title: Thickness of soft tissue of lower extremities measured with magnetic resonance imaging as a new indicator for staging unilateral secondary lower extremity lymphedema.
abstract: BACKGROUND
  Chronic progressive swelling of the lower extremity due to secondary lower extremity lymphedema (LEL) can affect a patient's quality of life, both physically and psychologically. A feasible and reproducible method for detecting and staging LEL will facilitate decision-making about appropriate management strategies.
  
  
  OBJECTIVE
  To determine whether the thickness of the soft tissues of the lower extremities, measured with magnetic resonance imaging (MRI), could stage unilateral secondary LEL.
  
  
  METHODS
  Seventy-two women with unilateral LEL and 22 participants without LEL underwent lower extremity MRI after treatment of uterine malignancies. LEL was classified clinically as stage 0, 1, 2, or 3. On fat-suppressed T2-weighted mid-axial images of calves and thighs, the total thickness of the soft tissue (TT), muscle thickness (MT), subcutaneous tissue thickness (STT), and the differences in TT (DTT), MT (DMT), and STT (DSTT) values and corresponding measurements in the contralateral lower extremity, were obtained and analyzed statistically for staging LEL.
  
  
  RESULTS
  There was a trend for the TT and STT of the affected calf and thigh to increase with increasing LEL stage. These parameters were strongly and moderately correlated with LEL stage, respectively (P < 0.001). Both the DTT and DSTT of the calves or thighs were strongly correlated with LEL stage (P < 0.001). Among the parameters, the DSTT of the calves could best stage LEL, with an area under the receiver operating curve of more than 0.89.
  
  
  CONCLUSIONS
  The DSTT of the calves could be recommended as an informative indicator for staging LEL.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
authors.forename: Yulai
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China Luqing_1973@163.com.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Sichuan, PR China.
authors.forename: Tian-wu
authors.initials: TW
authors.lastname: Chen
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
authors.forename: Zizhou
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
authors.forename: Jianrong
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Radiology, Wayne State University, Detroit, MI, USA.
authors.forename: Jiani
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Radiology, Wayne State University, Detroit, MI, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Haacke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007866:Leg / Q000473:pathology*; D008209:Lymphedema / Q000209:etiology* / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014594:Uterine Neoplasms / Q000150:complications* / Q000473:pathology
keywords: Magnetic resonance imaging; lower extremity; lymphedema; stage; uterine malignancy