Deprecated: Implicit conversion from float 211.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 J+Vasc+Surg+Venous+Lymphat+Disord 2017 ; 5 (2): 261-73 Nephropedia Template TP
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New Diagnostic Modalities in the Evaluation of Lymphedema #MMPMID28214496
Objective: Currently lymphedema (LED) is typically diagnosed clinically on the basis of a patient?s history and characteristic physical findings. While the diagnosis of LED is sometimes confirmed by lymphoscintigraphy (LSG), the technique is limited in its ability to identify pathology and guide therapy. Recent advancements provide opportunities for new imaging techniques to not only assist in the diagnosis of LED, based on anatomical changes, but also to assess contractile function and to guide therapeutic intervention. The purpose of this contribution is to review these imaging techniques. Methods: Literature for each technique is reviewed and discussed and the evidence for each of these new diagnostic techniques were assessed on several criteria to determine if each could: 1) establish whether disease is present; 2) determine the severity of the disease process; 3) define the pathophysiology of the disease process; 4) demonstrate whether intervention is possible as well as what type; and 5) objectively grade the response to therapy. Results: LSG is currently the standard test to confirm LED. Duplex ultrasound (DUS) is a simple, readily available non-invasive test that can identify LED by specific tissue characteristics and the response to therapy. MRI and CT scans similarly demonstrate the alterations in epidermal and subcutaneous tissue, but the latter can also detect obstructing neoplasms as a cause of secondary LED. Moreover, MR lymphangiography details lymphatic vessels and nodes and their function. Newer fluorescence imaging techniques provide opportunities to imaging lymphatic anatomy and function. Visible micro lymphangiography by fluorescein sodium is limited by tissue light absorption to imaging depths of 200 ?m. Near-infrared fluorescence (NIRF) lymphatic imaging [NIRF-LI], a newer test using intradermal injection of indocyanine green, can penetrate several centimeters of tissue and can visualize the initial and conducting lymphatics, the lymph node basins, as well as the active function of lymphangions (the key module) in exquisite detail. Conclusions: The availability and the non-invasive nature of DUS should make this modality the first choice for establishing the diagnosis of LED based on tissue changes. Further studies comparing DUS to LSG, however, are needed. The costs of MRI and CT limit their adoption as a means to regularly assess the lymphatics. While lymphatic truncal anatomy and transit times can be delineated by the older technique of LSG, NIRF-LI is rapid, highly sensitive, repeatable, and provides exquisite detail for lymphatic vessel anatomy/function of the lymphangions as well as the response to therapy.
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J+Vasc+Surg+Venous+Lymphat+Disord 2017 ; 5 (2): 261-73
