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Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs.

Mihara M, Hara H, Araki J, Kikuchi K, Narushima M, Yamamoto T, Iida T, Yoshimatsu H, Murai N, Mitsui K, Okitsu T, Koshima I - PLoS ONE (2012)

Bottom Line: In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema.ICG lymphography showed a dermal backflow pattern in these cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan. mihara@keiseigeka.name

ABSTRACT

Background: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.

Patients and methods: Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis.

Results: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases.

Conclusions: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.

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Related in: MedlinePlus

Case 3.Collecting lymph vascular endothelial cells in (a) linear pattern (LP), (b) splash pattern (SP), and (c) diffuse pattern (DP) areas. Regions in which endothelial cells were detached are indicated with red arrows. (d) ‘Contractile’ smooth muscle cells in (d) LP, (e) SP, and (f) DP areas. The space between smooth muscle cells was widened due to overgrowth of collagen fibers.
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pone-0038182-g003: Case 3.Collecting lymph vascular endothelial cells in (a) linear pattern (LP), (b) splash pattern (SP), and (c) diffuse pattern (DP) areas. Regions in which endothelial cells were detached are indicated with red arrows. (d) ‘Contractile’ smooth muscle cells in (d) LP, (e) SP, and (f) DP areas. The space between smooth muscle cells was widened due to overgrowth of collagen fibers.

Mentions: In TEM findings in the linear pattern region, lymph vascular endothelial cells showed a concave structure toward the lumen (Figure 3a) and smooth muscle cells were present in the tunica media as ‘contractile’ smooth muscle cells in collecting lymph vessels (Figure 3d). In the splash pattern area, lymph vascular endothelial cells were flattened (Figure 3b) and smooth muscle cells were altered to a ‘secretory type’ and were present in the tunica media in collecting lymph vessels (Figure 3e). Some ‘secretory’ smooth muscle cells were also diffusely present directly below lymph vascular endothelial cells. In the diffuse pattern region, lymph vascular endothelial cells were flattened in collecting lymph vessels (Figure 3c) and endothelial cells were detached in several regions (Figure 3c, red arrows), exposing collagen fibers of the tunica media to the lumen. Smooth muscle cells of collecting lymph vessels became ‘secretory’, as in the splash pattern area, and were present directly below lymph vascular endothelial cells over the tunica media. The space between smooth muscle cells was widened with overgrowth of collagen fibers (Figure 3f).


Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs.

Mihara M, Hara H, Araki J, Kikuchi K, Narushima M, Yamamoto T, Iida T, Yoshimatsu H, Murai N, Mitsui K, Okitsu T, Koshima I - PLoS ONE (2012)

Case 3.Collecting lymph vascular endothelial cells in (a) linear pattern (LP), (b) splash pattern (SP), and (c) diffuse pattern (DP) areas. Regions in which endothelial cells were detached are indicated with red arrows. (d) ‘Contractile’ smooth muscle cells in (d) LP, (e) SP, and (f) DP areas. The space between smooth muscle cells was widened due to overgrowth of collagen fibers.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3366958&req=5

pone-0038182-g003: Case 3.Collecting lymph vascular endothelial cells in (a) linear pattern (LP), (b) splash pattern (SP), and (c) diffuse pattern (DP) areas. Regions in which endothelial cells were detached are indicated with red arrows. (d) ‘Contractile’ smooth muscle cells in (d) LP, (e) SP, and (f) DP areas. The space between smooth muscle cells was widened due to overgrowth of collagen fibers.
Mentions: In TEM findings in the linear pattern region, lymph vascular endothelial cells showed a concave structure toward the lumen (Figure 3a) and smooth muscle cells were present in the tunica media as ‘contractile’ smooth muscle cells in collecting lymph vessels (Figure 3d). In the splash pattern area, lymph vascular endothelial cells were flattened (Figure 3b) and smooth muscle cells were altered to a ‘secretory type’ and were present in the tunica media in collecting lymph vessels (Figure 3e). Some ‘secretory’ smooth muscle cells were also diffusely present directly below lymph vascular endothelial cells. In the diffuse pattern region, lymph vascular endothelial cells were flattened in collecting lymph vessels (Figure 3c) and endothelial cells were detached in several regions (Figure 3c, red arrows), exposing collagen fibers of the tunica media to the lumen. Smooth muscle cells of collecting lymph vessels became ‘secretory’, as in the splash pattern area, and were present directly below lymph vascular endothelial cells over the tunica media. The space between smooth muscle cells was widened with overgrowth of collagen fibers (Figure 3f).

Bottom Line: In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema.ICG lymphography showed a dermal backflow pattern in these cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan. mihara@keiseigeka.name

ABSTRACT

Background: Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.

Patients and methods: Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis.

Results: The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases.

Conclusions: Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.

Show MeSH
Related in: MedlinePlus