Abstract：
OBJECTIVE: Currently, the focus on limb lymphedema (LE) is on classification and staging. However, few scholars have conducted staging for Klippel-Trenaunay syndrome complicated LE (KTS-LE). This study aimed to investigate the value of the short time inversion recovery sequence of magnetic resonance imaging (MRI) in the staging of KTS-LE.
METHODS: Forty-six patients who were diagnosed with KTS-LE were recruited for this retrospective study from July 2011 to November 2022. Referring to the clinical staging standard of lower extremity LE of the International Society of Lymphology in 2020, all patients were divided into three groups: stages I, II, and III. The MRI indicators of the three groups were recorded and statistically compared: LE range (unilateral bilateral, lower limbs, only thighs, only calves and ankles), abnormal parts (skin thickening, abnormal subcutaneous fat signal, abnormal muscle signal, muscle hypertrophy or contraction, abnormal bone signal, hyperostosis), and subcutaneous soft tissue signs (parallel line sign, grid sign, band sign, honeycomb sign, lymph lake sign, crescent sign, and nebula sign).
RESULTS: There was a significant difference in the honeycomb sign among the three periods (P = .028). There was a significant difference between stage II and stage I disease (P < .05). There was a significant difference between stage II and stage III disease (P < .05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the honeycomb sign in diagnosing KTS-LE of stage II were 87.5%, 63.2%, 33.3%, 96.0%, and 67.4%, respectively. In contrast, the other signs were not statistically significant among the three periods.
CONCLUSIONS: The short time inversion recovery sequence of MRI is of great value in KTS-LE. The honeycomb sign is an important imaging indicator for the diagnosis of stage II disease. It is necessary to evaluate the severity of edema with MRI for KTS-LE, which is very important for therapeutic options.
METHODS: Forty-six patients who were diagnosed with KTS-LE were recruited for this retrospective study from July 2011 to November 2022. Referring to the clinical staging standard of lower extremity LE of the International Society of Lymphology in 2020, all patients were divided into three groups: stages I, II, and III. The MRI indicators of the three groups were recorded and statistically compared: LE range (unilateral bilateral, lower limbs, only thighs, only calves and ankles), abnormal parts (skin thickening, abnormal subcutaneous fat signal, abnormal muscle signal, muscle hypertrophy or contraction, abnormal bone signal, hyperostosis), and subcutaneous soft tissue signs (parallel line sign, grid sign, band sign, honeycomb sign, lymph lake sign, crescent sign, and nebula sign).
RESULTS: There was a significant difference in the honeycomb sign among the three periods (P = .028). There was a significant difference between stage II and stage I disease (P < .05). There was a significant difference between stage II and stage III disease (P < .05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the honeycomb sign in diagnosing KTS-LE of stage II were 87.5%, 63.2%, 33.3%, 96.0%, and 67.4%, respectively. In contrast, the other signs were not statistically significant among the three periods.
CONCLUSIONS: The short time inversion recovery sequence of MRI is of great value in KTS-LE. The honeycomb sign is an important imaging indicator for the diagnosis of stage II disease. It is necessary to evaluate the severity of edema with MRI for KTS-LE, which is very important for therapeutic options.
摘要：
目标：目前，国内外对肢体淋巴水肿的研究重点是分类和分期。然而,很少有学者对Klippel-Trenaunay综合征（KTS）并发淋巴水肿（LE）进行分期。本研究旨在探讨MRI的STIR序列在Klippel-Trenaunay综合征合并淋巴水肿（KTS-LE）分期中的价值。
方法：从2011年7月至2022年11月招募46名诊断为KTS-LE的患者进行这项回顾性研究。参照国际淋巴学会2020年下肢淋巴水肿临床分期标准,将所有患者分为三组:Ⅰ、第二阶段和第三阶段。记录三组患者的MRI指标,并进行统计学比较:淋巴水肿范围(单侧、双侧、下肢,只有大腿,只有小牛+脚踝)，异常部位（皮肤增厚，异常皮下脂肪信号，异常肌肉信号,肌肉肥大或收缩，骨信号异常,骨肥大)，和皮下软组织体征(平行线体征，网格标志,乐队标志,蜂巢标志,淋巴湖标志，新月星座和星云星座)。
结果：三个周期之间的蜂窝符号存在显着差异（p=0.028）。Ⅱ期与Ⅰ期比较差异有统计学意义(P<0.05),Ⅱ期与Ⅲ期比较差异有统计学意义(P<0.05)。敏感性,特异性，正预测值，负预测值，蜂窝标志诊断II期KTS-LE的准确率为87.5%,63.2%,33.3%,96.0%,和67.4%，分别。相比之下,其他体征在三个时期中没有统计学意义。
结论：MRI的STIR序列在KTS-LE中具有重要价值。蜂窝标志是诊断Ⅱ期的重要影像学指标。有必要用MRI评估KTS-LE的水肿严重程度，这对治疗选择非常重要。
方法：从2011年7月至2022年11月招募46名诊断为KTS-LE的患者进行这项回顾性研究。参照国际淋巴学会2020年下肢淋巴水肿临床分期标准,将所有患者分为三组:Ⅰ、第二阶段和第三阶段。记录三组患者的MRI指标,并进行统计学比较:淋巴水肿范围(单侧、双侧、下肢,只有大腿,只有小牛+脚踝)，异常部位（皮肤增厚，异常皮下脂肪信号，异常肌肉信号,肌肉肥大或收缩，骨信号异常,骨肥大)，和皮下软组织体征(平行线体征，网格标志,乐队标志,蜂巢标志,淋巴湖标志，新月星座和星云星座)。
结果：三个周期之间的蜂窝符号存在显着差异（p=0.028）。Ⅱ期与Ⅰ期比较差异有统计学意义(P<0.05),Ⅱ期与Ⅲ期比较差异有统计学意义(P<0.05)。敏感性,特异性，正预测值，负预测值，蜂窝标志诊断II期KTS-LE的准确率为87.5%,63.2%,33.3%,96.0%,和67.4%，分别。相比之下,其他体征在三个时期中没有统计学意义。
结论：MRI的STIR序列在KTS-LE中具有重要价值。蜂窝标志是诊断Ⅱ期的重要影像学指标。有必要用MRI评估KTS-LE的水肿严重程度，这对治疗选择非常重要。
