Noncontrast magnetic resonance imaging-based evaluation of quality of life in secondary upper extremity lymphedema

Noncontrast magnetic resonance imaging (NMRI) has emerged as an efficient tool for evaluating fluid infiltration in upper extremity lymphedema (UEL). This study aimed to examine the relationship between quality of life (QOL) in UEL and regional fluid infiltration on NMRI.

A single-center retrospective observational study was conducted involving 65 patients with secondary UEL who underwent NMRI and ICG-L between 2017 and 2021. The presence of NMRI findings (reticular, thin stripe, thick stripe, multiple stripes, and honeycomb) in six regions of the upper arm and the NMRI stage were compared with Lymphedema Quality of Life Score (LeQOLiS), Quick Disabilities of the Arm, Shoulder and Hand (DASH) scores, ICG-L stage, International Society of Lymphology stage, and UEL index.

NMRI patterns were observed in 276 of 390 regions (70.8%) of 62 of 65 patients (95.4%). Thin stripe was most significantly associated with the greatest number of items (7/10) constituting the LeQOLiS score. Thick stripe had the most significant relationships with heaviness (r_s = 0.40; P < .001) and distention (r_s = 0.29; P = .021), and multiple stripes had the most significantly associated with the appearance distortion (r_s = 0.37; P = .002). The hand localization of thin stripe was significantly correlated with worsening of the greatest number of 7 of 11 items on the Quick DASH, and the upper arm localization of thin stripe was related with 4 of 10 LeQOLiS items. The higher NMRI stage was associated significantly with the deterioration of the total score (P = .012) and six items in the LeQOLiS and two items on the Quick DASH. A higher NMRI stage had significant correlations with the advancement of the ICG-L stage and UEL index (r_s = 0.83 [P < .001] and r_s = 0.65 [P < .001], respectively).

The greater total number of thin stripes in the upper limb has potential as an indicator of overall deterioration of quality of life in UEL patients. The hand and upper arm localization of thin stripe had significant associations with hand-related functional disability and lymphedema-specific symptoms, respectively.