The value of sonographic microvascular imaging in the diagnosis of lipedema

Issue title: Selected articles from the 3rd Joint Meeting of The European Society for Clinical Hemorheology and Microcirculation (ESCHM) , The International Society for Clinical Hemorheology (ISCH) and The International Society of Biorheology (ISB), Regensburg, Germany, 28 – 30 September 2023

Guest editors: L. Prantl, A. Krueger-Genge and F. Jung

Article type: Research Article

Authors: Kempa, S.^{a; *} | Tessmann, V.^a | Prantl, L.^a | Schmid, S.^b | Müller, M.^b | Jung, E.-M.^c | Tews, H.C.^b

Affiliations: [a] Department for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany | [b] Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany | [c] Institute for Diagnostic Radiology and Interdisciplinary Ultrasound, University Hospital Regensburg, Regensburg, Germany

Correspondence: [*] Corresponding author: Dr. Med. Sally Kempa, Department for Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany. E-mail: Sally.Kempa@klinik.uni-regensburg.de.

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.

Keywords: Lipedema, diagnosis, ultrasound, ultra micro angiography, UMA

DOI: 10.3233/CH-238103

Journal: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 99-108, 2024