The value of the dermal rim sign on nonenhanced magnetic resonance imaging for predicting dermal backflow in patients with primary lower extremity lymphedema

Xingpeng Li; Zhe Wen; Kun Hao; Mengke Liu; Jie Ren; Jia Guo; Yimeng Zhang; Qi Hao; Xiaoli Sun; Yunlong Yue; Rengui Wang

doi:10.1016/j.jvsv.2024.101890

The value of the dermal rim sign on nonenhanced magnetic resonance imaging for predicting dermal backflow in patients with primary lower extremity lymphedema

J Vasc Surg Venous Lymphat Disord. 2024 Apr 16:101890. doi: 10.1016/j.jvsv.2024.101890. Online ahead of print.

Authors

Xingpeng Li¹, Zhe Wen², Kun Hao³, Mengke Liu¹, Jie Ren⁴, Jia Guo¹, Yimeng Zhang¹, Qi Hao¹, Xiaoli Sun¹, Yunlong Yue⁴, Rengui Wang⁵

Affiliations

¹ Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
² Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
³ Department of Lymph Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
⁴ Department of MRI, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Beijing, China.
⁵ Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China. Electronic address: wangrg@bjsjth.cn.

PMID: 38636733
DOI: 10.1016/j.jvsv.2024.101890

Abstract

Purpose: The dermal rim sign (DRS) on nonenhanced magnetic resonance imaging has been shown to predict dermal backflow (DBF) in patients with secondary upper limb lymphedema. However, whether the DRS has the same effects on primary lower extremity lymphedema (PLEL) has not been clearly reported. Therefore, this study aimed to explore whether the DRS can be used to diagnose DBF on lymphoscintigraphy in patients with PLEL.

Methods: A total of 94 patients who were diagnosed with PLEL were recruited for this retrospective study from January 2022 to December 2023. All the patients were divided into two groups according to the lymphoscintigraphy findings: no DBF and DBF. The magnetic resonance imaging data of the two groups were recorded and statistically compared for the following indicators: range of lymphedema involvement (left, right, whole lower limbs, only thigh, only calf and ankle), signs of lymphedema (notable thickening of skin, parallel line sign, grid sign, honeycomb sign, band sign, lymph lake sign, crescent sign, DRS), and lymphedema measurement (skin thickness, band width). The DRS is characterized by notable thickening of the skin plus the grid sign and/or honeycomb sign, plus the band sign.

Results: The following statistically significant differences in the following indicators were found between the two groups (P < .05): notable skin thickening, parallel line sign, grid sign, honeycomb sign, band sign, DRS, skin thickness, and band width. The sensitivity, specificity, and accuracy for predicting for DBF with the DRS was 82%, 64%, and 77%, respectively.

Conclusions: This study confirmed good consistency between the DRS and DBF from the perspective of imaging. This tool is suitable for children, adolescents, and patients with contraindications to lymphoscintigraphy. The DRS has important value in assessing the severity of PLEL. The DRS is suggested for the clinical use of combined surgical treatment of PLEL.

Keywords: Lower extremity; Lymph; Lymphedema; Lymphoscintigraphy; MRI.