High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema
Identifieur interne : 000252 ( PascalFrancis/Checkpoint ); précédent : 000251; suivant : 000253High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema
Auteurs : M. Naouri [France] ; M. Samimi [France] ; M. Atlan [France] ; E. Perrodeau [France] ; C. Vallin [France] ; G. Zakine [France] ; L. Vaillant [France] ; L. Machet [France]Source :
- British journal of dermatology : (1951) [ 0007-0963 ] ; 2010.
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- Pascal (Inist)
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Abstract
Background Lipoedema is an accumulation of fat abnormally distributed in the lower limbs, and lymphoedema is oedema caused by a deficiency of the lymphatic system. High-resolution ultrasound operating at 20 MHz makes it possible to characterize dermal oedema. Objectives The purpose of our study was to demonstrate that high-resolution ultrasound imaging of the skin can differentiate lipoedema from lymphoedema. Methods Sixteen patients with lymphoedema (22 legs), eight patients with lipoedema (16 legs) and eight controls (16 legs) were included. Patients with lipolymphoedema were excluded. Ultrasound examinations were carried out with a real-time high-resolution ultrasound device on three different sites for each lower limb. The images were then anonymized and examined by an independent dermatologist who was blind to the clinical diagnosis. A new series of images was examined by three dermatologists to check interobserver agreement. Results A significant difference in dermal thickness was observed between patients with lymphoedema and those with lipoedema and between patients with lymphoedema and controls. No significant difference in dermal thickness was shown between patients with lipoedema and controls at the thigh or ankle. Dermal hypoechogenicity was found in at least one of the three sites in 100% of patients with lymphoedema, 12.5% of cases with lipoedema and 6.25% of the controls. Hypoechogenicity affected the entire dermis in all cases of lymphoedema except one. In cases of lipoedema and controls, hypoechogenicity was localized at the ankle and prevailed in the upper dermis. The expert correctly diagnosed all lower limbs with lymphoedema. No cases of lipoedema were diagnosed as lymphoedema. Exact interobserver agreement was excellent (0.98). Conclusions High-resolution cutaneous ultrasonography makes it possible to differentiate lymphoedema from lipoedema. Obtaining a reliable diagnosis through high-resolution cutaneous ultrasonography might be valuable for improving the treatment of lipoedema and lymphoedema.
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Naouri</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Dermatology, Université François Rabelais, CHRU de Tours</s1><s2>37044 Tours</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Centre-Val de Loire</region><region type="old region" nuts="2">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Samimi, M" sort="Samimi, M" uniqKey="Samimi M" first="M." last="Samimi">M. Samimi</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Dermatology, Université François Rabelais, CHRU de Tours</s1><s2>37044 Tours</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region" nuts="2">Centre-Val de Loire</region><region type="old region" nuts="2">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Atlan, M" sort="Atlan, M" uniqKey="Atlan M" first="M." last="Atlan">M. Atlan</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Plastic Surgery, CHRU</s1><s2>Tours</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Perrodeau, E" sort="Perrodeau, E" uniqKey="Perrodeau E" first="E." last="Perrodeau">E. Perrodeau</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Inserm CIC 202</s1><s2>Tours</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Vallin, C" sort="Vallin, C" uniqKey="Vallin C" first="C." last="Vallin">C. Vallin</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Radiology, CHRU</s1><s2>Tours</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Zakine, G" sort="Zakine, G" uniqKey="Zakine G" first="G." last="Zakine">G. Zakine</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Department of Plastic Surgery, CHRU</s1><s2>Tours</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Vaillant, L" sort="Vaillant, L" uniqKey="Vaillant L" first="L." last="Vaillant">L. Vaillant</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Dermatology, Université François Rabelais, CHRU de Tours</s1><s2>37044 Tours</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>37044 Tours</wicri:noRegion><wicri:noRegion>CHRU de Tours</wicri:noRegion><wicri:noRegion>37044 Tours</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>UMR, Inserm U930, CNRS ERL 3106</s1><s2>Tours</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author><author><name sortKey="Machet, L" sort="Machet, L" uniqKey="Machet L" first="L." last="Machet">L. Machet</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Department of Dermatology, Université François Rabelais, CHRU de Tours</s1><s2>37044 Tours</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>37044 Tours</wicri:noRegion><wicri:noRegion>CHRU de Tours</wicri:noRegion><wicri:noRegion>37044 Tours</wicri:noRegion></affiliation><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>UMR, Inserm U930, CNRS ERL 3106</s1><s2>Tours</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>8 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Centre-Val de Loire</region><region type="old region">Région Centre</region><settlement type="city">Tours</settlement></placeName></affiliation></author></analytic><series><title level="j" type="main">British journal of dermatology : (1951)</title><title level="j" type="abbreviated">Br. j. dermatol. : (1951)</title><idno type="ISSN">0007-0963</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">British journal of dermatology : (1951)</title><title level="j" type="abbreviated">Br. j. dermatol. : (1951)</title><idno type="ISSN">0007-0963</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Dermatology</term><term>Diagnosis</term><term>Echography</term><term>High resolution</term><term>Lipoedema</term><term>Lymphedema</term><term>Skin</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Lipoedème</term><term>Lymphoedème</term><term>Echographie</term><term>Haute résolution</term><term>Peau</term><term>Diagnostic</term><term>Dermatologie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Lipoedema is an accumulation of fat abnormally distributed in the lower limbs, and lymphoedema is oedema caused by a deficiency of the lymphatic system. High-resolution ultrasound operating at 20 MHz makes it possible to characterize dermal oedema. Objectives The purpose of our study was to demonstrate that high-resolution ultrasound imaging of the skin can differentiate lipoedema from lymphoedema. Methods Sixteen patients with lymphoedema (22 legs), eight patients with lipoedema (16 legs) and eight controls (16 legs) were included. Patients with lipolymphoedema were excluded. Ultrasound examinations were carried out with a real-time high-resolution ultrasound device on three different sites for each lower limb. The images were then anonymized and examined by an independent dermatologist who was blind to the clinical diagnosis. A new series of images was examined by three dermatologists to check interobserver agreement. Results A significant difference in dermal thickness was observed between patients with lymphoedema and those with lipoedema and between patients with lymphoedema and controls. No significant difference in dermal thickness was shown between patients with lipoedema and controls at the thigh or ankle. Dermal hypoechogenicity was found in at least one of the three sites in 100% of patients with lymphoedema, 12.5% of cases with lipoedema and 6.25% of the controls. Hypoechogenicity affected the entire dermis in all cases of lymphoedema except one. In cases of lipoedema and controls, hypoechogenicity was localized at the ankle and prevailed in the upper dermis. The expert correctly diagnosed all lower limbs with lymphoedema. No cases of lipoedema were diagnosed as lymphoedema. Exact interobserver agreement was excellent (0.98). Conclusions High-resolution cutaneous ultrasonography makes it possible to differentiate lymphoedema from lipoedema. Obtaining a reliable diagnosis through high-resolution cutaneous ultrasonography might be valuable for improving the treatment of lipoedema and lymphoedema.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0007-0963</s0></fA01><fA02 i1="01"><s0>BJDEAZ</s0></fA02><fA03 i2="1"><s0>Br. j. dermatol. : (1951)</s0></fA03><fA05><s2>163</s2></fA05><fA06><s2>2</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema</s1></fA08><fA11 i1="01" i2="1"><s1>NAOURI (M.)</s1></fA11><fA11 i1="02" i2="1"><s1>SAMIMI (M.)</s1></fA11><fA11 i1="03" i2="1"><s1>ATLAN (M.)</s1></fA11><fA11 i1="04" i2="1"><s1>PERRODEAU (E.)</s1></fA11><fA11 i1="05" i2="1"><s1>VALLIN (C.)</s1></fA11><fA11 i1="06" i2="1"><s1>ZAKINE (G.)</s1></fA11><fA11 i1="07" i2="1"><s1>VAILLANT (L.)</s1></fA11><fA11 i1="08" i2="1"><s1>MACHET (L.)</s1></fA11><fA14 i1="01"><s1>Department of Dermatology, Université François Rabelais, CHRU de Tours</s1><s2>37044 Tours</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>2 aut.</sZ><sZ>7 aut.</sZ><sZ>8 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Plastic Surgery, CHRU</s1><s2>Tours</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>6 aut.</sZ></fA14><fA14 i1="03"><s1>Inserm CIC 202</s1><s2>Tours</s2><s3>FRA</s3><sZ>4 aut.</sZ></fA14><fA14 i1="04"><s1>Department of Radiology, CHRU</s1><s2>Tours</s2><s3>FRA</s3><sZ>5 aut.</sZ></fA14><fA14 i1="05"><s1>UMR, Inserm U930, CNRS ERL 3106</s1><s2>Tours</s2><s3>FRA</s3><sZ>7 aut.</sZ><sZ>8 aut.</sZ></fA14><fA20><s1>296-301</s1></fA20><fA21><s1>2010</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>1043</s2><s5>354000194135000080</s5></fA43><fA44><s0>0000</s0><s1>© 2010 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>27 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>10-0400217</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>British journal of dermatology : (1951)</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>Background Lipoedema is an accumulation of fat abnormally distributed in the lower limbs, and lymphoedema is oedema caused by a deficiency of the lymphatic system. High-resolution ultrasound operating at 20 MHz makes it possible to characterize dermal oedema. Objectives The purpose of our study was to demonstrate that high-resolution ultrasound imaging of the skin can differentiate lipoedema from lymphoedema. Methods Sixteen patients with lymphoedema (22 legs), eight patients with lipoedema (16 legs) and eight controls (16 legs) were included. Patients with lipolymphoedema were excluded. Ultrasound examinations were carried out with a real-time high-resolution ultrasound device on three different sites for each lower limb. The images were then anonymized and examined by an independent dermatologist who was blind to the clinical diagnosis. A new series of images was examined by three dermatologists to check interobserver agreement. Results A significant difference in dermal thickness was observed between patients with lymphoedema and those with lipoedema and between patients with lymphoedema and controls. No significant difference in dermal thickness was shown between patients with lipoedema and controls at the thigh or ankle. Dermal hypoechogenicity was found in at least one of the three sites in 100% of patients with lymphoedema, 12.5% of cases with lipoedema and 6.25% of the controls. Hypoechogenicity affected the entire dermis in all cases of lymphoedema except one. In cases of lipoedema and controls, hypoechogenicity was localized at the ankle and prevailed in the upper dermis. The expert correctly diagnosed all lower limbs with lymphoedema. No cases of lipoedema were diagnosed as lymphoedema. Exact interobserver agreement was excellent (0.98). Conclusions High-resolution cutaneous ultrasonography makes it possible to differentiate lymphoedema from lipoedema. Obtaining a reliable diagnosis through high-resolution cutaneous ultrasonography might be valuable for improving the treatment of lipoedema and lymphoedema.</s0></fC01><fC02 i1="01" i2="X"><s0>002B08J</s0></fC02><fC02 i1="02" i2="X"><s0>002B12B04</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Lipoedème</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Lipoedema</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Lipoedema</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Lymphoedème</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Lymphedema</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Linfedema</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Echographie</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Echography</s0><s5>04</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Ecografía</s0><s5>04</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Haute résolution</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>High resolution</s0><s5>07</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Alta resolucion</s0><s5>07</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Peau</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Skin</s0><s5>08</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Piel</s0><s5>08</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Diagnostic</s0><s5>09</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Diagnosis</s0><s5>09</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Diagnóstico</s0><s5>09</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Dermatologie</s0><s5>13</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Dermatology</s0><s5>13</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Dermatología</s0><s5>13</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Exploration ultrason</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Sonography</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Exploración ultrasonido</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Pathologie de la peau</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Skin disease</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Piel patología</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Pathologie du tissu adipeux</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Adipose tissue disorders</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Tejido adiposo patología</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Pathologie de l'appareil circulatoire</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Cardiovascular disease</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Aparato circulatorio patología</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Pathologie des vaisseaux lymphatiques</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Lymphatic vessel disease</s0><s5>41</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Linfático patología</s0><s5>41</s5></fC07><fN21><s1>256</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>France</li></country><region><li>Centre-Val de Loire</li><li>Région Centre</li></region><settlement><li>Tours</li></settlement></list><tree><country name="France"><region name="Centre-Val de Loire"><name sortKey="Naouri, M" sort="Naouri, M" uniqKey="Naouri M" first="M." last="Naouri">M. Naouri</name></region><name sortKey="Atlan, M" sort="Atlan, M" uniqKey="Atlan M" first="M." last="Atlan">M. Atlan</name><name sortKey="Machet, L" sort="Machet, L" uniqKey="Machet L" first="L." last="Machet">L. Machet</name><name sortKey="Machet, L" sort="Machet, L" uniqKey="Machet L" first="L." last="Machet">L. Machet</name><name sortKey="Perrodeau, E" sort="Perrodeau, E" uniqKey="Perrodeau E" first="E." last="Perrodeau">E. Perrodeau</name><name sortKey="Samimi, M" sort="Samimi, M" uniqKey="Samimi M" first="M." last="Samimi">M. Samimi</name><name sortKey="Vaillant, L" sort="Vaillant, L" uniqKey="Vaillant L" first="L." last="Vaillant">L. Vaillant</name><name sortKey="Vaillant, L" sort="Vaillant, L" uniqKey="Vaillant L" first="L." last="Vaillant">L. Vaillant</name><name sortKey="Vallin, C" sort="Vallin, C" uniqKey="Vallin C" first="C." last="Vallin">C. Vallin</name><name sortKey="Zakine, G" sort="Zakine, G" uniqKey="Zakine G" first="G." last="Zakine">G. 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