Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema

Almeida, Camila Alcoforado de; Lins, Esdras Marques; Brandão, Simone Cristina Soares; Ferraz, Álvaro Antônio Bandeira; Pinto, Flávia Cristina Morone; Marques, Silvio Romero de Barros

doi:10.1016/j.jvsv.2016.11.008

Cited by 11 publications

(4 citation statements)

References 12 publications

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“…It is also noteworthy that, in a prior review of NIRF-LI studies of unilateral BCRL patients, contralateral, undiagnosed arms exhibited increasing surface coverage of dermal backflow with stage and duration of diagnosed contralateral LE, even though cancer treatments were confined to the ipsilateral arm [94]. Other studies have found disrupted lymphatic flow on contralateral limbs in unilateral BCRL patients [95][96][97], suggesting unknown mechanisms that may work to progressively deteriorate lymphatics systemically after initial clinical LE diagnosis.…”

Section: Diagnosis Of Lymphatic Dysfunction and Its Treatment In Patimentioning

confidence: 97%

“…NIRF-LI has shown that manual lymphatic drainage (MLD), as part of comprehensive CDT, can stimulate lymphatic contractile function by the lymphangions in the affected limbs of patients with diagnosed LE, but is more effective in contralateral "normal" limbs [97]. One may expect that lymphatic contractile function seen through NIRF-LI may be more readily stimulated at early stages of lymphatic dysfunction, than at later stages, consistent with enhanced efficacy of MLD at early stages of diagnosed LE.…”

Section: Imaging Lymphatic Response To Le Treatmentmentioning

confidence: 99%

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The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors

Aldrich

Rasmussen

Fife

et al. 2020

Cancers

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Breast-cancer-acquired lymphedema is routinely diagnosed from the appearance of irreversible swelling that occurs as a result of lymphatic dysfunction. Yet in head and neck cancer survivors, lymphatic dysfunction may not always result in clinically overt swelling, but instead contribute to debilitating functional outcomes. In this review, we describe how cancer metastasis, lymph node dissection, and radiation therapy alter lymphatic function, as visualized by near-infrared fluorescence lymphatic imaging. Using custom gallium arsenide (GaAs)-intensified systems capable of detecting trace amounts of indocyanine green administered repeatedly as lymphatic contrast for longitudinal clinical imaging, we show that lymphatic dysfunction occurs with cancer progression and treatment and is an early, sub-clinical indicator of cancer-acquired lymphedema. We show that early treatment of lymphedema can restore lymphatic function in breast cancer and head and neck cancer patients and survivors. The compilation of these studies provides insights to the critical role that the lymphatics and the immune system play in the etiology of lymphedema and associated co-morbidities.

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Section: Diagnosis Of Lymphatic Dysfunction and Its Treatment In Patimentioning

confidence: 97%

Section: Imaging Lymphatic Response To Le Treatmentmentioning

confidence: 99%

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors

Aldrich

Rasmussen

Fife

et al. 2020

Cancers

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“…In a recent study of 43 patients with chronic lower limb lymphedema, 70% exhibited some form of lymphadenopathy in the contralateral limb apparent on lymphoscintigraphy. 28 In a separate study, near infrared fluorescent imaging in 18 patients with BCRL revealed lymphatic abnormalities in both limbs of patients, with bilateral abnormalities being most prevalent in more chronic patients, 29 highlighting that lymphedema secondary to cancer therapies can have a systemic influence on lymphatic function.…”

Section: Ln Relaxometry Asymmetry In Patients With Bcrlmentioning

confidence: 98%

3.0 T relaxation time measurements of human lymph nodes in adults with and without lymphatic insufficiency: Implications for magnetic resonance lymphatic imaging

et al. 2018

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Purpose: To quantify 3.0T (i) T1 and T2 relaxation times of in vivo human lymph nodes (LNs), and (ii) LN relaxometry differences between healthy LNs and LNs from patients with lymphatic insufficiency secondary to breast cancer treatment-related lymphedema (BCRL). Materials and Methods: MR relaxometry was performed over bilateral axillary regions at 3.0T in healthy female controls (105 LNs from 20 participants) and patients with BCRL (108 LNs from 20 participants). Quantitative T1 maps were calculated using a multi-flip-angle (20, 40, 60 degrees) method with B1-correction (dual-TR method, TR1/TR2=30/130 ms), and T2 maps using a multi-echo (TE=9–189 ms; 12 ms intervals) method. T1 and T2 were quantified in the LN cortex and hilum. A Mann-Whitney U-test was applied to compare LN relaxometry values between patients and controls (significance: two-sided p<0.05). Linear regression was applied to evaluate how LN relaxometry varied with age, BMI, and clinical indicators of disease. Results: LN substructure relaxation times (mean ± standard deviation) in healthy controls were: T1 cortex=1435±391 ms, T1 hilum=714±123 ms; T2 cortex=102±12 ms, and T2 hilum=119±21 ms. T1 of the LN cortex was significantly reduced in the contralateral axilla of BCRL patients compared to the axilla on the surgical side (p<0.001) and compared to bilateral control values (p<0.01). The LN cortex T1 asymmetry discriminated cases vs. controls (p=0.004) in a multiple linear regression, accounting for age and BMI. Conclusion: Human 3.0T T1 and T2 relaxation times in axillary LNs were quantified for the first time in vivo. Measured values are relevant for optimizing acquisition parameters in anatomical lymphatic imaging sequences, and can serve as a reference for novel functional and molecular LN imaging methods that require quantitative knowledge of LN relaxation times.

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“…Limiting the injection to only the edematous limb has the disadvantage of missing any functional and/or morphologic lymphatic abnormalities in the "normal" nonedematous contralateral limb. These cryptic or clinically latent abnormalities can be found in both primary and secondary cases [24,25].…”

Section: For Other Lymphoscintigraphic Approaches?mentioning

confidence: 99%

Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas

Bourgeois

Leduc

2021

PLoS ONE

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Introduction The classical lymphoscintigraphic investigations of lower-limb lymphatic edema [LLLE] sometimes reveal either no or few lymph nodes [LNs] at the root of the limb[s] and/or in the abdomen. The aim of the present paper is to report the results of performing one additional injection at the root of the edematous limb[s] to force the visualization of the LNs and/or to demonstrate the collateral lymphatic pathways in such patients. Methods and findings We retrospectively reviewed our database and found 99 patients [44 primary LLLE with 47 limbs injected and 55 with LLLE secondary to treatments for cancer with 64 limbs injected] where such an additional injection had been performed. In the 43 LLLE patients where no LNs were seen at the end of the classical exam [15 primary LLLE and 28 secondary LLLE], the extra injection showed lymphatic drainage toward LN[s] in all except 3 and when at least one LN was seen, the injection showed lymphatic drainage in every case toward the same ipsilateral [inguinal and/or iliac] LNs [as shown by the classical injection] and/or toward additional LNs. In 40.7% of patients, we observed one or more additional lymphatic pathways: prepubic superficial lymphatic vessels [LV] crossing the midline anteriorly toward contralateral inguinal LNs in 21 [18.9%], “posterior” LV [toward contralateral inguinal LNs and/or ipsi- or contralateral lumbo-aortic and/or para-renal LNs] in 14 [12.6%], but deep LV toward the ipsilateral common iliac LNs passing between the gluteal muscles in 32 [28.8%]. Conclusion Our work pinpoints one limitation of classical bipedal radionuclide lymphangiography. In patients with primary and secondary LLLE where inguinal and/or iliac LNs cannot be seen on bipedal radionuclide lymphangiography, this additional injection reveals the true lympho-nodal status and shows unexpected collateral lymphatic pathways in 40% of cases. Such information is of the utmost importance in LLLE management and its acquisition is consequently recommended in these patients.

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Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema

Cited by 11 publications

References 12 publications

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors

The Development and Treatment of Lymphatic Dysfunction in Cancer Patients and Survivors

3.0 T relaxation time measurements of human lymph nodes in adults with and without lymphatic insufficiency: Implications for magnetic resonance lymphatic imaging

Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas

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