Magnetic resonance lymphography as three-dimensional navigation for lymphaticovenular anastomosis in patients with leg lymphedema.
Anastomosis, Surgical
/ methods
Coloring Agents
/ pharmacology
Female
Humans
Indocyanine Green
/ pharmacology
Lower Extremity
/ blood supply
Lymphatic Vessels
/ diagnostic imaging
Lymphedema
/ diagnosis
Lymphography
/ methods
Magnetic Resonance Imaging
/ methods
Male
Microsurgery
/ methods
Middle Aged
Outcome and Process Assessment, Health Care
Preoperative Care
/ methods
Surgery, Computer-Assisted
/ methods
Veins
/ surgery
Indocyanine green lymphography
Lymphaticovenular anastomosis
Lymphedema
Magnetic resonance lymphangiography
Magnetic resonance lymphography
Patent blue
Journal
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
01
10
2019
revised:
29
09
2020
accepted:
26
10
2020
pubmed:
6
12
2020
medline:
16
6
2021
entrez:
5
12
2020
Statut:
ppublish
Résumé
Precise mapping of functional lymphatic vessels is essential for successful lymphaticovenular anastomosis (LVA). This study aimed to clarify the precision of magnetic resonance lymphography (MRL) in detecting lymphatic vessels prior to LVA. Eighteen patients with leg lymphedema were recruited for this prospective study. All patients underwent MRL before LVA to obtain three-dimensional coordinates of lymphatic vessels from MRL images. The precision of MRL for detecting lymphatic vessels was evaluated and compared with those of other contrast techniques. Twenty legs from 18 patients were analyzed. A total of 40 skin incisions were made, 32 of which were determined by MRL. The precision of MRL to detect lymphatic vessels was 94%. With the addition of MRL, the number of lymphatic vessels identified preoperatively was increased as compared with indocyanine green lymphography (ICG-L) alone. Assuming a detection sensitivity of MRL for lymphatic vessels of 1, those of other contrast techniques were 0.90 for ICG-L under microscopy, 0.73 for patent blue staining, and 0.43 for ICG-L before incision. Whereas ICG-L before incision could not detect lymphatic vessels at depths greater than 17.0 mm, all deeper anastomosed lymphatic vessels were identified by MRL. Lymphatic vessels enhanced on MRL can be reliably identified intraoperatively. MRL is a promising preoperative examination in LVA that can selectively depict suitable lymphatic vessels even in deep tissue layers.
Sections du résumé
BACKGROUND
BACKGROUND
Precise mapping of functional lymphatic vessels is essential for successful lymphaticovenular anastomosis (LVA). This study aimed to clarify the precision of magnetic resonance lymphography (MRL) in detecting lymphatic vessels prior to LVA.
METHODS
METHODS
Eighteen patients with leg lymphedema were recruited for this prospective study. All patients underwent MRL before LVA to obtain three-dimensional coordinates of lymphatic vessels from MRL images. The precision of MRL for detecting lymphatic vessels was evaluated and compared with those of other contrast techniques.
RESULTS
RESULTS
Twenty legs from 18 patients were analyzed. A total of 40 skin incisions were made, 32 of which were determined by MRL. The precision of MRL to detect lymphatic vessels was 94%. With the addition of MRL, the number of lymphatic vessels identified preoperatively was increased as compared with indocyanine green lymphography (ICG-L) alone. Assuming a detection sensitivity of MRL for lymphatic vessels of 1, those of other contrast techniques were 0.90 for ICG-L under microscopy, 0.73 for patent blue staining, and 0.43 for ICG-L before incision. Whereas ICG-L before incision could not detect lymphatic vessels at depths greater than 17.0 mm, all deeper anastomosed lymphatic vessels were identified by MRL.
CONCLUSION
CONCLUSIONS
Lymphatic vessels enhanced on MRL can be reliably identified intraoperatively. MRL is a promising preoperative examination in LVA that can selectively depict suitable lymphatic vessels even in deep tissue layers.
Identifiants
pubmed: 33277216
pii: S1748-6815(20)30597-0
doi: 10.1016/j.bjps.2020.10.099
pii:
doi:
Substances chimiques
Coloring Agents
0
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1253-1260Informations de copyright
Copyright © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None