Comparison of a novel algorithm quantitatively estimating epifascial fibrosis in three-dimensional computed tomography images to other clinical lymphedema grading methods
No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mea...
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| description | No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients. |
| doi_str_mv | 10.1371/journal.pone.0224457 |
| format | Article |
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This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0224457</identifier><identifier>PMID: 31821335</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Absorptivity ; Algorithms ; Balances (scales) ; Bioelectricity ; Biology ; Biology and Life Sciences ; Biomedical engineering ; Breast cancer ; Cancer surgery ; CAT scans ; Cohort Studies ; Comparative analysis ; Computed tomography ; Cross-Sectional Studies ; Diagnostic imaging ; Drug dosages ; Edema ; Electric Impedance ; Electrical engineering ; Electrical impedance ; Evaluation ; Feasibility Studies ; Female ; Fibrosis ; Fibrosis - diagnosis ; Fibrosis - diagnostic imaging ; Fibrosis - etiology ; Hospitals ; Humans ; Imaging, Three-Dimensional - methods ; Impedance ; Lymphedema ; Lymphedema - complications ; Lymphoscintigraphy - methods ; Male ; Medical imaging ; Medical research ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Patient monitoring equipment ; Patients ; Physiology ; Professional associations ; Rehabilitation ; Research and Analysis Methods ; Skin ; Surgical outcomes ; Swelling ; Tomography ; Tomography, X-Ray Computed - methods ; Tumor necrosis factor-TNF</subject><ispartof>PloS one, 2019-12, Vol.14 (12), p.e0224457-e0224457</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Koo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Koo et al 2019 Koo et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-7fe18c7632291b772d2cd596977656826669ef9c6241ff7671fd32c7fb6848dc3</citedby><cites>FETCH-LOGICAL-c692t-7fe18c7632291b772d2cd596977656826669ef9c6241ff7671fd32c7fb6848dc3</cites><orcidid>0000-0003-0444-3602</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903723/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6903723/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31821335$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koo, Kyo-In</creatorcontrib><creatorcontrib>Ko, Myoung-Hwan</creatorcontrib><creatorcontrib>Lee, Yongkwan</creatorcontrib><creatorcontrib>Son, Hye Won</creatorcontrib><creatorcontrib>Lee, Suwon</creatorcontrib><creatorcontrib>Hwang, Chang Ho</creatorcontrib><title>Comparison of a novel algorithm quantitatively estimating epifascial fibrosis in three-dimensional computed tomography images to other clinical lymphedema grading methods</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients.]]></description><subject>Absorptivity</subject><subject>Algorithms</subject><subject>Balances (scales)</subject><subject>Bioelectricity</subject><subject>Biology</subject><subject>Biology and Life Sciences</subject><subject>Biomedical engineering</subject><subject>Breast cancer</subject><subject>Cancer surgery</subject><subject>CAT scans</subject><subject>Cohort Studies</subject><subject>Comparative analysis</subject><subject>Computed tomography</subject><subject>Cross-Sectional Studies</subject><subject>Diagnostic imaging</subject><subject>Drug dosages</subject><subject>Edema</subject><subject>Electric Impedance</subject><subject>Electrical engineering</subject><subject>Electrical impedance</subject><subject>Evaluation</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Fibrosis - 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One</addtitle><date>2019-12-10</date><risdate>2019</risdate><volume>14</volume><issue>12</issue><spage>e0224457</spage><epage>e0224457</epage><pages>e0224457-e0224457</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[No method has yet been approved for detecting lymphedema fibrosis before its progression. This study assessed the feasibility of computed tomography-based estimation of fibrosis. This observational, cross-sectional study included patients with lymphedema affecting one limb. Three types (maximum, mean, minimum) of computed tomography reticulation indexes were digitally calculated from trans-axial images using absorptive values, and the computed tomography reticulation indexes compared with clinical scales and measurements. Of 326 patients evaluated by at least one of lymphoscintigraphy, bio-electrical impedance, and computed tomography, 24 were evaluated by all three. The mean number of computed tomography scans in these patients was 109. Sixteen patients had breast cancer, seven had gynecologic cancers, and one had primary lymphedema. Mean computed tomography reticulation index (r = 0.52, p < 0.01) and maximal computed tomography reticulation index (r = 0.45, p < 0.05) were significantly associated with time from initial limb swelling to computed tomography. Mean computed tomography reticulation index (r = 0.86, p < 0.01), minimal computed tomography reticulation index (r = 0.79, p < 0.01), and maximal computed tomography reticulation index (r = 0.68, p < 0.01) were significantly associated with International Society of Lymphedema substage. Minimal computed tomography reticulation index correlated with 1-kHz-based bio-electrical impedance ratio (r = -0.46, p < 0.05) and with standardized proximal limb circumference difference ratio (r = 0.45, p < 0.05) of both limbs. Maximal computed tomography reticulation index had a sensitivity of 0.78, specificity of 0.60, and areas under the curve of 0.66 in detecting lymphoscintigraphic stage IV. The algorithm utilizing three-dimensional computed tomography images of epifascial fibrosis may be used as a marker for lymphedema duration, limb swelling, International Society of Lymphedema substage, and interstitial lymphatic fluids of lymphedema. The current approach shows promise in providing an additional method to assist in characterizing and monitoring lymphedema patients.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31821335</pmid><doi>10.1371/journal.pone.0224457</doi><tpages>e0224457</tpages><orcidid>https://orcid.org/0000-0003-0444-3602</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-12, Vol.14 (12), p.e0224457-e0224457 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2323437151 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Absorptivity Algorithms Balances (scales) Bioelectricity Biology Biology and Life Sciences Biomedical engineering Breast cancer Cancer surgery CAT scans Cohort Studies Comparative analysis Computed tomography Cross-Sectional Studies Diagnostic imaging Drug dosages Edema Electric Impedance Electrical engineering Electrical impedance Evaluation Feasibility Studies Female Fibrosis Fibrosis - diagnosis Fibrosis - diagnostic imaging Fibrosis - etiology Hospitals Humans Imaging, Three-Dimensional - methods Impedance Lymphedema Lymphedema - complications Lymphoscintigraphy - methods Male Medical imaging Medical research Medicine Medicine and Health Sciences Methods Middle Aged Patient monitoring equipment Patients Physiology Professional associations Rehabilitation Research and Analysis Methods Skin Surgical outcomes Swelling Tomography Tomography, X-Ray Computed - methods Tumor necrosis factor-TNF |
| title | Comparison of a novel algorithm quantitatively estimating epifascial fibrosis in three-dimensional computed tomography images to other clinical lymphedema grading methods |
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