Assessment of Lymphatic Contractile Function After Manual Lymphatic Drainage Using Near-Infrared Fluorescence Imaging

Abstract

Objective To investigate the feasibility of assessing the efficacy of manual lymphatic drainage (MLD), a method for lymphedema (LE) management, using near-infrared (NIR) fluorescence imaging. Design Exploratory pilot study. Setting Primary care unit. Intervention Indocyanine green of 25 μg in 0.1 cc each was injected intradermally in bilateral arms or legs of subjects. Diffused excitation light illuminated the limbs and NIR fluorescence images were collected using custom-built imaging systems. The subjects received MLD therapy, and imaging was performed pre- and post- therapy. Participants Ten subjects (age 18 – 68) diagnosed with Grade I or II LE and 12 normal control subjects (age 22 – 59). Main outcome measures Apparent lymph velocities and the periods between lymphatic propulsion events were computed from fluorescence images. The data collected pre- and post- MLD were compared and evaluated for differences. Results By comparing the pre- MLD lymphatic contractile function against post- MLD lymphatic function, our results show that the average apparent lymph velocity increased in both the symptomatic (+23%) and asymptomatic (+25%) limbs of LE subjects and in the control limbs (+28%) of normal subjects. The average lymphatic propulsion period decreased in the symptomatic (−9%) and asymptomatic (−20%) limbs of LE subjects, as well as in the control limbs (−23%). Conclusions We demonstrated that NIR fluorescence imaging could be used to quantify immediate benefits of lymphatic contractile function following MLD.

Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema

“…The increase in water T 2 on the contralateral side is not surprising, and is consistent with fluid being relocated to the healthy quadrant as a result of the MLD intervention. This is one of the first studies to our knowledge that demonstrates these expected internal changes in the tissue microenvironment with this intervention and is consistent with results from Tan et al 23 who found an increased lymphatic fluid velocity and frequency propulsion in both the symptomatic and asymptomatic limbs using fluorescence imaging. On average, we also observed a significant increase in T 2 in the involved arm, although the statistical significance of this finding was lower.…”

“…21,22 In a pilot study, Tan et al. 23 reported near-infrared fluorescence imaging visualized lymphatic contractility improvements with an increase in both lymph velocity and propulsive frequencies immediately post-MLD for the involved and contralateral limbs in patients with known lymphedema and in both limbs of healthy controls.…”

Rare adipose disorders (RADs) masquerading as obesity

“…Includes manual lymphatic drainage (MLD), wrapping of the limbs, compression garments, movement therapy, dietary recommendations, and skin care. LDT has been shown to improve skin elasticity, restore the venoarteriolar reflex, increase pre-lymph drainage and lymph transport in lymphatic vessels [116,151] , and reduce capillary fragility in lipedema [152] . Intermittent pneumatic compression may not improve limb size over MLD alone [153] but may be effective alone when MLD is not available [154] .…”

Sensitivity analysis of near-infrared functional lymphatic imaging

“…19,[21][22][23] Such a device would be strongly suited to enhance the diagnosis and treatment of lymphatic disorders through the visualization and quantification of changes in functional lymphatic transport before clinical manifestations are present and tissue damage is irreversible. Current NIR lymphatic imaging technology has been quite successful at demonstrating differences in lymphatic function and architecture in patients who have already been diagnosed with lymphedema, 18,19,24 differences in lymphatic function in response to manual lymphatic drainage 25 and pneumatic pressure devices, 23 as well as a decline in lymphatic pumping pressure in response to aging. 26 However, it is currently unclear how effective this approach will be at predicting lymphedema disease risk or providing early detection, as most of its successes to date have involved showing differences in lymphatic function after significant deterioration has already occurred.…”