremity lymphedem...

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Bibliographic Details
Published in:Clinical imaging 2021-12, Vol.80, p.400-405
Main Authors: Kim, Geunwon, Donohoe, Kevin, Smith, Martin P., Hamaguchi, Ryoko, Johnson, Anna Rose, Singhal, Dhruv, Tsai, Leo L.
Format: Article
Language:English
Subjects:
Aged
Biomarkers
Biopsy
Breast cancer
Cancer therapies
Dermal backflow
Extremities
Humans
Lumpectomy
Lymphatic system
Lymphedema
Lymphedema - diagnostic imaging
Lymphedema - etiology
Lymphography
Lymphoma
Lymphoscintigraphy
Magnetic Resonance Imaging
Mastectomy
Mathematical analysis
Middle Aged
MRI
Patients
Sensitivity
Skin
Spectrum analysis
Surgery
Thickening
Upper Extremity
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Summary:The purpose of the study is to determine if a combination of dermal thickening and subcutaneous fluid honeycombing on non-contrast MRI, termed the dermal rim sign (DRS), can be diagnostically analogous to dermal backflow seen on lymphoscintigraphy in patients with secondary upper extremity lymphedema. Upper extremity MRI and lymphoscintigraphy were performed on patients referred to a multidisciplinary lymphedema clinic for suspicion of secondary lymphedema. Sensitivity, specificity, and positive and negative predictive values of DRS on MRI in detecting dermal backflow on lymphoscintigraphy and the correlation between DRS, Indocyanine Green (ICG) lymphography, bioimpedence L-Dex® ratio and MRI Lymphedema Staging were calculated. Weighted interobserver agreements on the presence and location of DRS on MRI were calculated. Of the 45 patients in the study, 91.1% (41/45) of patients had history of breast cancer. The average age was 58.4 ± 10.5 years, with a mean symptom duration of 4.7 ± 4.4 years. The mean BMI was 30.5 ± 7.0 kg/m2. Interobserver agreement on the presence and the extent of DRS on MRI was 0.93 [95% confidence-interval: 0.80–1]. DRS was present in 97% (32/33) of patients who demonstrated dermal backflow on lymphoscintigraphy. Sensitivity, specificity, PPV, and NPV of DRS were 96.6% [81.7%–99.9%], and 75.0% [47.6%–92.7%], 87.5% [74.9%–94.3%], and 92.3% [63.1%–98.8%]. DRS was associated with severity on ICG lymphography and bioimpedance (both p 
ISSN:0899-7071
1873-4499
DOI:10.1016/j.clinimag.2021.08.018