Annali italiani di chirurgia · 2021
Comparison of indocyanine green fluorescence lymphangiography and magnetic resonance lymphangiography to investigate lymphedema of the extremities.
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Gentili Francesco, Mazzei Francesco Giuseppe, Monteleone Ilaria, Gabriele Guido, Nigri Andrea, Zerini Federico, Aboud Michael Gasser, Mazzei Maria Antonietta, Gennaro Paolo
Аннотация
PURPOSE: The aim of this study is to compare two dynamic imaging modalities employed to study peripheral lymphatic system, Magnetic Resonance Lymphangiography (MRL) and Indocyanine Green Lymphangiography (ICGL), evaluating their role for planning lymphaticovenular anastomosis (LVA) or other surgical-nonsurgical treatments in patients with lymphedema of the extremities.
MATERIALS AND METHODS: We conducted a retrospective study of 32 patients (26 women) with a mean age of 38 years (range 18-73) enrolled from January 2014 to December 2018; 20 out of 32 were affected by lower limb lymphedema with 6 cases of primary lymphedema; all of them had stage II disease. All the patient underwent ICGL and MRL within a month of one another, by injecting different contrast medium into interdigital web spaces. In each patient we rated the number of lymphatic vessels visualized, considering the wrist for the upper limb and the ankle for the lower limb. Student's t-test was applied.
RESULTS: All patients completed both the diagnostic examinations without any significant complications. A statistically significant difference (p < 0.05) was found between the number of lymphatic vessels identified on the wrist/ankle (34 on ICGL vs 70 on MRL and 82 on ICGL vs 26 on MRL, considering affected and healthy limbs respectively). In particular, dermal backflow in advanced lymphedema seems to hinder lymphatic vessels detection on ICGL. Conversely, on healthy limbs, MRL hardly identifies lymphatics, because of their fast lymphatic flow and almost virtual lumen.
CONCLUSIONS: Both MRL and ICGL are dynamic diagnostic modalities that permit an effective evaluation of lymphatic vessels anatomical and functional status in extremities lymphedema these diagnostic procedures may be considered complementary because they show different aspects of lymphatic system.
KEY WORDS: Indocyanine green, MR lymphangiography.
MATERIALS AND METHODS: We conducted a retrospective study of 32 patients (26 women) with a mean age of 38 years (range 18-73) enrolled from January 2014 to December 2018; 20 out of 32 were affected by lower limb lymphedema with 6 cases of primary lymphedema; all of them had stage II disease. All the patient underwent ICGL and MRL within a month of one another, by injecting different contrast medium into interdigital web spaces. In each patient we rated the number of lymphatic vessels visualized, considering the wrist for the upper limb and the ankle for the lower limb. Student's t-test was applied.
RESULTS: All patients completed both the diagnostic examinations without any significant complications. A statistically significant difference (p < 0.05) was found between the number of lymphatic vessels identified on the wrist/ankle (34 on ICGL vs 70 on MRL and 82 on ICGL vs 26 on MRL, considering affected and healthy limbs respectively). In particular, dermal backflow in advanced lymphedema seems to hinder lymphatic vessels detection on ICGL. Conversely, on healthy limbs, MRL hardly identifies lymphatics, because of their fast lymphatic flow and almost virtual lumen.
CONCLUSIONS: Both MRL and ICGL are dynamic diagnostic modalities that permit an effective evaluation of lymphatic vessels anatomical and functional status in extremities lymphedema these diagnostic procedures may be considered complementary because they show different aspects of lymphatic system.
KEY WORDS: Indocyanine green, MR lymphangiography.