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Objective@#To evaluate the diagnostic value of indocyanine green(ICG)lymphography in primary lymphedema of extremities.@*Methods@#61 patients with limb lymphedema were enrolled in the study. The contralateral healthy limbs were used as controls. After intradermal injection of Indocyanine Green, dynamic observation of lymphatic vessels and lymph flow was performed using PDE near-infrared fluorescent instrument. The frequency of lymphatic contraction was calculated.@*Results@#Lymphatic vessel images were clearly visualized in healthy limbs. Inguinal or axillary lymph nodes can be visualized when examined 30 minutes after injection. Lymphatic contraction frequency was 1(0.33-5.00)time per minute. 94.8% lymphedematous limb demonstrated delayed lymphatic vessel or lymph nodes. "Dermal backflow" and diffused shadow pattern can be observed in all affected limbs. Abnormal lymphatic vasculature and contraction can be visualized. The frequency of lymphatic contraction in the affected limb was higher compared to controls: 2.5(0.5-7.0) times per minute.@*Conclusions@#ICG lymphography possess high sensitivity for lymphedema diagnosis. ICG lymphography furthers our understanding of pathophysiological alterations of lymphatic disorders.
RESUMO
OBJECTIVE: The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb. MATERIALS AND METHODS: For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65). RESULTS: In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%). CONCLUSION: As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.