Differentiation of lipoedema from bilateral lower limb lymphoedema by imaging assessment of indocyanine green lymphography

Abstract

Summary Lipoedema is characterized by disproportionate painful fat accumulation mostly in the lower limbs. The presence of lymphoedema in lipoedema remains controversial. This study aimed to assess the presence or absence of lymphoedema in the lower limbs of women with lipoedema using indocyanine green (ICG) lymphography. A cross‐sectional retrospective study was undertaken in women with a clinical diagnosis of lipoedema whose lower limbs were examined with ICG lymphography. MD Anderson Cancer Center (MDACC) ICG staging was used to determine lymphoedema presence and severity. Patient characteristics, ICG lymphography findings, Stemmer sign, body mass index, waist‐to‐hip ratio, limb volume and bioimpedance spectroscopy measures were recorded. Forty women with lipoedema underwent ICG lymphography for the lower limbs from January 2018 to July 2022. Thirty‐four women (85.0%) were determined by ICG lymphography as MDACC ICG Stage 0 representing normal lymphatics. Of the six women who demonstrated dermal backflow on ICG lymphography, all were determined as ICG Stage 1, four had localized traumatic dermal backflow area at their ankles, one had previously diagnosed with primary lymphoedema and one was classified as lipoedema stage 4. ICG lymphography findings suggested the absence of lymphoedema in a clear majority of women with lower limb lipoedema.

Diagnostic imaging in lipedema: A systematic review

“…Four studies evaluated indocyanine green findings in lipedema (Table 8). 19,[37][38][39] These studies revealed significant changes in superficial lymph flow in lipedema with slower lymph flow, higher number of abnormal lymphatic vessels, and higher fluorescent intensity in the skin, 19 dilation of lymphatic vessels, intravascular pooling, and greater propulsion rates. 39 Overall, only three studies reported cutoff values for diagnosing lipedema, and five studies reported the diagnostic accuracy of imaging studies (Table 9).…”

Indocyanine green fluorescence applied to gynecologic oncology: beyond sentinel lymph node

“…Among these, only two—the ipsilateral inguinal and popliteal regions—were original regions, while the remaining six were compensatory regions. The most common compensatory pathways include the contralateral inguinal region, identified in 13–30% of patients with cancer-related LLLE, followed by the gluteal pathway in 4–23% 16 , 17 .…”

Auf der Suche nach der Evidenz: Eine systematische Übersichtsarbeit zur Pathologie des Lipödems

“…Unterstützend dazu quantifizierten Birkballe et al keine Unterschiede im lokalen Wassergehalt (Tissue Dielectric Constant TDC, n=10, ns ) der Probanden 47 . Mackie et al konnten das Lipödem ebenso nicht mit dem Vorhandensein eines Lymphödems in Verbindung bringen (Indocyaningrün Färbung, n=40) 48 .…”