Measurement of Elasticity of Epifascial Tissues in Arm Lymphoedema Using Acoustic Radiation Force Impulse Quantification (ARFI-Q): our experience

Aims and objectives: Chronic lymphoedema is associated with fibrosclerosis, lipid cell proliferation, angiogenesis as well as increase of tissue thickness and hardness. Here we quantitively assessed epifascial tissue elasticity in arm lymphoedema patients using the Acoustic Radiation Force Impulse Quantification (ARFI-Q) approach. Materials and methods: Thickness and elasticity of the epifascial tissues of both forearms (healthy and lymphoedematous) were measured, with and without tissue compression, using a Siemens Acuson 2000 - Virtual Touch ultrasound equipment. Differences in ARFI-Q values among epifascial tissue layers (superficial, intermediate and deep) of both forearms were assessed. Quantitative variables were evaluated using Spearman coefficient. ARFI values were evaluated using Kruskal Wallis non parametric test. Results: 41 patients (38 females, 3 males; age 63.3±11 years; weight 72.8±11 kg, height 162.5±7.8cm and BMI 27.6±4.8 kg/m2 with unilateral breast cancer related lymphoedema were enrolled into this study. The median elastographic values, in m/sec, without compression at the lymphoedematous limb were: superficial layer 1.70 m/s (0.78-2.82); intermediate layer 1.14 m/s (0.71-3.66) and deep layer 2.10 m/s (0.71-4.29). With tissue compression, values were 3.23 m/s (0.98-4.92), 3.16 m/s (1.29-7.92) and 3.65 m/s (1.72-5.70), respectively. In the lymphoedematous limb we found significant differences between intermediate and deep layers with no compression (p = 0.005), and between superficial and intermediate layers (p = 0.004) as well as intermediate and deep layers (p < 0.001) with compression. Conclusions: ARFI Quantification could demonstrate different stiffness values for the three layers in lymphoedematous limbs. The reduced elasticity of deep epifascial tissues could be an expression of fibrotic degeneration. Moreover, elastic compression, normally used as a treatment, could prevent or reduce fibrosis of the more superficial layers.