MR lymphography in patients with upper limb lymphedema: The GPS for feasibility and surgical planning for lympho‐venous bypass

Zeltzer, Assaf; Brussaard, Carola; Koning, M.W.A. de; Baerdemaeker, Randy De; Hendrickx, Benoit; Hamdi, Moustapha; Mey, Johan De

doi:10.1002/jso.25145

Cited by 32 publications

(39 citation statements)

References 17 publications

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“…Preoperative MRL allowed the identification of 7.2 ± 2.4 submental lymph nodes, which was greater than preoperative ultrasound doppler (3.2 ± 1.1) and intraoperative finding (3.1 ± 0.6) (Asuncion et al, 2018). Zeltzer et al (2018) conducted a prospective on 25 patients with upper extremity lymphedema where MRL allowed the identification of lymphatic circulation in 18 patients. They reported that LVA was successfully performed in 16 patients from their cohort (Zeltzer et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Zeltzer et al (2018) conducted a prospective on 25 patients with upper extremity lymphedema where MRL allowed the identification of lymphatic circulation in 18 patients. They reported that LVA was successfully performed in 16 patients from their cohort (Zeltzer et al, 2018). Lohrmann et al (2008) used MRL to preoperatively and postoperatively (LVA or Lymph vessel transplant) evaluate lymphedema grade and lymphatic channel characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…The use of MRL for preoperative planning of lymphedema surgery is summarized in this systematic review consisting of nine studies, in which a total of 334 lymphedema patients were included (Asuncion et al, 2018; Dayan et al, 2014; Gennaro et al, 2017; Lohrmann et al, 2008; Long et al, 2017; Mazzei et al, 2017; Notohamiprodjo et al, 2012; Pons et al, 2019; Zeltzer et al, 2018). Lymphatic channel assessment was performed with three‐dimensional T1‐weighted gradient‐echo sequences with spectral fat suppression.…”

Section: Discussionmentioning

confidence: 99%

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Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review

et al. 2021

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Background In recent years, magnetic resonance imaging lymphangiography (MRL) has emerged as a way to predict if patients are candidates for lymphedema surgery, particularly lymphovenous anastomosis (LVA). Our goal was to conduct a systematic review of the literature on the use of MRL for preoperative planning in lymphedema surgery. We hypothesized that MRL could add valuable information to the standard preoperative evaluation of lymphedema patients. Methods On February 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, and Embase databases, without time frame or language limitations, to identify articles on the use of MRL for preoperative planning of lymphedema surgery. We excluded studies that investigated other applications of magnetic resonance imaging, such as lymphedema diagnosis and treatment evaluation. The primary outcome was the examination capacity to identify lymphatic anatomy and the secondary outcome was the presence of adverse effects. Results Of 372 potential articles identified with the search, nine studies fulfilled the eligibility criteria. A total of 334 lymphedema patients were enrolled in these studies. Two studies compared MRL findings with those of other standard examinations (indocyanine green lymphography [ICG‐L] or lymphoscintigraphy). No adverse effects due to MRL were reported. A study shown that MRL had higher sensitivity to detect lymphatic vessel abnormalities compared with lymphoscintigraphy and a statistically higher chance of successful LVA was observed when the results of MRL agreed with those of ICG‐L (p < .001). Conclusions MRL could be useful for preoperative planning in lymphedema surgery. The scientific evidence has been limited, so further studies with greater numbers of patients and cost analysis are necessary to justify the addition of MRL to current preoperative protocols.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review

et al. 2021

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“…So wurde ein schweres Lymphödem in 46 % der Patienten mit aplastischen, 37 % der Patienten mit hyperplastischen, aber nur bei 15 % der Patienten mit hypoplastischen und nie bei Patienten mit normalen inguinalen Lymphgefäßen beobachtet [20]. [20,22]. Es sind also insbesondere die neueren Operationsmethoden, die zur adäquaten Therapieplanung eine exakte Diagnosestellung sowie eine möglichst genaue Lokalisierung funktioneller (!)…”

Section: Klinische Anwendungenunclassified

“…Lymphgefäße und -knoten erfordern. Die präoperative Darstellung einzelner Lymphgefäße sowie deren anatomische Lagebeziehung zu venösen Gefäßen ist in der MRL ohne weiteres möglich und kann auch gelingen, wenn mittels ICG-L keine Gefäße darstellbar sind [22]. Darüber hinaus kann die MRL auch zur postoperativen Verlaufsbeurteilung und zur Beurteilung möglicher Komplikationen eingesetzt werden.…”

Section: Klinische Anwendungenunclassified

Techniken und klinische Anwendungen der MR-Lymphangiografie in Diagnostik und Therapie von Lymphgefäßerkrankungen

Pieper

2021

Phlebologie

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ZusammenfassungNeue Methoden der Lymphgefäßbildgebung werden zunehmend in Diagnostik und Therapie von Lymphgefäßerkrankungen eingesetzt. Die Magnetresonanz-Lymphangiografie nimmt dabei als strahlungsfreies und non- bzw. minimalinvasives Verfahren eine zentrale Rolle ein. Es stehen verschiedene Techniken zur Verfügung, die Informationen sowohl über Anatomie als auch Funktion des peripheren und zentralen Lymphgefäßsystems liefern können. Damit trägt die Magnetresonanz-Lymphangiografie insbesondere in der Differenzialdiagnostik und in der Therapieplanung von Patienten mit Lymphödemen, Lymphgefäßleckagen und komplexen Lymphgefäßanomalien zur Ermöglichung einer zielgerichteten, minimalinvasiven und insbesondere individualisierten Therapie betroffener Patienten bei. Im Folgenden soll ein Überblick über den aktuellen Stand der MR-Lymphangiografie als neue Methode zur Untersuchung von Patienten mit Lymphgefäßerkrankungen gegeben werden, diese in das Spektrum anderer verfügbarer Bildgebungsmethoden eingeordnet und mögliche klinische Indikationen aufgezeigt werden.

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Anatomic study of the profunda artery perforators by multidetector CT scanner and clinical use of the banana‐shaped flap design for breast reconstruction

Zeltzer

Waked

Brussaard

et al. 2021

Journal of Surgical Oncology

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Background: The profunda artery perforator (PAP) flap is a well-known free flap for breast reconstruction. However, a reproducible perforator mapping system has yet to be developed. Methods:The PAP perforators were localized by CTA using a novel X-Y axis system.Flap dimensions were based on the CTA images and localized PAP-perforators.Perioperative findings and postoperative outcomes were analyzed.Results: A total of 70 lower limbs and 180 PAP perforators were evaluated. An average of 2.78 ± 1.22 and 2.22 ± 0.96 perforators were seen, in the right and left legs, respectively, and were divided in five clusters (PAP1-PAP5) based on their location on the Y-axis. The course of the perforators was noted as well as the average diameter at the origin. The overall average diameter was 1.99 ± 0.86 mm. A banana-shaped PAP-flap was harvested in 10 patients. The mean operative time was 278 min, pedicle length 76 ± 12 mm, and mean flap weight 247 g. No major complications were seen. Conclusion:The PAP flap can be mapped by CTA in a reproducible way. The X and Y axes are based on fixed anatomic landmarks and may form the basis for a bananashaped flap design of the PAP-flap.

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MR lymphography in patients with upper limb lymphedema: The GPS for feasibility and surgical planning for lympho‐venous bypass

Abstract: MR lymphangiography is an accurate and reproducible method for imaging and mapping of lymphatic channels in the lymphedemateous limb.

Cited by 32 publications

References 17 publications

Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review

Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review

Techniken und klinische Anwendungen der MR-Lymphangiografie in Diagnostik und Therapie von Lymphgefäßerkrankungen

Anatomic study of the profunda artery perforators by multidetector CT scanner and clinical use of the banana‐shaped flap design for breast reconstruction

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