Primary lower limb lymphoedema: classification with non-contrast MR lymphography.

Area of Science:

• Radiology
• Medical Imaging
• Vascular Medicine

Background:

• Primary lower limb lymphoedema presents a significant clinical challenge.
• Accurate classification is crucial for effective patient management and treatment strategies.

Purpose of the Study:

• To evaluate the performance of non-contrast MR lymphography in classifying primary lower limb lymphoedema.
• To correlate imaging findings with clinical severity and lymphatic vessel characteristics.

Main Methods:

• 121 patients with primary lower limb lymphoedema underwent non-contrast MR lymphography.
• A free-breathing 3D fast spin-echo sequence was utilized.
• Lymphoedema severity and lymphatic trunk characteristics (aplasia, hypoplasia, normal, hyperplasia) were retrospectively graded.

Main Results:

• Non-contrast MR lymphography demonstrated feasibility in differentiating lymphatic vessel patterns: aplasia (21%), hypoplasia (15%), normal (53%), and hyperplasia (11%).
• A strong correlation was observed between clinical stage and lymphoedema severity (Cramer's V = 0.73).
• Severe lymphoedema was more frequent in aplastic (46%) and hyperplasic (37%) patterns compared to hypoplasic (15%) and normal (0%) patterns.

Conclusions:

• Non-contrast MR lymphography is a valuable tool for classifying primary lower limb lymphoedemas.
• The technique can categorize lymphoedema into distinct patterns: hyperplasic, aplastic, hypoplasic, and normal.
• This classification has the potential to optimize the clinical management of primary lower limb lymphoedemas.