Bringing Lymphangiography into the 21st Century

Weiss, Clifford R.; Liddell, Robert P.

doi:10.1148/radiol.2019192368

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…[19][20][21][22][23][24][25] Indocyanine green (ICG) lymphography is an alternate modality to image the lymphatics for the evaluation of lymphedema, the assessment of lymphatic drainage, and the detection of sentinel lymph nodes of various tumors. [26][27][28][29] Despite its promising prospect, considerable drawbacks in terms of photobleaching, uncontrollable diffusion, and insufficient detection depth/contrast limit the clinical applications of the nearinfrared (NIR) lymphography. [30] Thus, a multidisciplinary collaboration among specialists will be urgently required to develop new or improved methodologies to achieve precise NIR lymphography.…”

Section: Introductionmentioning

confidence: 99%

Protein@Cyanine‐Based NIR‐II Lymphography Enables the Supersensitive Visualization of Lymphedema and Tumor Lymphatic Metastasis

Han

et al. 2023

Adv Healthcare Materials

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Visualization of the lymphatic system is clinically indispensable for the diagnosis and/or treatment of lymphatic diseases. Although indocyanine green (ICG) lymphography becomes an alternate imaging modality compared to traditional lymphoscintigraphy, it is still far from ideal due to the insufficient detection depth and low spatiotemporal resolution. Herein, protein@cyanine probes are rationally developed to solve the limitations of the current near‐infrared‐I (NIR‐I) lymphography. The protein@cyanine probes are synthesized following a chlorine‐containing dye‐labeling strategy based on structure‐selectivity (facile covalent binding between the dye and protein with a 1:1 molar ratio). As expected, the probes display exceptional NIR‐II imaging ability with much‐improved imaging contrast/resolution and controllable pharmacokinetics, superior to the clinical ICG. The protein@cyanine probes locate lymph nodes and delineate lymphatic vessels with super‐high sensitivity and signal‐to‐background ratio, enabling real‐time diagnosing lymphatic diseases such as lymphedema and tumor lymphatic metastasis. In particular, the NIR‐II lymphography provides an opportunity to discover the disparate morbidity rate of primary lymphedema in different types of mice. Given the fact of lacking clinically transferable NIR‐II probes, this work not only provides a promising strategy for enriching of the current library of NIR‐II probes, but also promotes the clinical translation of NIR‐II lymphography technology.

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Section: Introductionmentioning

confidence: 99%

Protein@Cyanine‐Based NIR‐II Lymphography Enables the Supersensitive Visualization of Lymphedema and Tumor Lymphatic Metastasis

Han

et al. 2023

Adv Healthcare Materials

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“…Near-infrared fluorescence lymphangiography or lymphography using indocyanine green dye (NIRF-ICG lymphangiography) is a primary technique in lymphatic research and clinical practice for diagnosis of lymphatic diseases 1 – 3 . In this minimally invasive imaging technique, indocyanine green (ICG), a fluorescent cyanine dye, is injected intradermally, and the flow and distribution of this dye in the body are analyzed using a near-infrared optical system.…”

Section: Introductionmentioning

confidence: 99%

Investigation of optimizing indocyanine green solution for in vivo lymphatic research using near-infrared fluorescence indocyanine green lymphangiography

Cheon,

Kim,

Kim

et al. 2023

Sci Rep

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Despite the tireless efforts of many researchers in lymphatic research, indocyanine green (ICG) solution conditions suitable for lymphatic circulation tests have not been perfectly established yet. We aimed to investigate the optimal in vivo conditions of ICG solution to avoid photobleaching and quenching effects, which may affect the accuracy of lymphatic circulation evaluation. After ICG fluorescence intensity (or ICG intensity) was assessed under different in vitro conditions, the image quality of brachial lymph nodes (LNs) and collecting lymphatic vessels (LVs) in eight rats was investigated. The in vitro results showed that ICG intensity depends on concentration and time in various solvents; however, the brightest intensity was observed at a concentration of 8–30 μg/mL in all solvents. ICG concentration in the albumin (bovine serum albumin; BSA) solution and rat’s plasma showed more than two times higher fluorescence intensity than in distilled water (DW) in the same range. However, saline reduced the intensity by almost half compared to DW. In the in vivo experiment, we obtained relatively high-quality images of the LNs and LVs using ICG in the BSA solution. Even at low concentrations, the result in the BSA solution was comparable to those obtained from high-concentration solutions commonly used in conventional circulation tests. This study provides valuable information about the conditions for optimal ICG intensity in near infrared fluorescence indocyanine green (NIRF-ICG) lymphangiography, which may be useful not only for the diagnosis of lymphatic circulation diseases such as lymphedema but also for preclinical research for the lymphatic system.

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“…Then, the lymph fluid flows in the lymphatic vessels through several lymph nodes to obtain lymphocytes and plasma cells, converges into the thoracic and right lymphatic ducts, and finally enters the cardiac vascular circulation through the bilateral jugular angles. However, our understanding of lymphatic physiology and pathology is limited, and the availability of lymphangiography and lymphatic interventional techniques is not prevailed worldwide (Weiss and Liddell 2020). So, there are still insufficiencies in diagnosing and treating lymphatic diseases caused by damage to the lymphatic circulation system.…”

Section: Introductionmentioning

confidence: 99%

“…So far, understanding the pathophysiology of the impaired lymphatic circulation system and making an optimized clinical management plan for lymphatic diseases are still essential (Weiss and Liddell 2020). However, because of the relatively little clinical need, only a few centers have the conditions to carry out these procedures.…”

Section: Introductionmentioning

confidence: 99%

Standardizing lymphangiography and lymphatic interventions: a preclinical in vivo approach with detailed procedural steps

et al. 2023

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Purpose To present a preclinical in vivo approach for standardization and training of lymphangiography and lymphatic interventions using a pictorial review. Materials and methods Different lipiodol- and gadolinium-based lymphangiography and lymphatic interventions were performed in twelve (12) landrace pigs with a mean bodyweight of 34 ± 2 kg using various imaging and guiding modalities, similar to the procedures used in humans. The techniques used were explicitly introduced and illustrated. The potential applications of each technique in preclinical training were also discussed. Results By applying visual, ultrasonography, fluoroscopy, CT, cone-beam CT, and/or MRI examination or guidance, a total of eleven techniques were successfully implemented in twelve pigs. The presented techniques include inguinal postoperative lymphatic leakage (PLL) establishment, interstitial dye test, five types of lymphangiography [incl. lipiodol-based translymphatic lymphangiography (TL), lipiodol-based percutaneous intranodal lymphangiography (INL), lipiodol-based laparotomic INL, lipiodol-based interstitial lymphangiography, and interstitial magnetic resonance lymphangiography (MRL)], and four types of percutaneous interventions in the treatment of PLL [incl. thoracic duct embolization (TDE), intranodal embolization (INE), afferent lymphatic vessel sclerotherapy (ALVS), and afferent lymphatic vessel embolization (ALVE)]. Conclusion This study provides a valuable resource for inexperienced interventional radiologists to undergo the preclinical training in lymphangiography and lymphatic interventions using healthy pig models.

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Bringing Lymphangiography into the 21st Century

Cited by 10 publications

References 8 publications

Protein@Cyanine‐Based NIR‐II Lymphography Enables the Supersensitive Visualization of Lymphedema and Tumor Lymphatic Metastasis

Protein@Cyanine‐Based NIR‐II Lymphography Enables the Supersensitive Visualization of Lymphedema and Tumor Lymphatic Metastasis

Investigation of optimizing indocyanine green solution for in vivo lymphatic research using near-infrared fluorescence indocyanine green lymphangiography

Standardizing lymphangiography and lymphatic interventions: a preclinical in vivo approach with detailed procedural steps

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