Volume 57, Issue 2 pp. 598-608

Research Article

Subcutaneous Adipose Tissue Edema in Lipedema Revealed by Noninvasive 3T MR Lymphangiography

Rachelle Crescenzi PhD,

Corresponding Author

Rachelle Crescenzi PhD

[email protected]

orcid.org/0000-0003-1008-4570

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Address reprint requests to: R.C., Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Avenue South, Medical Center North AA-1105B, Nashville, Tennessee 37232, USA. E-mail: [email protected]

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Paula M. C. Donahue DPT, CLT-LANA,

Paula M. C. Donahue DPT, CLT-LANA

Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Maria Garza BA,

Maria Garza BA

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Niral J. Patel MPH,

Niral J. Patel MPH

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Chelsea Lee BS,

Chelsea Lee BS

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Kelsey Guerreso MD,

Kelsey Guerreso MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Greg Hall MD,

Greg Hall MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Yu Luo MD,

Yu Luo MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Sheau-Chiann Chen PhD,

Sheau-Chiann Chen PhD

Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Karen L. Herbst MD, PhD,

Karen L. Herbst MD, PhD

Total Lipedema Care, Beverly Hills, California, 90211 USA

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Michael Pridmore PhD,

Michael Pridmore PhD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Aaron W. Aday MD, MSc,

Aaron W. Aday MD, MSc

Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Joshua A. Beckman MD,

Joshua A. Beckman MD

Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Manus J. Donahue PhD,

Manus J. Donahue PhD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Rachelle Crescenzi PhD,

Corresponding Author

Rachelle Crescenzi PhD

[email protected]

orcid.org/0000-0003-1008-4570

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Paula M. C. Donahue DPT, CLT-LANA,

Paula M. C. Donahue DPT, CLT-LANA

Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Search for more papers by this author

Maria Garza BA,

Maria Garza BA

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Search for more papers by this author

Niral J. Patel MPH,

Niral J. Patel MPH

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Search for more papers by this author

Chelsea Lee BS,

Chelsea Lee BS

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Search for more papers by this author

Kelsey Guerreso MD,

Kelsey Guerreso MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Search for more papers by this author

Greg Hall MD,

Greg Hall MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Yu Luo MD,

Yu Luo MD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Sheau-Chiann Chen PhD,

Sheau-Chiann Chen PhD

Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Karen L. Herbst MD, PhD,

Karen L. Herbst MD, PhD

Total Lipedema Care, Beverly Hills, California, 90211 USA

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Michael Pridmore PhD,

Michael Pridmore PhD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Aaron W. Aday MD, MSc,

Aaron W. Aday MD, MSc

Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Joshua A. Beckman MD,

Joshua A. Beckman MD

Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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Manus J. Donahue PhD,

Manus J. Donahue PhD

Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA

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First published: 03 June 2022

https://doi.org/10.1002/jmri.28281

Citations: 5

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Abstract

Background

Lipedema exhibits excessive lower-extremity subcutaneous adipose tissue (SAT) deposition, which is frequently misidentified as obesity until lymphedema presents. MR lymphangiography may have relevance to distinguish lipedema from obesity or lymphedema.

Hypothesis

Hyperintensity profiles on 3T MR lymphangiography can identify distinct features consistent with SAT edema in participants with lipedema.

Study Type

Prospective cross-sectional study.

Subjects

Participants (48 females, matched for age [mean = 44.8 years]) with lipedema (n = 14), lipedema with lymphedema (LWL, n = 12), cancer treatment-related lymphedema (lymphedema, n = 8), and controls without these conditions (n = 14).

Field Strength/Sequence

3T MR lymphangiography (nontracer 3D turbo-spin-echo).

Assessment

Review of lymphangiograms in lower extremities by three radiologists was performed independently. Spatial patterns of hyperintense signal within the SAT were scored for extravascular (focal, diffuse, or not apparent) and vascular (linear, dilated, or not apparent) image features.

Statistical Tests

Interreader reliability was computed using Fleiss Kappa. Fisher's exact test was used to evaluate the proportion of image features between study groups. Multinomial logistic regression was used to assess the relationship between image features and study groups. The odds ratio (OR) and 95% confidence interval (CI) of SAT extravascular and vascular features was reported in groups compared to lipedema. The threshold of statistical significance was P < 0.05.

Results

Reliable agreement was demonstrated between three independent, blinded reviewers (P < 0.001). The frequency of SAT hyperintensities in participants with lipedema (36% focal, 36% diffuse), LWL (42% focal, 33% diffuse), lymphedema (62% focal, 38% diffuse), and controls (43% focal, 0% diffuse) was significantly distinct. Compared with lipedema, SAT hyperintensities were less frequent in controls (focal: OR = 0.63, CI = 0.11–3.41; diffuse: OR = 0.05, CI = 0.00–1.27), similar in LWL (focal: OR = 1.29, CI = 0.19–8.89; diffuse: OR = 1.05, CI = 0.15–7.61), and more frequent in lymphedema (focal: OR = 9.00, CI = 0.30–274.12; diffuse: OR = 5.73, CI = 0.18–186.84).

Data Conclusion

Noninvasive MR lymphangiography identifies distinct signal patterns indicating SAT edema and lymphatic load in participants with lipedema.

Evidence Level

Technical Efficacy

Stage 1

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Citing Literature

Volume57, Issue2

February 2023

Pages 598-608

Subcutaneous Adipose Tissue Edema in Lipedema Revealed by Noninvasive 3T MR Lymphangiography

Abstract

Background

Hypothesis

Study Type

Subjects

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Evidence Level

Technical Efficacy

References

Citing Literature

References

Information

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Subcutaneous Adipose Tissue Edema in Lipedema Revealed by Noninvasive 3T MR Lymphangiography

Abstract

Background

Hypothesis

Study Type

Subjects

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Evidence Level

Technical Efficacy

References

Citing Literature

References

Related

Information