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J Reconstr Microsurg 2024; 40(03): 177-185
DOI: 10.1055/a-2102-0261
Original Article

Association between Bioimpedance Spectroscopy and Magnetic Resonance Lymphangiography in the Diagnosis and Assessment of Lymphedema

Kaamya Varagur 
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Anup S. Shetty
2   Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
,
Karim Saoud
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Esther Ochoa
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Rachel Skladman
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Gary B. Skolnick
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Justin M. Sacks
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
,
Joani M. Christensen
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations Funding This study was supported by the Washington University School of Medicine Yearlong Research Scholars Grant from the DeNardo Education & Research Foundation.
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Abstract

Background This study assesses associations between bioimpedance spectroscopy (BIS) and magnetic resonance lymphangiography (MRL) in the staging and assessment of lymphedema.

Methods Adults who received MRL and BIS between 2020 and 2022 were included. We collected fluid, fat, and lymphedema severity ratings, and measured fluid stripe thickness, subcutaneous fat width, and lymphatic diameter on MRL. BIS lymphedema index (L-Dex) scores were collected from patient charts. We assessed sensitivity and specificity of L-Dex scores to detect MRL-identified lymphedema, and examined associations between L-Dex scores and MRL imaging measures.

Results Forty-eight limbs across 40 patients were included. L-Dex scores had 72.5% sensitivity and 87.5% specificity for detecting MRL-defined lymphedema, with a 96.7% estimated positive predictive value and 38.9% negative predictive value. L-Dex scores were associated with MRL fluid and fat content scores (p ≤ 0.05), and lymphedema severity (p = 0.01), with better discrimination between fluid than fat content levels on pairwise analysis, and poor discrimination between adjacent severity levels. L-Dex scores were correlated with distal and proximal limb fluid stripe thickness (distal: rho = 0.57, p < 0.01; proximal: rho = 0.58, p < 0.01), partially correlated with distal subcutaneous fat thickness when accounting for body mass index (rho = 0.34, p = 0.02), and were not correlated with lymphatic diameter (p = 0.25).

Conclusion L-Dex scores have high sensitivity, specificity, and positive predictive value for the identification of MRL-detected lymphedema. L-Dex has difficulty distinguishing between adjacent severity levels of lymphedema and a high false negative rate, explained in part by reduced discrimination between levels of fat accumulation.

Keywords

MR lymphangiography - bioimpedance spectroscopy - lymphedema - diagnostic imaging - lymphedema staging

Institutional Review Board Approval

This study was approved by the Washington University School of Medicine Institutional Review Board (IRB ID: 202209002).


Presentations

Presented at the Plastic Surgery Research Council (PSRC) Meeting, April 13–16, 2023, Cleveland, OH.


Financial Disclosure

K.V., K.S., R.S., E.O., A.S.S., and J.M.C. have nothing to disclose. J.M.S. is a co-founder and equity holder of LifeSprout, and a consultant for 3M. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. No funding was received for this article.




Publication History

Received: 04 March 2023

Accepted: 23 May 2023

Accepted Manuscript online:
26 May 2023

Article published online:
05 July 2023

© 2023. Thieme. All rights reserved.

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