Lymphedematous Skin and Subcutis: In Vivo High Resolution Magnetic Resonance Imaging Evaluation

Abstract

Physico-chemical and morphologic parameters of skin layers and subcutaneous tissue in lymphedematous limb were studied in vivo using magnetic resonance imaging. High resolution images were obtained with a depth resolution of about 70 microm, using a specific surface gradient coil specially designed for skin imaging and connected to a standard whole-body imager at 1.5 T. Twenty-one patients with unilateral lower extremity lymphedema (11 primary and 10 secondary) were examined. Skin thickness, relaxation times, and relative proton density were calculated in lymphedematous limbs and in contralateral extremities. In diseased limbs, the average skin thickness (2.17 mm) was significantly larger (p = 1.5 x 10(-4)) than that of contralateral limb (1.14 mm). Major cutaneous alterations due to lymphedema took place in dermis. In lymphedematous dermis, the significant increase of relaxation time values could be due to a shift in the equilibrium of water inside this tissue in relation to the interactions between macromolecules and water molecules. In lymphedematous epidermis our results showed an increase in the number of free water protons. Information about water and fat distribution in lymphedema was also obtained using chemical shift weighted images. Our results demonstrated a water retention diffusely spread over the entire dermis, and an important fluid retention located in the interlobular spacing and beside the superficial fascia. Inside the subcutis, the mean thickness of the superficial fat lobules was increased more than that of the deep fat lobules. From all the various measurements we could not distinguish primary from secondary lymphedema.

Assessment of Near-Infrared Densitometry for in situ Determination of the Total Stratum Corneum Thickness on Pig Skin: Influence of Storage Time

“…A variety of techniques has been investigated for the noninvasive measurement of epidermal thickness emphasizing the high demand for a suitable method. However, techniques such as optical coherence tomography [15,16], NIR reflectance confocal microscopy, high-frequency ultrasound imaging [17,18], high-resolution magnetic resonance imaging [19] and pulsed terahertz radiation [20] do not achieve a sufficient resolution to measure the SC thickness other than at the heel or palm. A higher resolution is achieved with confocal microscopy methods.…”

T2 relaxation mapping MRI of healthy and inflamed gingival tissue

“…23 The T 2 values determined here, on the order of 64 ms in the healthy gum, are longer than those found in normal (36 ± 4 ms) or oedematous (40 ± 8 ms) skin dermis. 21 Lymphoedema was found to significantly increase the T 2 value found in the dermis, but to a smaller extent in the epidermis. Gingivitis is characterized by gingival bleeding and signs of gingival inflammation.…”

Evaluation of Skin Tumors by Magnetic Resonance Imaging

“…Because the thickness of the skin is small, MRI of the skin demands high resolution and high sensitivity. Recent developments in surface coil technology and high field scanners have made MRI useful to study superficial skin structures at high resolution (Idy-Peretti et al, 1998;Richard et al, 1991). Bond et al (1991) analyzed choroidal melanoma by MRI technique at various stages like pre-and postoperation.…”

“…The in vivo MRI in medical diagnosis has been reported to differentially evaluate malignant melanoma tumors (Maurer et al, 2000) and subcutaneous and pigmented skin of nodular and superficial spreading melanoma (Schwinghofer et al, 1989). Idy-Peretti et al (1998) have reported application of MRI for evaluating lymphodema in skin layers and subcutaneous tissue. An attempt has been made to evaluate unusual or aggressive tumors (eg, verrucous and sebaceous carcinoma) using MRI (Zemtsov et al, 1992a).…”