Breast cancer-related lymphedema: differentiating fat from fluid using magnetic resonance imaging segmentation

Yuka Sen, Yi Quan, Louise Koelmeyer, Robert Borotkanics, Robyn Ricketts, Helen Mackie, Thomas C. Lam, Kevin Ho Shon, Hiroo Suami, John Boyages

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Lymphedema is an iatrogenic complication after breast cancer treatment in which lymph fluid in the affected limb progresses to fat deposition and fibrosis that are amenable to liposuction treatment. Magnetic resonance imaging (MRI) for lymphedema can differentiate fat tissue from fluid, but estimating relative volumes remains problematic.

Methods and results: Patients underwent routine bilateral arm MRI both before and after liposuction for advanced lymphedema. The threshold-based level set (TLS) segmentation method was applied to segment the geometric image data and to measure volumes of soft tissue (fat, muscle, and lymph fluid) and bone. Bioimpedance testing (L-Dex®) to detect extracellular fluid was also used. Volumes derived by using TLS or girth measurement were evaluated and showed consistent agreement, whereas L-Dex showed no significant reduction between pre- and postoperative measures. The percentage median volume difference between the affected and unaffected sides was 132.4% for girth measures compared with 137.2% for TLS (p = 0.175) preoperatively, and 99.8% and 98.5%, respectively (p = 0.600), postoperatively. MRI segmentation detected reductions in fat (median 52.6%, p = 0.0163) and lymph fluid (median 66%, p = 0.094), but the volumes of muscle and bone were relatively constant.

Conclusions: MRI imaging with TLS technology may be a useful tool to quantitatively measure fat tissue and fluid for patients with advanced lymphedema and may assist in the selection of eligible liposuction candidates at initial assessment and follow-up of patients who proceed with surgery.
LanguageEnglish
Pages20-27
Number of pages8
JournalLymphatic Research and Biology
Volume16
Issue number1
Early online date27 Mar 2017
DOIs
Publication statusPublished - Feb 2018

Fingerprint

Lymphedema
Lipectomy
Fats
Magnetic Resonance Imaging
Lymph
Bone and Bones
Muscles
Extracellular Fluid
Arm
Fibrosis
Extremities
Breast Cancer Lymphedema
Breast Neoplasms
Technology
Therapeutics

Keywords

  • liposuction
  • lymphedema
  • MRI

Cite this

@article{9fdac1307afe43408bdcc1f089ee0b38,
title = "Breast cancer-related lymphedema: differentiating fat from fluid using magnetic resonance imaging segmentation",
abstract = "Background: Lymphedema is an iatrogenic complication after breast cancer treatment in which lymph fluid in the affected limb progresses to fat deposition and fibrosis that are amenable to liposuction treatment. Magnetic resonance imaging (MRI) for lymphedema can differentiate fat tissue from fluid, but estimating relative volumes remains problematic.Methods and results: Patients underwent routine bilateral arm MRI both before and after liposuction for advanced lymphedema. The threshold-based level set (TLS) segmentation method was applied to segment the geometric image data and to measure volumes of soft tissue (fat, muscle, and lymph fluid) and bone. Bioimpedance testing (L-Dex{\circledR}) to detect extracellular fluid was also used. Volumes derived by using TLS or girth measurement were evaluated and showed consistent agreement, whereas L-Dex showed no significant reduction between pre- and postoperative measures. The percentage median volume difference between the affected and unaffected sides was 132.4{\%} for girth measures compared with 137.2{\%} for TLS (p = 0.175) preoperatively, and 99.8{\%} and 98.5{\%}, respectively (p = 0.600), postoperatively. MRI segmentation detected reductions in fat (median 52.6{\%}, p = 0.0163) and lymph fluid (median 66{\%}, p = 0.094), but the volumes of muscle and bone were relatively constant.Conclusions: MRI imaging with TLS technology may be a useful tool to quantitatively measure fat tissue and fluid for patients with advanced lymphedema and may assist in the selection of eligible liposuction candidates at initial assessment and follow-up of patients who proceed with surgery.",
keywords = "liposuction, lymphedema, MRI",
author = "Yuka Sen and Yi Quan and Louise Koelmeyer and Robert Borotkanics and Robyn Ricketts and Helen Mackie and Lam, {Thomas C.} and {Ho Shon}, Kevin and Hiroo Suami and John Boyages",
year = "2018",
month = "2",
doi = "10.1089/lrb.2016.0047",
language = "English",
volume = "16",
pages = "20--27",
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issn = "1539-6851",
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Breast cancer-related lymphedema : differentiating fat from fluid using magnetic resonance imaging segmentation. / Sen, Yuka; Quan, Yi; Koelmeyer, Louise; Borotkanics, Robert; Ricketts, Robyn; Mackie, Helen; Lam, Thomas C.; Ho Shon, Kevin; Suami, Hiroo; Boyages, John.

In: Lymphatic Research and Biology, Vol. 16, No. 1, 02.2018, p. 20-27.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Breast cancer-related lymphedema

T2 - Lymphatic Research and Biology

AU - Sen, Yuka

AU - Quan, Yi

AU - Koelmeyer, Louise

AU - Borotkanics, Robert

AU - Ricketts, Robyn

AU - Mackie, Helen

AU - Lam, Thomas C.

AU - Ho Shon, Kevin

AU - Suami, Hiroo

AU - Boyages, John

PY - 2018/2

Y1 - 2018/2

N2 - Background: Lymphedema is an iatrogenic complication after breast cancer treatment in which lymph fluid in the affected limb progresses to fat deposition and fibrosis that are amenable to liposuction treatment. Magnetic resonance imaging (MRI) for lymphedema can differentiate fat tissue from fluid, but estimating relative volumes remains problematic.Methods and results: Patients underwent routine bilateral arm MRI both before and after liposuction for advanced lymphedema. The threshold-based level set (TLS) segmentation method was applied to segment the geometric image data and to measure volumes of soft tissue (fat, muscle, and lymph fluid) and bone. Bioimpedance testing (L-Dex®) to detect extracellular fluid was also used. Volumes derived by using TLS or girth measurement were evaluated and showed consistent agreement, whereas L-Dex showed no significant reduction between pre- and postoperative measures. The percentage median volume difference between the affected and unaffected sides was 132.4% for girth measures compared with 137.2% for TLS (p = 0.175) preoperatively, and 99.8% and 98.5%, respectively (p = 0.600), postoperatively. MRI segmentation detected reductions in fat (median 52.6%, p = 0.0163) and lymph fluid (median 66%, p = 0.094), but the volumes of muscle and bone were relatively constant.Conclusions: MRI imaging with TLS technology may be a useful tool to quantitatively measure fat tissue and fluid for patients with advanced lymphedema and may assist in the selection of eligible liposuction candidates at initial assessment and follow-up of patients who proceed with surgery.

AB - Background: Lymphedema is an iatrogenic complication after breast cancer treatment in which lymph fluid in the affected limb progresses to fat deposition and fibrosis that are amenable to liposuction treatment. Magnetic resonance imaging (MRI) for lymphedema can differentiate fat tissue from fluid, but estimating relative volumes remains problematic.Methods and results: Patients underwent routine bilateral arm MRI both before and after liposuction for advanced lymphedema. The threshold-based level set (TLS) segmentation method was applied to segment the geometric image data and to measure volumes of soft tissue (fat, muscle, and lymph fluid) and bone. Bioimpedance testing (L-Dex®) to detect extracellular fluid was also used. Volumes derived by using TLS or girth measurement were evaluated and showed consistent agreement, whereas L-Dex showed no significant reduction between pre- and postoperative measures. The percentage median volume difference between the affected and unaffected sides was 132.4% for girth measures compared with 137.2% for TLS (p = 0.175) preoperatively, and 99.8% and 98.5%, respectively (p = 0.600), postoperatively. MRI segmentation detected reductions in fat (median 52.6%, p = 0.0163) and lymph fluid (median 66%, p = 0.094), but the volumes of muscle and bone were relatively constant.Conclusions: MRI imaging with TLS technology may be a useful tool to quantitatively measure fat tissue and fluid for patients with advanced lymphedema and may assist in the selection of eligible liposuction candidates at initial assessment and follow-up of patients who proceed with surgery.

KW - liposuction

KW - lymphedema

KW - MRI

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U2 - 10.1089/lrb.2016.0047

DO - 10.1089/lrb.2016.0047

M3 - Article

VL - 16

SP - 20

EP - 27

JO - Lymphatic Research and Biology

JF - Lymphatic Research and Biology

SN - 1539-6851

IS - 1

ER -