MR IMAGING, PROTON MR SPECTROSCOPY, ULTRASONOGRAPHIC, HISTOLOGIC FINDINGS IN PATIENTS WITH CHRONIC LYMPHEDEMA

Lymphedema is a progressive disease withmultiple alterations occurring in the dermis.We undertook this study using high-frequencyultrasonography (US), magnetic resonanceimaging, proton MR spectroscopy and histologyto examine structural changes occurring inthe subcutaneous tissue and precisely describethe nature of intralobular changes in chroniclymphedema. Four cutaneous and subcutaneoustissue biopsies from patients withchronic lymphedema during lymphonodaltransplantation were studied. We performedUS with a 13.5 MHz transducer, TSE T1 andTSE T2 magnetic resonance images with andwithout fat-suppression, MR Chemical ShiftImaging Spectroscopy and histologicalevaluation on these biopsies. We found thatnormal subcutaneous septa are seen as hyperechogeniclines in US and hyposignal lines inMRI and that hyperechogenic subcutis in UScan be due to interlobular and intralobularwater accumulation and/or to interlobularand intralobular fibrosis. Our study alsoconfirms the usefulness of MR spectroscopyto assess water or fat content of soft tissue.Thus, multiple imaging modalities may benecessary to precisely delineate the nature oftissue alterations in chronic lymphedema

IDENTIFICATION AND DESCRIPTION OF THE AXILLARY WEB SYNDROME (AWS) BY CLINICAL SIGNS, MRI AND US IMAGING

The Axillary Web Syndrome (AWS)follows surgery for breast neoplasia andconsists of one, or more frequently two orthree, cords of subcutaneous tissue. Cordsoriginate from the axilla, spread to the anteromedialsurface of the arm down to the elbowand then move into the antero-medial aspectof the forearm and sometimes into the root ofthe thumb. The purpose of this study was tocompare two techniques, ultrasound (US) andMagnetic Resonance Imaging (MRI) for theirsensitivity and accuracy in identifying AWScords and to provide insights to the origin ofthis pathology. US examinations wereperformed on fifteen patients using a highfrequency probe (17MHz). We first palpatedand marked the cord with location aided bymaximum abduction. To identify the cord withMRI (1.5 Tesla), a catheter filled with a geldetectable under MRI was placed on the skinat the site of the cord. We found that in someUS cases, the dynamic abduction maneuverwas essential to facilitate detection of thecord. This dynamic method on ultrasoundconfirmed the precise location of the cordeven if it was located deeper in the hypodermisfascia junction. US and MRI images revealedfeatures of the cords and surrounding tissues.Imaging the cords was difficult with either ofthe imaging modalities. However, US seemedto be more efficient than MRI and alloweddynamic evaluation. Overall analysis of ourstudy results supports a lymphatic origin ofthe AWS cord

IGF-I and IGFBPs in plasma of growing Landrace and large withe pigs.

peer reviewe