Real-time tissue elastography assessment of skin and subcutaneous tissue strains in legs with lymphedema.
OBJECTIVE
To confirm the feasibility of assessing strains of the skin and subcutaneous tissue in normal legs and legs with lymphedema via free-hand real-time tissue elastography (RTE) using a phantom.


METHODS
After placing a phantom on the skin, we measured the strains of the phantom (S p), skin (S sk), and subcutaneous tissue (S sc) of the inner thigh and calf by free-hand RTE in 35 healthy volunteers. A reference S p was set using these data. We then assessed S sk and S sc in each leg of 15 patients with unilateral stage II lymphedema.


RESULTS
In the healthy volunteers, the strain was largest in the subcutaneous tissue of the thigh, followed by the subcutaneous tissue of the calf, skin of the thigh, and skin of the calf. These differences were each significant. In the patients with unilateral lymphedema, S sk and S sc in the thigh and calf were not different between the affected and unaffected legs.


CONCLUSIONS
It was feasible to assess the strains of the skin and subcutaneous tissue using free-hand RTE and standardization of the compression force using a phantom. We failed to demonstrate decreased strains of the skin and subcutaneous tissue in legs with stage II lymphedema compared with healthy legs.
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan. ksuehiro-circ@umin.org.
Kotaro
K
Suehiro
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Kaori
K
Nakamura
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Noriyasu
N
Morikage
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Masanori
M
Murakami
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Osamu
O
Yamashita
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Koshiro
K
Ueda
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Makoto
M
Samura
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
Kimikazu
K
Hamano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054459:Elasticity Imaging Techniques / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D019047:Phantoms, Imaging; D012016:Reference Values; D012867:Skin / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013312:Stress, Physiological; D040521:Subcutaneous Tissue / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods*
Elastography; Lymphedema; Ultrasound