MR软组织径线测量对单侧原发性下肢淋巴水肿临床分期的初步研究  

Preliminary Study on the Clinical Staging of Primary Lower Extremity Lymphedema by MR Soft Tissue Radial Measurements

作　　者：刘梦珂 张妍 张怡梦 李兴鹏 郝琪 张晓杰 李滨[2] 王仁贵 LIU Mengke;ZHANG Yan;ZHANG Yimeng(Department of Radiology,Affiliated Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,P.R.China)

机构地区：[1]首都医科大学附属北京世纪坛医院放射科,100038 [2]首都医科大学附属北京世纪坛医院MR室,100038 [3]北京大学第九临床医学院放射科,100038

出　　处：《临床放射学杂志》2024年第1期105-110,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金(编号:61876216);北京市属医院科研培育计划(PX2020030)资助项目。

摘　　要：目的探讨基于磁共振测量肢体的二维径线数据在评估单侧原发性下肢淋巴水肿(PLEL)临床分期的价值。方法回顾性搜集132例经确诊为PLEL患者,所有患者均行下肢MRI检查。采用短时反转恢复(STIR)序列测量双侧小腿软组织纵向及横向的总径线(TD)、肌骨径线(MD)和皮下软组织径线(SD),分别计算患侧与健侧TD及SD的差值(DTD、DSD)。依据2020年国际淋巴协会(International Society of Lymphology,ISL)临床分期标准对患者进行相关分期。对所有测量数据进行统计分析,以确定MRI径线测量方法在PLEL临床分期中的可行性。结果横径TD(R=0.492)、SD(R=0.596)、DTD(R=0.608)、DSD(R=0.620)与临床分期的相关性明显大于纵径的TD(R=0.430)、SD(R=0.532)、DTD(R=0.547)和DSD(R=0.519),横径DSD与临床分期相关性最高。无论横径或纵径,淋巴水肿Ⅰ期患者TD、SD、DTD及DSD的值明显小于Ⅱ期及Ⅲ期(P<0.05),而Ⅱ期与Ⅲ期之间各测量值差异均无统计学意义(P>0.05)。横径鉴别临床分期的曲线下面积(AUC)大于纵径,其中横径DSD(AUC=0.930)鉴别Ⅰ期与Ⅱ期的AUC值最高。结论基于MRI测量软组织径线可以作为一种单侧PLEL临床分期的定量方法,推荐横径的皮下软组织差值DSD作为鉴别Ⅰ期与Ⅱ期淋巴水肿的最佳评估指标。Objective Exploring the value of magnetic resonance-based measurement of two-dimensional radial data of the limb in assessing the clinical staging of primary lower extremity lymphedema(PLEL).Methods A retrospective col-lection of 132 patients diagnosed with primary LEL by our hospital was made,and all patients underwent MR examination of the lower extremities.Short Time Inversion Recovery(STIR)sequences were used to measure the total longitudinal and transverse soft tissue diameter(TD),musculoskeletal diameter(MD)and subcutaneous soft tissue diameter(S)of the lower leg,and the difference between TD and SD on the affected and the healthy side(DTD,DSD)were calculated respec-tively.The patients were staged according to the International Society of Lymphology(ISL)clinical staging criteria in 2020.Statistical analysis of all measurements was performed to determine the feasibility of MRI measurements for clinical staging of PLEL.Results The correlation between the transverse diameter TD(R=0.492),SD(R=0.596),DTD(R=0.608),and DSD(R=0.620)and clinical stage was significantly greater than that between the longitudinal diameter TD(R=0.430),SD(R=0.532),DTD(R=0.547),and DSD(R=0.519),and the highest correlation between the transverse diameter DSD and clinical stage.The values of TD,SD,DTD and DSD in stage I were significantly lower than those in stageⅡandⅢ(P<0.05),but there was no significant difference between stageⅡandⅢ(P>0.05).The area under the curve(AUC)of the transverse diameter to identify clinical stage was greater than that of the longitudinal diame-ter,with the transverse DSD(AUC=0.930)having the highest AUC value to identify stageⅠwith stageⅡ.Conclusion Based on the fact that MRI measurement of soft tissue trajectories can be used as a quantitative method for clinical staging of unilateral PLEL.We recommend the subcutaneous soft tissue difference of transverse diameter as the best measure to dis-tinguish stageⅠfrom stageⅡlymphedema.

关 键 词：原发性淋巴水肿 下肢 测量 磁共振成像 分期 

分 类 号：R445.2[医药卫生—影像医学与核医学] R551.2[医药卫生—诊断学]