Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study

Abstract

Background We investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema. Materials and methods A total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and four types of dermal backflow patterns (absent; distal only; proximal only; whole lower limb) were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole lower limb at 3 months (early response) and 1 year (late response) was measured. Volume difference ratios (continuous variable and binary variable with a cut-off value of zero) were compared according to the lymphoscintigraphic variables. Results The group with whole lower limb dermal backflow had a greater volume change than the other groups (p = 0.047). The group with dermal backflow in the whole lower limb OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p = 0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p = 0.016, p = 0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p = 0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p = 0.040). Conclusions Preoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

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

“…No clear relation between lymphatic vessel visualization and CDT treatment success was found; 33 however, visibly dilated lymph vessels, altered flow, and DBF patterns were significantly related to better LVB surgery outcomes. 44 – 46 …”

“…No clear relation between lymphatic vessel visualization and CDT treatment success was found; 33 however, visibly dilated lymph vessels, altered flow, and DBF patterns were significantly related to better LVB surgery outcomes. [44][45][46] Injection and Imaging Protocols Contrast agents were generally injected subcutaneously, and intradermal injections in smaller numbers (electronic supplementary Table 3). Intradermal injections yielded better image quality of the superficial lymphatics and are therefore a more accurate assessment.…”

Yellow nail syndrome accompanied by minimal-change nephrotic syndrome: A case report

“…Lymphedema mainly affects both lower limbs[ 14 ]. Lymphoscintigraphy is an effective imaging modality that is widely used for differential diagnosis of lymphedema and for determining the extent of the disease[ 15 ]. Lymphoscintigraphy of this case revealed that lymphatic vessels of the right lower limb were interrupted and collateral circulation appeared in the lymphatic vessels below the left knee which resulted in edema of both lower limbs (Figure 1D ).…”

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

“…A recent study by Kwon et al [24] has opened up the possibility of using quantitative parameters to predict surgical procedure outcomes. The aim of the study was to investi- The quantitative method is more sensitive when used in the diagnosis of lymphedema, especially in the earliest stages, where slight differences are difficult to assess.…”

“…A recent study by Kwon et al [24] has opened up the possibility of using quantitative parameters to predict surgical procedure outcomes. The aim of the study was to investigate factors predicting early and late treatment outcomes using lymphoscintigraphic factors before LVA.…”