Regional Patterns of Fluid and Fat Accumulation in Patients with Lower Extremity Lymphedema Using Magnetic Resonance Angiography

Dayan, Joseph H.; Wiser, Itay; Verma, Richa; Shen, Jody; Talati, Nishi; Goldman, Debra A.; Mehrara, Babak J.; Smith, Mark L.; Dayan, Erez; Coriddi, Michelle; Kagan, A

doi:10.1097/prs.0000000000006520

Cited by 26 publications

(26 citation statements)

References 21 publications

(20 reference statements)

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“…This is in stark contrast to the generally accepted dogma that lymphedema is initially comprised of a fluid component, that over time is replaced by fat. Yet, similar descriptive studies carried out by Dayan et al and Brorson et al support our findings [ 7 , 14 ]. Remarkably, we found that patients with BCRL in their dominant arm had 13 percentage points more excess lymphedema volume (dominated by excess lean mass).…”

Section: Discussionsupporting

confidence: 93%

“…However, the apparent benefit in this study setting of DEXA over magnetic resonance angiography is that magnetic resonance angiography relies on manual and qualitative assessments. In contrast, DEXA scans provide an exact quantitative measure of each tissue component, which is not currently feasible using magnetic resonance angiography [ 14 , 36 ]. Bioimpedance spectroscopy is increasingly being used for evaluating BCRL due to its quick, simple, and noninvasive design [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

“…The characteristics of BCRL patients who have previously had an episode of cellulitis are not well understood, despite being a large patient subgroup with a worse prognosis [ 9 , 10 ]. In light of recent progress in BCRL treatments, the biocomposition of BCRL is set to become a vital factor in patient stratification, prognosis, and treatment-decision making between conservative, microsurgical or debulking treatments [ 14 , 15 , 16 ]. Therefore, it is critical to assess if BCRL patients with a previous episode of cellulitis have a different biocomposition profile to BCRL patients without cellulitis.…”

Section: Introductionmentioning

confidence: 99%

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Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition

Jørgensen

Hermann

Madsen

et al. 2021

Cancers

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Cellulitis is a common complication in Breast Cancer-Related Lymphedema (BCRL). The excess amount of fat and lean mass in BCRL is a vital factor in patient stratification, prognosis, and treatments. However, it is not known whether cellulitis is associated with the excess fat and lean mass in BCRL. Therefore, this prospective observational study was designed to fundamentally understand the heterogonous biocomposition of BCRL. For this study, we consecutively enrolled 206 patients with unilateral BCRL between January 2019 and February 2020. All patients underwent Dual-Energy X-Ray Absorptiometry scans, bioimpedance spectroscopy, indocyanine green lymphangiography comprehensive history of potential risk factors, and a clinical exam. Multivariate linear and beta regression models were used to determine the strength of association and margins effect. Sixty-nine patients (33%) had at least one previous episode of cellulitis. Notably, a previous episode of cellulitis was associated with 20 percentage points more excess fat and 10 percentage points more excess lean mass compared to patients without cellulitis (p < 0.05). Moreover, each 1 increase in the patients BMI was associated with a 0.03 unit increase in the fat mass proportion of the lymphedema arm. Cellulitis was associated with more excess fat and lean arm mass in BCRL. In addition, patients BMI affect the proportion of fat mass in the arm.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition

Jørgensen

Hermann

Madsen

et al. 2021

Cancers

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“…In addition, on LE CTV images, the lymphedematous limbs of patients taking mTOR inhibitors showed peculiar trabecular areas with honeycomb patterns in the subcutaneous fat, signifying fluid and fibrotic tissue surrounding the adipose tissue accumulation. 30,31 LE CTV images demonstrate the alteration in epidermal and subcutaneous tissue. 32 By measuring the muscular, subcutaneous fat, and total mid-thigh CSA, we analyzed not only qualitative but also quantitative LE CTV findings.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Lymphedema in Patients Treated with Mammalian Target of Rapamycin Inhibitors

Kim

Jeon

et al. 2021

Lymphatic Research and Biology

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Purpose: To investigate the characteristics of lymphedema in patients treated with mammalian target of rapamycin (mTOR) inhibitors and delineate complex decongestive therapy (CDT) outcomes. Methods and Results: We retrospectively analyzed 24 patients with mTOR inhibitor-induced lymphedema and 7 lymphedema patients (control) not treated with mTOR inhibitors, who visited the lymphedema clinic of the department of rehabilitation medicine from March 2016 to December 2019. We comprehensively reviewed clinical features, medication history, associated diseases, lymphoscintigraphy, lower extremity computed tomography venography (LE CTV), and the effect of CDT. By using ImageJ program, we measured the crosssectional area (CSA) of muscle and subcutaneous fat of mid-thigh image in LE CTV and compared them to a control group not treated with mTOR inhibitors. Seventeen patients on sirolimus and seven patients on everolimus were included, with an approximately equal distribution of stages 2 and 3 lymphedema, and most with pitting edema. Ten patients had breast or gynecological cancer and underwent lymph node dissection. Lymphedema developed after mTOR inhibitor initiation, not postoperatively. Lymphoscintigraphy revealed decreased lymph node uptake and dermal backflow. LE CTV revealed subcutaneous honeycomb-shaped trabecular areas in the affected limbs of seven patients. Patients treated with mTOR inhibitors had a larger mean subcutaneous fat CSA and a smaller mean muscular CSA than controls. Lymphedema improved or remained unchanged after initial CDT. Daily CDT adequately controlled 11 cases, but exacerbation occurred in 5 of 7 poorly compliant patients, and cellulitis occurred in 6 patients. Conclusion: Physicians should identify mTOR inhibitor-related lymphedema early and discuss medication alternatives and CDT with patients.

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“…For example, MRA not only enables us to diagnose lymphedema, it also gives information regarding the distribution of fluid and/or fibrofatty tissue in the limb, as well as information regarding vascular status and possible venous stenosis. A recent study by Dayan et al [ 14 ] shows the impact that MRA can have on the treatment of lymphedema patients. In this study, they examine the MRA results in patients with either primary or secondary lower extremity lymphedema, and subjectively classify and grade the fluid or fat distribution in the limb.…”

Section: Imaging Techniquesmentioning

confidence: 99%

Advances in surgical treatment of lymphedema

Beederman

Chang

2021

Arch Plast Surg

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An estimated 250 million people worldwide suffer from lymphedema. In the past, the firstline option for treatment was nonsurgical management, either in the form of compression garments or wrapping, or comprehensive decongestive therapy, with debulking surgery reserved for the more advanced cases. However, with improvements in microsurgical techniques and imaging modalities, surgical intervention is increasingly being utilized. This review highlights recent advancements in the surgical treatment of lymphedema, specifically focusing on improvements in imaging, surgical techniques, and prevention of lymphedema.

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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. Additionally, the specific regional patterns of fat and fluid accumulation remain unknown and might affect outcomes following medical or surgical

Cited by 26 publications

References 21 publications

Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition

Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition

Characteristics of Lymphedema in Patients Treated with Mammalian Target of Rapamycin Inhibitors

Advances in surgical treatment of lymphedema

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