title: Breast Cancer-Related Lymphedema: Differentiating Fat from Fluid Using Magnetic Resonance Imaging Segmentation.
abstract: Lymphedema is an iatrogenic complication after breast cancer treatment in which lymph fluid in the affected limb progresses to fat deposition and fibrosis that are amenable to liposuction treatment. Magnetic resonance imaging (MRI) for lymphedema can differentiate fat tissue from fluid, but estimating relative volumes remains problematic.
  
  
  
  Patients underwent routine bilateral arm MRI both before and after liposuction for advanced lymphedema. The threshold-based level set (TLS) segmentation method was applied to segment the geometric image data and to measure volumes of soft tissue (fat, muscle, and lymph fluid) and bone. Bioimpedance testing (L-Dex®) to detect extracellular fluid was also used. Volumes derived by using TLS or girth measurement were evaluated and showed consistent agreement, whereas L-Dex showed no significant reduction between pre- and postoperative measures. The percentage median volume difference between the affected and unaffected sides was 132.4% for girth measures compared with 137.2% for TLS (p = 0.175) preoperatively, and 99.8% and 98.5%, respectively (p = 0.600), postoperatively. MRI segmentation detected reductions in fat (median 52.6%, p = 0.0163) and lymph fluid (median 66%, p = 0.094), but the volumes of muscle and bone were relatively constant.
  
  
  
  MRI imaging with TLS technology may be a useful tool to quantitatively measure fat tissue and fluid for patients with advanced lymphedema and may assist in the selection of eligible liposuction candidates at initial assessment and follow-up of patients who proceed with surgery.
authors.affiliation: 1 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Sen
authors.affiliation: 1 Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Qian
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .
authors.forename: Louise
authors.initials: L
authors.lastname: Koelmeyer
authors.affiliation: 3 Department of Biostatistics and Epidemiology, Faculty of Health and Environmental Sciences, Auckland University of Technology , Auckland, New Zealand .
authors.forename: Robert
authors.initials: R
authors.lastname: Borotkanics
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .
authors.forename: Robyn
authors.initials: R
authors.lastname: Ricketts
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .
authors.forename: Helen
authors.initials: H
authors.lastname: Mackie
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lam
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .|4 Macquarie Medical Imaging, Macquarie University Hospital, Macquarie University , Sydney, Australia .
authors.forename: Kevin Ho
authors.initials: KH
authors.lastname: Shon
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .
authors.forename: Hiroo
authors.initials: H
authors.lastname: Suami
authors.affiliation: 2 Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University , Sydney, Australia .
authors.forename: John
authors.initials: J
authors.lastname: Boyages
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging; D000072656:Breast Cancer Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D001943:Breast Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D045604:Extracellular Fluid / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D015187:Lipectomy; D008196:Lymph / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging
keywords: MRI; liposuction; lymphedema