妇科恶性肿瘤术后下肢淋巴水肿MRI分期研究

目的 应用小腿MRI横断面面积评估妇科肿瘤术后下肢淋巴水肿(LEL)分期的可行性.方法 本研究纳入妇科肿瘤治疗后患者148例,其中单侧LEL 116例,术后无LEL 32例.所有患者均接受小腿MRI检查和排水法小腿体积测量.分别测量MRI横断面图像上小腿中段软组织总面积(T),肌肉面积(M)和皮下软组织面积(S),并计算上述几个指标与对侧无LEL小腿之间差值(DT、DM、DS).患侧小腿的体积(V)通过排水量获得,并计算其与对侧健侧小腿间的体积差(DV).对所有获得的指标进行统计分析,以确定MRI测量用于LEL分期的可行性.结果 患侧小腿V与患侧小腿T、S及DV与DT、DS均存在强相关性.其中,患侧小腿T、S及DT、DS与LEL分期的相关性显著强于患侧小腿V、DV与LEL分期的相关性(P<0.01).多变量分析显示,不同级别的LEL患侧小腿T、S及DS在LEL不同分期之间的差异性大于患侧小腿V及DV(P<0.05).在LEL的0期和Ⅰ期的患者中,患侧小腿V和DV无显著差异.在所有参数中,DS显示出对LEL分期最强的分级能力.结论 DS对LEL的分期区分度最强,推荐作为LEL分期可靠的指标,可用于LEL早期诊断的重要依据.

Cross-sectional areas of calf soft tissue measured with MRI as a new method for staging gynecologic oncology-related extremity lymphedema

Objective To determine whether the cross-sectional area (CSA)of the calf measured with MRI could stage lower ex-tremity lymphedema (LEL)secondary to gynecological cancer treatments.Methods 148 patients were enrolled in this research.116 females with unilateral LEL and 32 without LEL after gynecological cancer treatments underwent calf MRI and water displacement. Total soft tissue CSA (T),muscle CSA (M)and subcutaneous tissue CSA (S)of affected calf,and difference of T (DT),M (DM) and S (DS)between calves were obtained on MRI at mid-calf level.Volume of affected calf and difference of volume (DV)between calves were obtained by water displacement.Statistical analysis was performed to determine feasibility of MRI measurements for ac-cessing LEL.Results There were close correlations between volume and T or S of affected calf,and between DV and DT or DS of calves.The correlations of stages of LEL with T and S of affected calf as well as DT and DS were stronger than the volume of affect-ed calf and DV (P< 0.01).Multivariate analysis showed more significant differences in T and S than in volume of affected calf,and in DS than in DV between LEL stages (P< 0.05).No difference was found in volume of affected calf and in DV between stage 0 andⅠ. For staging LEL,DS showed the most profound discrimination ability among all measurable parameters.Conclusion DS of calves could be the most reliable parameter recommended for staging and early diagnosis of LEL.