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Computed Tomography as an Objective Measurement Tool for Secondary Lymphedema Treated With Extracorporeal Shock Wave Therapy.

Kim SY, Bae H, Ji HM - Ann Rehabil Med (2015)

Bottom Line: We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities.There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT.CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema. Therefore, CT may have good clinical potential for treatment and follow-up in the management of lymphedema.

No MeSH data available.


Related in: MedlinePlus

Comparison of computed tomography of the upper extremity. Before (A) and after (B) treatment in the case 1 patient. Before (C) and after (D) treatment of the case 2 patient.
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Figure 1: Comparison of computed tomography of the upper extremity. Before (A) and after (B) treatment in the case 1 patient. Before (C) and after (D) treatment of the case 2 patient.

Mentions: A CT scan of the upper extremities was performed using SOMATOM Sensation 16 (Siemens, Forchheim, Germany) in order to determine the location and volume of lymphedema and to establish a treatment plan. The patient underwent a CT scan with a slice thickness of 10 mm from the aortic arch to the tip of the fingers in the supine position with the shoulder at 180° flexion, elbow extended, forearm pronated, and fingers extended. According to the results of the CT scan, the right medial forearm showed the most severe honeycomb pattern. When the right and left sides were compared, it was found that the thickness of the skin and subcutaneous fat had increased on the right side (Fig. 1A). The patient had severe skin hardening and underwent ESWT around the right forearm, and bandage therapy was continued. The ESWT was performed with Dornier AR2 (Dornier MedTech, Wessling, Germany), which is the electromagnetic defocused type. During one session of treatment, stimulation was applied 2,000 times. Stimulation was applied 1,000 times to the right medial forearm, which showed the most severe honeycomb pattern, and to the rest of the right upper limb. ESWT was performed twice a week for eight weeks, and a total of 16 sessions were administered. The intensity of treatment was 0.040-0.069 mJ/mm2 energy flux density and the frequency was 5 Hz.


Computed Tomography as an Objective Measurement Tool for Secondary Lymphedema Treated With Extracorporeal Shock Wave Therapy.

Kim SY, Bae H, Ji HM - Ann Rehabil Med (2015)

Comparison of computed tomography of the upper extremity. Before (A) and after (B) treatment in the case 1 patient. Before (C) and after (D) treatment of the case 2 patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496522&req=5

Figure 1: Comparison of computed tomography of the upper extremity. Before (A) and after (B) treatment in the case 1 patient. Before (C) and after (D) treatment of the case 2 patient.
Mentions: A CT scan of the upper extremities was performed using SOMATOM Sensation 16 (Siemens, Forchheim, Germany) in order to determine the location and volume of lymphedema and to establish a treatment plan. The patient underwent a CT scan with a slice thickness of 10 mm from the aortic arch to the tip of the fingers in the supine position with the shoulder at 180° flexion, elbow extended, forearm pronated, and fingers extended. According to the results of the CT scan, the right medial forearm showed the most severe honeycomb pattern. When the right and left sides were compared, it was found that the thickness of the skin and subcutaneous fat had increased on the right side (Fig. 1A). The patient had severe skin hardening and underwent ESWT around the right forearm, and bandage therapy was continued. The ESWT was performed with Dornier AR2 (Dornier MedTech, Wessling, Germany), which is the electromagnetic defocused type. During one session of treatment, stimulation was applied 2,000 times. Stimulation was applied 1,000 times to the right medial forearm, which showed the most severe honeycomb pattern, and to the rest of the right upper limb. ESWT was performed twice a week for eight weeks, and a total of 16 sessions were administered. The intensity of treatment was 0.040-0.069 mJ/mm2 energy flux density and the frequency was 5 Hz.

Bottom Line: We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities.There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT.CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

ABSTRACT
Two patients with stage three secondary lymphedema of the upper extremities underwent treatment for breast cancer, including surgery, chemotherapy, and radiotherapy. They were examined with computed tomography (CT) before and after extracorporeal shock wave therapy (ESWT). We used a manual tracing method using PiViewSTAR software to calculate the volume of the upper extremities. There was a decrease in the volume of the subcutaneous compartment measured by CT before and after ESWT. CT may be helpful in determining the treatment target area of ESWT and to monitor the effect of treatment by measuring the changes in volume before and after ESWT in patients with lymphedema. Therefore, CT may have good clinical potential for treatment and follow-up in the management of lymphedema.

No MeSH data available.


Related in: MedlinePlus