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Indocyanine Green Lymphography Findings in Limb Lymphedema
Mitsunaga Narushima1, Takumi Yamamoto1, Fusa Ogata2
1Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
Insights
Indocyanine green (ICG) lymphography visualizes lymphatic channels for lymphedema evaluation. Advanced dermal backflow patterns correlate with disease progression, guiding treatment decisions for limb lymphedema.
Area of Science:
- Medical Imaging
- Vascular Surgery
- Lymphedema Management
Background:
- Indocyanine green (ICG) lymphography is a key imaging technique for assessing lymphatic system abnormalities.
- It utilizes near-infrared fluorescence imaging to visualize lymphatic channels and evaluate patients with limb lymphedema.
- Digitalization of fluorescence images allows for real-time display and analysis.
Purpose of the Study:
- To describe the patterns and stages of Indocyanine green (ICG) lymphography in lymphedema.
- To correlate ICG lymphography findings with disease progression and severity.
- To establish guidelines for treatment based on ICG lymphography staging.
Main Methods:
- Indocyanine green (ICG) was administered and visualized using a near-infrared camera.
- Fluorescence images were digitalized for real-time display and analysis.
- ICG lymphography patterns were classified as normal linear or abnormal dermal backflow (DB).
Main Results:
- ICG lymphography patterns progress from normal linear to various abnormal dermal backflow (DB) patterns (splash, stardust, diffuse) with lymphedema.
- A staging system (0-V for extremities, 0-IV for genital area) was developed based on ICG lymphography progression.
- DB stage II indicates symptomatic disease, while stages III-V suggest refractoriness to conservative therapies.
Conclusions:
- ICG lymphography provides a valuable tool for staging lymphedema progression.
- Aggressive treatments like lymphaticovenular anastomosis are indicated for symptomatic DB stage II lymphedema.
- Lymphaticovenular anastomosis is recommended for DB stages III-V due to poor response to conservative management.
Background And Methods:
Indocyanine green (ICG) lymphography is one of several methods of lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display.
Results:
ICG lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area.
Conclusion:
In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.
