NON-CONTRAST MR LYMPHOGRAPHY OF RARE LYMPHATIC ABNORMALITIES

Detailed imaging of the lymphatic system often requires direct injection of contrast into lymph nodes which can be technically challenging, time consuming, and produce painful stimuli. We sought to describe the use of non-contrast MR lymphography (NCMRL) for normal controls and patients with a variety of rare disorders associated with lymphatic pathologies. Two control subjects and five affected patients (decompensated Fontan circulation, central conducting lymphatic abnormality, familial lymphedema and two with Gorham-Stout disease) were studied. NCMRL images were segmented in a semi-automated fashion and the major lymphatic channels and thoracic duct (TD) highlighted for identification. Adequate imaging was available for both controls and 4/5 affected patients; the youngest patient could not be imaged given patient motion. For the two controls, the TD was seen in the expected anatomic location. For the decompensated Fontan patient, there were numerous tortuous lymphatic channels, predominantly in the upper chest and neck. For the familial lymphedema patient, a TD was not identified; instead, peripheral lymphatic collaterals near the lateral chest walls. For the first Gorham-Stout patient, the TD was enlarged with large intrathoracic lymph collections. For the second Gorham-Stout patient, there were bilateral TD with lymph collections in vertebral bodies. Using NCMRL, we were able to image normal and abnormal lymphatic systems. An important learning point is the potential need for sedation for younger patients due to long image acquisition times and fine resolution of the structures of interest

EDITORIAL

MORBIDITY MANAGEMENT AND DISABILITY PREVENTION:AN AGENDA FOR DEVELOPING NATIONS INITIATED IN INDI

ISL NEWS

2020 ISL NEW

ISL NEWS

2020 ISL NEW

FOREARM AND BICEPS CIRCUMFERENTIAL VARIATIONS IN SKIN TISSUE DIELECTRIC CONSTANT AND FIRMNESS

Tissue dielectric constant (TDC) andskin firmness assessed via indentation force(FORCE) help quantify lymphedema and trackchanges. We sought to determine potentialdifferences in these parameters dependent onarm circumferential locations. Thus, TDC andFORCE were measured in 40 healthy womenat medial, anterior and lateral locations onforearm and biceps. In five other women withunilateral lymphedema (68.6±7.6 years), TDCwas measured at corresponding circumferentialforearm positions. Measurements were done intriplicate using compact noninvasive devices.Results for healthy women (23.8±2.7 years)showed forearm medial TDC values (26.7±2.2)were less than anterior (28.0±2.4) or lateral(28.0±2.5) positions (p0.001). Lymphedemapatients had elevated values but similar medialanterior-lateral patterns (33.7±8.0, 39.8±10.2and 42.9±10.0). Biceps medial TDC values(24.1±2.2) were also less than either anterior(27.0±2.1) or lateral (28.2±3.3). Contrastingly,medial FORCE values at forearm and bicepswere less than at anterior and lateral locations(p0.001) and increased in the order of medialanterior-lateral on forearm (p0.001). Thepresent findings provide reference values forboth TDC and FORCE of commonly measuredarm sites with specificity as to circumferentialvariations. This observed variation indicatesthe need for care in locating measurementpositions for tracking patients withlymphedema

A NEW ERA OF SEEKING KNOWLEDGE FOR #LYMPHEDEMA ON SOCIAL MEDIA: A DETAILED INSTAGRAM HASHTAG ANALYSIS

Instagram® is one of the most activesocial media platforms with over a billion usersworldwide. Since the importance of educationon lymphedema has been established due to thechronic nature of the disease, seeking knowledgeattracts much attention not only clinicallybut also on social platforms such as Instagram®. Our aim was to examine content byanalyzing posts tagged with hashtags on Instagram® related to lymphedema. Nine predefinedhashtags related to lymphedema were used tosearch posts uploaded to Instagram® via theApify tool. Retrieved public posts were classifiedand analyzed by four researchers for theircontent and post-type. We found that the vastmajority of sharing on Instagram® in thecontext of lymphedema and its related aspectshave relatively low scores for both relevancyand accuracy with a 77% irrelevancy rate. Thebest posts were those determined to be educational,which were found 57% relevant andcorrect. Medical professionals should considerthat disseminating true guidance and therapycarries importance for patients with lymphedemaand treatment success. The ability forpatients to reach knowledge via social mediamight also be an important aspect in relivingsuffering due to lymphedema. However, ourresults demonstrate that Instagram® might notbe a good platform for patients to discoverreliable information about lymphedema

SUBJECT INDEX

2020 SUBJECT INDE

IMAGING OF LYMPHATIC DYSPLASIA IN NOONAN SYNDROME: CASE STUDIES AND HISTORICAL ATLAS

To determine the historical use andutility of various lymphatic imagingmodalities in Noonan syndrome (NS) patients,we performed a comprehensive literaturereview by collecting the published medicalimaging of NS lymphatic dysplasias. Wecorrelated imaging findings with clinicalphenotypes and treatment. Our analysis oflymphatic imaging modalities provides analgorithmic approach to imaging and patientcare across the spectrum of NS developmentaldefects. A total of 54 NS cases have beenpublished since 1975. Using the observationsreported in 15 reviewed publications, anassociation was made between disruptions incentral lymphatic flow and poor clinicalpresentations/outcomes in NS patients