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 17.(a, b) Clinical presentations. The circumferences were increased by 0.5, 0.5, 1.0, and 0 cm in the upper arm, elbow, forearm, and wrist, respectively, compared to the healthy side (left). (c) Findings from lymphoscintigraphy. A normal lymph vessel distribution was found in both upper limbs.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3366958&req=5

pone-0038182-g005: Case 17.(a, b) Clinical presentations. The circumferences were increased by 0.5, 0.5, 1.0, and 0 cm in the upper arm, elbow, forearm, and wrist, respectively, compared to the healthy side (left). (c) Findings from lymphoscintigraphy. A normal lymph vessel distribution was found in both upper limbs.

Mentions: For further illustration, we describe Case 17. The patient was a 57-year-old woman who underwent mastectomy, axillary lymph node dissection, and chemotherapy and radiotherapy (50 Gy) for left breast cancer 1 year ago. Lymphedema appeared in the right upper limb 10 months ago and slowly aggravated. Conservative treatment with lymph massage and elastic stockings was used from immediately after the appearance of lymphedema, but edema was not remitted. Physical examination revealed enlargement of the circumference of the right upper extremity by +0.5 cm at the upper arm, +0.5 cm at the elbow, +1.0 cm at the forearm, and +0 cm at the wrist, compared to the right upper extremity (Figure 5a,b). On lymphoscintigraphy, dermal back flow (reflux of lymph flow in the skin) was noted in the left upper arm over the forearm, compared to normal lymph flow in the healthy right arm. Lymphoscintigraphy showed normal lymph flow in the bilateral upper arms (Figure 5c). However, an ICG fluorescent test (Figure 6) showed a linear pattern only in one shoulder. A splash pattern was noted in the lateral forearm, lateral upper arm, and right axillary region over the precordia. A diffuse pattern was found in the dorsum of the hand, medial forearm, and medial upper arm. On MRI, mild fluid retention was noted in the lateral forearm. On CT, there was no major change other than an increase in the circumference compared to that of the healthy limb.


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 17.(a, b) Clinical presentations. The circumferences were increased by 0.5, 0.5, 1.0, and 0 cm in the upper arm, elbow, forearm, and wrist, respectively, compared to the healthy side (left). (c) Findings from lymphoscintigraphy. A normal lymph vessel distribution was found in both upper limbs.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0038182-g005: Case 17.(a, b) Clinical presentations. The circumferences were increased by 0.5, 0.5, 1.0, and 0 cm in the upper arm, elbow, forearm, and wrist, respectively, compared to the healthy side (left). (c) Findings from lymphoscintigraphy. A normal lymph vessel distribution was found in both upper limbs.
Mentions: For further illustration, we describe Case 17. The patient was a 57-year-old woman who underwent mastectomy, axillary lymph node dissection, and chemotherapy and radiotherapy (50 Gy) for left breast cancer 1 year ago. Lymphedema appeared in the right upper limb 10 months ago and slowly aggravated. Conservative treatment with lymph massage and elastic stockings was used from immediately after the appearance of lymphedema, but edema was not remitted. Physical examination revealed enlargement of the circumference of the right upper extremity by +0.5 cm at the upper arm, +0.5 cm at the elbow, +1.0 cm at the forearm, and +0 cm at the wrist, compared to the right upper extremity (Figure 5a,b). On lymphoscintigraphy, dermal back flow (reflux of lymph flow in the skin) was noted in the left upper arm over the forearm, compared to normal lymph flow in the healthy right arm. Lymphoscintigraphy showed normal lymph flow in the bilateral upper arms (Figure 5c). However, an ICG fluorescent test (Figure 6) showed a linear pattern only in one shoulder. A splash pattern was noted in the lateral forearm, lateral upper arm, and right axillary region over the precordia. A diffuse pattern was found in the dorsum of the hand, medial forearm, and medial upper arm. On MRI, mild fluid retention was noted in the lateral forearm. On CT, there was no major change other than an increase in the circumference compared to that of the healthy limb.

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