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Fat Hypertrophy Measurement Using Magnetic Resonance Imaging For Assessment Of Patients With Secondary Upper Extremity Lymphedema
Itay Wiser, MD, PhD1, Jacxelyn Moran, MD2, Rohan Damle, MD2, Elizabeth Kenworthy, MD1, Michelle Coriddi, MD1, Alexander Kagen, MD2, Babak Mehrara, MD1, Joe Dayan, MD1.
1Memorial Sloan Kettering, New York, NY, USA, 2Mount Sinai Hospital, New York, NY, USA.

PURPOSE: Vascularized lymph node transplant (VLNT) for secondary lymphedema has been shown to improve lymphedema markers such as limb volume difference and infection rate. However, the effect of VLNT on adipose deposition, a marker for advanced-stage lymphedema, remains unknown due to a lack of clinically feasible and effective fat volume quantification methods. We evaluated the feasibility of using 3-dimensional magnetic resonance imaging (MRI) to quantify adipose deposition changes in lymphedema patients following VLNT.
METHODS: We conducted a study of unilateral breast cancer-related lymphedema patients who underwent bilateral MRI of the upper extremities before and 1 year after omentum-based VLNT. Segmented volumes of fixed-length arm and subcutaneous fat volume were calculated with 3D MRI reconstruction software. Two radiologists performed all exams independently, which were assessed for interobserver agreement. Data collected included demographics, manual limb volume and bioimpedance score.
RESULTS: Twelve women were included; average age was 58.9 years (48 - 72) and body mass index was 25.7 (21.9 - 31.2). Post-operative results at 1 year showed reductions in volume from pre-operative measures between the affected and unaffected arms: 4.8% (89.5 ml, p=0.22) in manual limb volume, 14.1 (p=0.04) in L-Dex score, 12% (37.5 ml, p=0.008) in MRI total segment volume, and 15% (19.8 ml, p=0.02) in MRI subcutaneous fat volume. Post-operative affected limb infections were associated with increased difference in MRI subcutaneous fat volume.
CONCLUSION: 3D MRI is a feasible way to quantify adipose deposition in lymphedema patients. To our knowledge, this is the first study demonstrating association between VLNT and adipose deposition reduction.


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