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Noncontrast Magnetic Resonance Lymphography for Evaluation of Lymph Node Transfer for Secondary Upper Limb Lymphedema

Arrivé, Lionel, M.D.; Derhy, Sarah, M.D.; Dlimi, Chrif, M.D.; El Mouhadi, Sanaa, M.D.; Monnier-Cholley, Laurence, M.D.; Becker, Corinne, M.D.

Plastic and Reconstructive Surgery: December 2017 - Volume 140 - Issue 6 - p 806e-811e
doi: 10.1097/PRS.0000000000003862
Reconstructive: Trunk: Ideas and Innovations
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Background: The authors’ purpose was to evaluate the results of axillary lymph node transplantation with noncontrast magnetic resonance lymphography in 15 patients with secondary upper limb lymphedema.

Methods: Fifteen female patients with lymphedema following breast cancer treatment underwent lymph node transplantation. Noncontrast magnetic resonance lymphography was obtained with a free-breathing three-dimensional fast spin-echo sequence. Image analysis included criteria both before surgery (i.e., severity of lymphedema graded as absent, mild, moderate, or severe; involvement of the muscular compartment; and distal dilated lymphatic vessels) and after surgery (i.e., visualization of the site of transplantation; visualization of transplanted lymph nodes; and severity of lymphedema with regard to pretransplantation severity, namely, improvement, stability, or aggravation). Clinically, circumferential measures were performed at four different levels.

Results: Follow-up magnetic resonance examinations were performed at least 6 months after lymph node transplantation, with a longest follow-up time of 42 months. In two patients, no lymphedema was visualized before lymph node transplantation with magnetic resonance lymphography. In the other 13 patients, lymphedema was mild in four patients, moderate in five patients, and severe in the other four patients. After lymph node transplantation, an improvement of upper limb lymphedema was observed in seven of nine patients with moderate or severe upper limb lymphedema. In the 11 patients in whom comparison of magnetic resonance lymphography with circumferential measurement was available, evaluations were concordant in 10 cases.

Conclusion: Noncontrast magnetic resonance lymphography may be used as an objective technique to analyze the results of lymph node transplantation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Paris, France

From the Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris; Sorbonne Universités, UPMC; and the Department of Thoracic Surgery, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris.

Received for publication March 15, 2017; accepted July 11, 2017.

Disclosure:The authors have no financial interest in any of the products or devices mentioned in this article.

Lionel Arrivé, M.D., Department of Radiology, Saint-Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France, lionel.arrive@aphp.fr

Copyright © 2017 by the American Society of Plastic Surgeons