The value of sonographic microvascular imaging in the diagnosis of lipedema.

IF 2.1 4区医学 Q3 HEMATOLOGY Clinical hemorheology and microcirculation Pub Date : 2024-01-01 DOI:10.3233/CH-238103

S Kempa, V Tessmann, L Prantl, S Schmid, M Müller, E-M Jung, H C Tews

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Abstract

Background: Lipedema is a chronic disease marked by symmetric enlargement of painful nodular and fibrotic adipose tissue, predominantly affecting the limbs. Since there is no specific test or biomarker for this condition, years often pass before the diagnosis of lipedema is established for the first time, thereby causing psychosocial distress, including depression, eating disorders, and social isolation. Over the last few years several advanced Doppler-based technologies have been developed to visualize slow flow blood vessels and superficial microvascular architecture undetectable by traditional color Doppler flow imaging (CDFI).

Objective: The aim of this study was to evaluate the superficial microvascular anatomy in lipedema patients compared to healthy controls and investigate the clinical significance of the Ultra Micro Angiography (UMA) technology in the diagnosis of lipedema. This new technique may contribute to reduce the diagnostic delay and, eventually, establish and guide treatment strategies toward a better therapeutic outcome in lipedema patients.

Methods: 25 patients with lipedema and ten healthy controls with no history of lipedema were included in this study. All ultrasound examinations were performed on a novel high-performance ultrasound system (Resona R9/Mindray) using CDFI and the UMA technique.

Results: In all of the patients, Ultra Micro Angiography achieved the excellent visualization of microvascular structures, revealing that most lipedema patients showed grade 3 (n = 13) or grade 2 (n = 8) flow. UMA was superior to CDFI for depicting the microvascular structures.

Conclusions: Here we show that UMA imaging characterizes the subcutaneous microvasculature with an unprecedented accuracy. The method has the advantage of being sensitive to small, slow-flowing vessels. This allows for the assessment of the course of vessels and vascular pathologies in great detail. Thus, UMA as a non-invasive diagnostic method can improve diagnostic accuracy in lipedema.

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超声微血管成像在脂肪性水肿诊断中的价值。

背景：脂肪性水肿是一种慢性疾病，主要表现为四肢对称性肿大的疼痛性结节和纤维化脂肪组织。由于这种疾病没有特异性的检测方法或生物标志物，因此往往要经过数年才能首次确诊为脂肪性水肿，从而造成心理社会方面的困扰，包括抑郁、饮食失调和社会隔离。过去几年中，已开发出几种先进的多普勒技术，可观察到传统彩色多普勒血流成像（CDFI）无法检测到的慢流血管和浅表微血管结构：本研究旨在评估脂肪性水肿患者与健康对照组相比的浅表微血管解剖结构，并探讨超微血管造影（UMA）技术在脂肪性水肿诊断中的临床意义。这项新技术可能有助于减少诊断延误，并最终建立和指导治疗策略，使脂肪性水肿患者获得更好的治疗效果。方法：本研究纳入了 25 名脂肪性水肿患者和 10 名无脂肪性水肿病史的健康对照组。所有超声检查均在新型高性能超声系统（Resona R9/Mindray）上使用 CDFI 和 UMA 技术进行：结果：在所有患者中，超显微血管造影术都能很好地观察到微血管结构，显示大多数脂肪性水肿患者的血流为3级（13人）或2级（8人）。在描绘微血管结构方面，UMA优于CDFI：结论：我们在此表明，UMA 成像能以前所未有的准确性描述皮下微血管。该方法的优点是对细小、流动缓慢的血管敏感。这样就可以非常详细地评估血管的走向和血管病变。因此，作为一种无创诊断方法，UMA 可以提高脂肪性水肿的诊断准确性。

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来源期刊

Clinical hemorheology and microcirculation 医学-外周血管病

CiteScore

4.30

自引率

33.30%

发文量

170

期刊介绍： Clinical Hemorheology and Microcirculation, a peer-reviewed international scientific journal, serves as an aid to understanding the flow properties of blood and the relationship to normal and abnormal physiology. The rapidly expanding science of hemorheology concerns blood, its components and the blood vessels with which blood interacts. It includes perihemorheology, i.e., the rheology of fluid and structures in the perivascular and interstitial spaces as well as the lymphatic system. The clinical aspects include pathogenesis, symptomatology and diagnostic methods, and the fields of prophylaxis and therapy in all branches of medicine and surgery, pharmacology and drug research. The endeavour of the Editors-in-Chief and publishers of Clinical Hemorheology and Microcirculation is to bring together contributions from those working in various fields related to blood flow all over the world. The editors of Clinical Hemorheology and Microcirculation are from those countries in Europe, Asia, Australia and America where appreciable work in clinical hemorheology and microcirculation is being carried out. Each editor takes responsibility to decide on the acceptance of a manuscript. He is required to have the manuscript appraised by two referees and may be one of them himself. The executive editorial office, to which the manuscripts have been submitted, is responsible for rapid handling of the reviewing process. Clinical Hemorheology and Microcirculation accepts original papers, brief communications, mini-reports and letters to the Editors-in-Chief. Review articles, providing general views and new insights into related subjects, are regularly invited by the Editors-in-Chief. Proceedings of international and national conferences on clinical hemorheology (in original form or as abstracts) complete the range of editorial features.