{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:11:17Z","timestamp":1787065877160,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:00:00Z","timestamp":1732838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Lymphedema, a common source of disability among oncology patients, necessitates continuous targeted rehabilitation. Recent studies have revealed the role of connective tissue in this pathology; however, despite existing research on ultrasound (US) use in lymphedema, no studies have specifically addressed the use of ultrasound to assess fasciae in patients with lymphedema. This study aims to provide a more objective characterization of typical US alterations in these patients by quantifying the thickness of superficial and deep fasciae and comparing them with those of healthy volunteers. Methods: A cross-sectional study was performed using US imaging to measure the thickness of superficial and deep fascia in different regions and levels of the arm and forearm in a sample of 50 subjects: 25 chronic lymphedema patients and 25 healthy participants. Results: No significant difference in fascial thickness was observed between affected and unaffected upper limbs, but patients had notably thinner superficial fascia and deep fascia compared with healthy volunteers. The findings for superficial and deep fascia revealed statistically significant differences (p &lt; 0.0001) in all regions and levels. Conclusions: This study demonstrates the effectiveness of US imaging as a non-invasive tool for detecting subtle fascial changes in chronic lymphedema patients, revealing thinner fasciae compared with those in healthy volunteers. These findings suggest a potential anatomical predisposition to lymphedema, highlighting the importance of incorporating detailed US assessments in diagnosis and management to improve early intervention and patient outcomes. Future studies could, therefore, investigate whether preventive fascia assessment might improve the early identification of individuals at risk.<\/jats:p>","DOI":"10.3390\/diagnostics14232697","type":"journal-article","created":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T09:00:10Z","timestamp":1733130010000},"page":"2697","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Ultrasound Imaging of the Superficial and Deep Fasciae Thickness of Upper Limbs in Lymphedema Patients Versus Healthy Subjects"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0119-6549","authenticated-orcid":false,"given":"Carmelo","family":"Pirri","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Pirri","sequence":"additional","affiliation":[{"name":"Department of Medicine\u2014DIMED, School of Radiology, Radiology Institute, University of Padova, 35122 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Ferraretto","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation School, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Bonaldo","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Section of Rehabilitation, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2307-0277","authenticated-orcid":false,"given":"Raffaele","family":"De Caro","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0361-4898","authenticated-orcid":false,"given":"Stefano","family":"Masiero","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Section of Rehabilitation, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8767-4555","authenticated-orcid":false,"given":"Carla","family":"Stecco","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/1358863X9700200408","article-title":"Lymphedema: Anatomy, physiology and pathogenesis","volume":"2","author":"Szuba","year":"1997","journal-title":"Vasc. Med."},{"key":"ref_2","unstructured":"International Society of Lymphology (2009). The diagnosis and treatment of peripheral lymphedema. 2009 Concensus Document of the International Society of Lymphology. Lymphology, 42, 51\u201360."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Douglass, J., Graves, P., and Gordon, S. (2016). Self-care for management of secondary lymphedema: A systematic review. PLoS Negl. Trop. Dis., 10.","DOI":"10.1371\/journal.pntd.0004740"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1177\/1358863X10364553","article-title":"Current concepts and future directions in the diagnosis and management of lymphatic vascular disease","volume":"15","author":"Rockson","year":"2010","journal-title":"Vasc. Med."},{"key":"ref_5","unstructured":"Executive Committee (2016). The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology, 49, 170\u2013184."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/tmi.13359","article-title":"Human skin fibrosis: Up-regulation of collagen type III gene transcription in the fibrotic skin nodules of lower limb lymphoedema","volume":"25","author":"Karayi","year":"2020","journal-title":"Trop. Med. Int. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"a041272","DOI":"10.1101\/cshperspect.a041272","article-title":"Molecular mechanisms driving lymphedema and other lymphatic anomalies","volume":"12","author":"Geng","year":"2022","journal-title":"Cold Spring Harb. Perspect. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2620","DOI":"10.1111\/cas.14457","article-title":"Potential role of transforming growth factor-beta 1\/Smad signaling in secondary lymphedema after cancer surgery","volume":"111","author":"Sano","year":"2020","journal-title":"Cancer Sci."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Torrisi, J.S., Hespe, G.E., Cuzzone, D.A., Savetsky, I.L., Nitti, M.D., Gardenier, J.C., Nores, G.D.G., Jowhar, D., and Kataru, R.P. (2016). Mehrara. Inhibition of inflammation and iNOS improves lymphatic function in obesity. Sci. Rep., 6.","DOI":"10.1038\/srep19817"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1002\/jum.15148","article-title":"Ultrasound Imaging of the Fascial Layers: You See (Only) What You Know","volume":"39","author":"Pirri","year":"2020","journal-title":"J. Ultrasound Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/srt.13084","article-title":"Elastic Fibres in the subcutaneous tissue: Is there a difference between superficial and muscular fascia? A cadaver study","volume":"28","author":"Pirri","year":"2022","journal-title":"Skin Res. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s40477-021-00633-4","article-title":"From physical to ultrasound examination in lymphedema: A novel dynamic approach","volume":"25","author":"Ricci","year":"2022","journal-title":"J. Ultrasound"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"334","DOI":"10.23736\/S0392-9590.19.04176-2","article-title":"Upper limb secondary lymphedema ultrasound mapping and characterization","volume":"38","author":"Mander","year":"2019","journal-title":"Int. Angiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pirri, C., Pirri, N., Guidolin, D., Macchi, V., De Caro, R., and Stecco, C. (2022). Ultrasound Imaging of the Superficial Fascia in the Upper Limb: Arm and Forearm. Diagnostics, 12.","DOI":"10.3390\/diagnostics12081884"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pirri, C., Pirri, N., Porzionato, A., Boscolo-Berto, R., De Caro, R., and Stecco, C. (2022). Inter- and Intra-Rater Reliability of Ultrasound Measurements of Superficial and Deep Fasciae Thickness in Upper Limb. Diagnostics, 12.","DOI":"10.3390\/diagnostics12092195"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1037\/0003-066X.45.12.1304","article-title":"Things I have learned (so far)","volume":"45","author":"Cohen","year":"1990","journal-title":"Am. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Albertin, G., Astolfi, L., Fede, C., Simoni, E., Contran, M., Petrelli, L., Tiengo, C., Guidolin, D., De Caro, R., and Stecco, C. (2023). Detection of Lymphatic Vessels in the Superficial Fascia of the Abdomen. Life, 13.","DOI":"10.3390\/life13030836"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/j.1075-122X.2004.21458.x","article-title":"Dual-frequency ultrasound examination of skin and subcutis thickness in breast cancer-related lymphedema","volume":"10","author":"Mellor","year":"2004","journal-title":"Breast J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1097\/01.prs.0000246516.64780.61","article-title":"The lymphatic territories of the upper limb: Anatomical study and clinical implications","volume":"119","author":"Suami","year":"2007","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1038\/ng1642","article-title":"Lymphatic vascular defects promoted by Prox1 haploinsufficiency cause adult-onset obesity","volume":"37","author":"Harvey","year":"2005","journal-title":"Nat. Genet."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lee, S.O., and Kim, I.K. (2024). Molecular pathophysiology of secondary lymphedema. Front. Cell Dev. Biol., 12.","DOI":"10.3389\/fcell.2024.1363811"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Li, C.Y., Kataru, R.P., and Mehrara, B.J. (2020). Histopathologic Features of Lymphedema: A Molecular Review. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21072546"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Pavan, P., Monti, E., Bond\u00ed, M., Fan, C., Stecco, C., Narici, M., Reggiani, C., and Marcucci, L. (2020). Alterations of Extracellular Matrix Mechanical Properties Contribute to Age-Related Functional Impairment of Human Skeletal Muscles. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21113992"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1038\/ijo.2016.96","article-title":"Obesity but not high-fat diet impairs lymphatic function","volume":"40","author":"Cuzzone","year":"2016","journal-title":"Int. J. Obes."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/j.1749-6632.2002.tb04875.x","article-title":"The molecular control of adipogenesis, with special reference to lymphatic pathology","volume":"979","author":"Rosen","year":"2002","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"H165","DOI":"10.1152\/ajpheart.00244.2014","article-title":"Obesity increases inflammation and impairs lymphatic function in a mouse model of lymphedema","volume":"307","author":"Savetsky","year":"2014","journal-title":"Am. J. Physiol. Heart Circ. Physiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/23\/2697\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:42:46Z","timestamp":1760114566000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/23\/2697"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,29]]},"references-count":29,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["diagnostics14232697"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14232697","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,29]]}}}