Limits...
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.

Show MeSH

Related in: MedlinePlus

Case 3. (a, b) Macroscopic and ICG lymphography findings in the dorsum of the hand over the forearm. (c) Magnified ICG lymphography findings in (c) splash pattern (SP) and (d) linear pattern (LP) areas. (e) Immunostaining of the skin in the SP area (LYVE-1). Overgrowth of subcutaneous capillary lymph vessels was apparent (red arrows). (f) Immunostaining of the skin in the LP area (LYVE-1). Skin capillary lymph vessels are diffusely present directly below the dermis (red arrows).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3366958&req=5

pone-0038182-g004: Case 3. (a, b) Macroscopic and ICG lymphography findings in the dorsum of the hand over the forearm. (c) Magnified ICG lymphography findings in (c) splash pattern (SP) and (d) linear pattern (LP) areas. (e) Immunostaining of the skin in the SP area (LYVE-1). Overgrowth of subcutaneous capillary lymph vessels was apparent (red arrows). (f) Immunostaining of the skin in the LP area (LYVE-1). Skin capillary lymph vessels are diffusely present directly below the dermis (red arrows).

Mentions: In immunostaining (LYVE-1) of the skin in the linear pattern region, capillary lymph vessels were diffusely present directly below the dermis, as in the normal skin (Figure 4a,b,c,e). In the splash and diffuse pattern areas, overgrowth of capillary lymph vessels (Figure 4, red arrows) was noted directly below the dermis and in the middle layer of fat, compared to the normal skin (Figure 4b,d,f).


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. (a, b) Macroscopic and ICG lymphography findings in the dorsum of the hand over the forearm. (c) Magnified ICG lymphography findings in (c) splash pattern (SP) and (d) linear pattern (LP) areas. (e) Immunostaining of the skin in the SP area (LYVE-1). Overgrowth of subcutaneous capillary lymph vessels was apparent (red arrows). (f) Immunostaining of the skin in the LP area (LYVE-1). Skin capillary lymph vessels are diffusely present directly below the dermis (red arrows).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0038182-g004: Case 3. (a, b) Macroscopic and ICG lymphography findings in the dorsum of the hand over the forearm. (c) Magnified ICG lymphography findings in (c) splash pattern (SP) and (d) linear pattern (LP) areas. (e) Immunostaining of the skin in the SP area (LYVE-1). Overgrowth of subcutaneous capillary lymph vessels was apparent (red arrows). (f) Immunostaining of the skin in the LP area (LYVE-1). Skin capillary lymph vessels are diffusely present directly below the dermis (red arrows).
Mentions: In immunostaining (LYVE-1) of the skin in the linear pattern region, capillary lymph vessels were diffusely present directly below the dermis, as in the normal skin (Figure 4a,b,c,e). In the splash and diffuse pattern areas, overgrowth of capillary lymph vessels (Figure 4, red arrows) was noted directly below the dermis and in the middle layer of fat, compared to the normal skin (Figure 4b,d,f).

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