Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images

Fujiyoshi, Takahiro; Mikami, Taisei; Hashimoto, Koukichi; Asano, Saori; Adachi, E.; Kagimoto, Shintaro; Yabuki, Yuichiro; Kitayama, Shinya; Matsubara, S; Maegawa, Jiro; Iwai, Toshinori; Ishibe, Atsushi; Miyagi, Etsuko; Kaneta, Tomohiro

doi:10.1089/lrb.2021.0040

Cited by 4 publications

(3 citation statements)

References 15 publications

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“…47 Single Photon Emission Computed Tomography Single photon emission computed tomography (SPECT) combined with CT imaging has widely been used for identification of sentinel lymph nodes but the application for visualizing lymphatic vessels is limited. In contrast to scintigraphy, SPECT/CT provides three-dimensional (3D) and in-depth information, 48,49 and also provides information on lymphostasis in patients with early lymphedema, which was detected sporadically with planar scintigraphy. SPECT/CT mostly confirmed and improved localized findings from planar scintigraphy, and soft tissue changes could be assessed.…”

Section: Parameters For Diagnosis and Severity Stagingmentioning

confidence: 99%

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Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

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Background Secondary lymphedema is a common complication after surgical or radiotherapeutic cancer treatment. (Micro) surgical intervention such as lymphovenous bypass and vascularized lymph node transfer is a possible solution in patients who are refractory to conventional treatment. Adequate imaging is needed to identify functional lymphatic vessels and nearby veins for surgical planning. Methods A systematic literature search of the Embase, MEDLINE ALL via Ovid, Web of Science Core Collection and Cochrane CENTRAL Register of Trials databases was conducted in February 2022. Studies reporting on lymphatic vessel detection in healthy subjects or secondary lymphedema of the limbs or head and neck were analyzed. Results Overall, 129 lymphatic vessel imaging studies were included, and six imaging modalities were identified. The aim of the studies was diagnosis, severity staging, and/or surgical planning. Conclusion Due to its utility in surgical planning, near-infrared fluorescence lymphangiography (NIRF-L) has gained prominence in recent years relative to lymphoscintigraphy, the current gold standard for diagnosis and severity staging. Magnetic resonance lymphography (MRL) gives three-dimensional detailed information on the location of both lymphatic vessels and veins and the extent of fat hypertrophy; however, MRL is less practical for routine presurgical implementation due to its limited availability and high cost. High frequency ultrasound imaging can provide high resolution imaging of lymphatic vessels but is highly operator-dependent and accurate identification of lymphatic vessels is difficult. Finally, photoacoustic imaging (PAI) is a novel technique for visualization of functional lymphatic vessels and veins. More evidence is needed to evaluate the utility of PAI in surgical planning.

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Section: Parameters For Diagnosis and Severity Stagingmentioning

confidence: 99%

“…SPECT/CT mostly confirmed and improved localized findings from planar scintigraphy, and soft tissue changes could be assessed. [49][50][51]…”

Section: Parameters For Diagnosis and Severity Stagingmentioning

confidence: 99%

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

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“…However, it is not easy to assess differences with a planar method such as lymphoscintigraphy. For this purpose, methods such as SPECT, possibly associated with CT, have been used to improve spatial resolution, but without obtaining significant results [22].…”

Section: Lymphoscintigraphy: An Overview Of the Gold Standard Methodsmentioning

confidence: 99%

The Role of Imaging of Lymphatic System to Prevent Cancer Related Lymphedema

Cuccurullo,

Rapa,

Catalfamo

et al. 2023

Bioengineering

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Lymphedema is a progressive chronic condition affecting approximately 250 million people worldwide, a number that is currently underestimated. In Western countries, the most common form of lymphedema of the extremities is cancer-related and less radical surgical intervention is the main option to prevent it. Standardized protocols in the areas of diagnosis, staging and treatment are strongly required to address this issue. The aim of this study is to review the main diagnostic methods, comparing new emerging procedures to lymphoscintigraphy, considered as the golden standard to date. The roles of Magnetic Resonance Lymphangiography (MRL) or indocyanine green ICG lymphography are particularly reviewed in order to evaluate diagnostic accuracy, potential associations with lymphoscintigraphy, and future directions guided by AI protocols. The use of imaging to treat lymphedema has benefited from new techniques in the area of lymphatic vessels anatomy; these perspectives have become of value in many clinical scenarios to prevent cancer-related lymphedema.

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A new severity classification of lower limb secondary lymphedema based on lymphatic pathway defects in an indocyanine green fluorescent lymphography study

Shinaoka

Kamiyama

Yamada

et al. 2022

Sci Rep

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Most protocols for lymphatic imaging of the lower limb conventionally inject tracer materials only into the interdigital space; however, recent studies indicate that there are four independent lymphatic vessel groups (anteromedial, anterolateral, posteromedial, and posterolateral) in the lower limb. Thus, three additional injection sites are needed for lymphatic imaging of the entire lower limb. We aimed to validate a multiple injection designed protocol and demonstrate its clinical benefits. Overall, 206 lower limbs undergoing indocyanine green fluorescent lymphography with the new injection protocol were registered retrospectively. To assess the influence of predictor variables on the degree of severity, multivariable logistic regression models were used with individual known risk factors. Using a generalized linear model, the area under the curve (AUC) of the conventional clinical model, comprising known severity risk factors, was compared with that of the modified model that included defects in the posterolateral and posteromedial groups. Multivariable logistic regression models showed a significant difference for the posteromedial and posterolateral groups. The AUC of the modified model was significantly improved compared to that of the conventional clinical model. Finding defects in the posteromedial and posterolateral groups is a significant criterion for judging lymphedema severity and introducing a new lymphedema severity classification.

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Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images

Cited by 4 publications

References 15 publications

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

The Role of Imaging of Lymphatic System to Prevent Cancer Related Lymphedema

A new severity classification of lower limb secondary lymphedema based on lymphatic pathway defects in an indocyanine green fluorescent lymphography study

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