Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs
Identifieur interne : 002946 ( Pmc/Checkpoint ); précédent : 002945; suivant : 002947Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs
Auteurs : Makoto Mihara [Japon] ; Hisako Hara [Japon] ; Jun Araki [Japon] ; Kazuki Kikuchi [Japon] ; Mitsunaga Narushima [Japon] ; Takumi Yamamoto (chirurgien) [Japon] ; Takuya Iida [Japon] ; Hidehiko Yoshimatsu [Japon] ; Noriyuki Murai [Japon] ; Kito Mitsui [Japon] ; Taro Okitsu [Japon] ; Isao Koshima [Japon]Source :
- PLoS ONE [ 1932-6203 ] ; 2012.
Abstract
Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.
Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35–81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis.
The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases.
Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.
Url:
DOI: 10.1371/journal.pone.0038182
PubMed: 22675520
PubMed Central: 3366958
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Tokyo</orgName></affiliation></author><author><name sortKey="Narushima, Mitsunaga" sort="Narushima, Mitsunaga" uniqKey="Narushima M" first="Mitsunaga" last="Narushima">Mitsunaga Narushima</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Yamamoto, Takumi" sort="Yamamoto, Takumi" uniqKey="Yamamoto T" first="Takumi" last="Yamamoto">Takumi Yamamoto (chirurgien)</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic 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xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Yoshimatsu, Hidehiko" sort="Yoshimatsu, Hidehiko" uniqKey="Yoshimatsu H" first="Hidehiko" last="Yoshimatsu">Hidehiko Yoshimatsu</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Murai, Noriyuki" sort="Murai, Noriyuki" uniqKey="Murai N" first="Noriyuki" last="Murai">Noriyuki Murai</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama</wicri:regionArea><wicri:noRegion>Saitama</wicri:noRegion></affiliation></author><author><name sortKey="Mitsui, Kito" sort="Mitsui, Kito" uniqKey="Mitsui K" first="Kito" last="Mitsui">Kito Mitsui</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama</wicri:regionArea><wicri:noRegion>Saitama</wicri:noRegion></affiliation></author><author><name sortKey="Okitsu, Taro" sort="Okitsu, Taro" uniqKey="Okitsu T" first="Taro" last="Okitsu">Taro Okitsu</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Department of Rehabilitation Medicine, Keio University, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Rehabilitation Medicine, Keio University, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Koshima, Isao" sort="Koshima, Isao" uniqKey="Koshima I" first="Isao" last="Koshima">Isao Koshima</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22675520</idno><idno type="pmc">3366958</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366958</idno><idno type="RBID">PMC:3366958</idno><idno type="doi">10.1371/journal.pone.0038182</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">004438</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004438</idno><idno type="wicri:Area/Pmc/Curation">004437</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004437</idno><idno 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type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Hara, Hisako" sort="Hara, Hisako" uniqKey="Hara H" first="Hisako" last="Hara">Hisako Hara</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Araki, Jun" sort="Araki, Jun" uniqKey="Araki J" first="Jun" last="Araki">Jun Araki</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Kikuchi, Kazuki" sort="Kikuchi, Kazuki" uniqKey="Kikuchi K" first="Kazuki" last="Kikuchi">Kazuki Kikuchi</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Narushima, Mitsunaga" sort="Narushima, Mitsunaga" uniqKey="Narushima M" first="Mitsunaga" last="Narushima">Mitsunaga Narushima</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Yamamoto, Takumi" sort="Yamamoto, Takumi" uniqKey="Yamamoto T" first="Takumi" last="Yamamoto">Takumi Yamamoto (chirurgien)</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName><placeName><settlement type="city">Tokyo</settlement><region type="province">Région de Kantō</region></placeName><orgName type="university" n="3">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Iida, Takuya" sort="Iida, Takuya" uniqKey="Iida T" first="Takuya" last="Iida">Takuya Iida</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Yoshimatsu, Hidehiko" sort="Yoshimatsu, Hidehiko" uniqKey="Yoshimatsu H" first="Hidehiko" last="Yoshimatsu">Hidehiko Yoshimatsu</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author><author><name sortKey="Murai, Noriyuki" sort="Murai, Noriyuki" uniqKey="Murai N" first="Noriyuki" last="Murai">Noriyuki Murai</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama</wicri:regionArea><wicri:noRegion>Saitama</wicri:noRegion></affiliation></author><author><name sortKey="Mitsui, Kito" sort="Mitsui, Kito" uniqKey="Mitsui K" first="Kito" last="Mitsui">Kito Mitsui</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama</wicri:regionArea><wicri:noRegion>Saitama</wicri:noRegion></affiliation></author><author><name sortKey="Okitsu, Taro" sort="Okitsu, Taro" uniqKey="Okitsu T" first="Taro" last="Okitsu">Taro Okitsu</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Department of Rehabilitation Medicine, Keio University, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Rehabilitation Medicine, Keio University, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Koshima, Isao" sort="Koshima, Isao" uniqKey="Koshima I" first="Isao" last="Koshima">Isao Koshima</name><affiliation wicri:level="4"><nlm:aff id="aff1"><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region><settlement type="city">Tokyo</settlement></placeName><orgName type="university">Université de Tokyo</orgName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.</p></sec><sec><title>Patients and Methods</title><p>Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35–81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis.</p></sec><sec><title>Results</title><p>The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases.</p></sec><sec><title>Conclusions</title><p>Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Finnane, A" uniqKey="Finnane A">A Finnane</name></author><author><name sortKey="Hayes, Sc" uniqKey="Hayes S">SC Hayes</name></author><author><name sortKey="Obermair, A" uniqKey="Obermair A">A Obermair</name></author><author><name sortKey="Janda, M" uniqKey="Janda M">M Janda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim Do, S" uniqKey="Kim Do S">S Kim do</name></author><author><name sortKey="Sim, Yj" uniqKey="Sim Y">YJ Sim</name></author><author><name sortKey="Jeong, Hj" uniqKey="Jeong H">HJ Jeong</name></author><author><name sortKey="Kim, Gc" uniqKey="Kim 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22675520</article-id><article-id pub-id-type="pmc">3366958</article-id><article-id pub-id-type="publisher-id">PONE-D-12-04766</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0038182</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology</subject><subj-group><subject>Anatomy and Physiology</subject><subj-group><subject>Immune Physiology</subject><subj-group><subject>Lymphatic System</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Anatomy and Physiology</subject><subj-group><subject>Immune Physiology</subject><subj-group><subject>Lymphatic System</subject></subj-group></subj-group><subj-group><subject>Fluid Physiology</subject><subject>Skin</subject></subj-group></subj-group><subj-group><subject>Cardiovascular</subject><subj-group><subject>Peripheral Vascular Diseases</subject><subject>Vascular Biology</subject></subj-group></subj-group><subj-group><subject>Radiology</subject><subj-group><subject>Nuclear Medicine</subject><subj-group><subject>Radionuclide Imaging</subject></subj-group></subj-group><subj-group><subject>Diagnostic Radiology</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Indocyanine Green (ICG) Lymphography Is Superior to Lymphoscintigraphy for Diagnostic Imaging of Early Lymphedema of the Upper Limbs</article-title><alt-title alt-title-type="running-head">Indocyanin Green(ICG) Lymphography for Lymphaedema</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Mihara</surname><given-names>Makoto</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Hara</surname><given-names>Hisako</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Araki</surname><given-names>Jun</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kikuchi</surname><given-names>Kazuki</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Narushima</surname><given-names>Mitsunaga</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yamamoto</surname><given-names>Takumi</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Iida</surname><given-names>Takuya</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yoshimatsu</surname><given-names>Hidehiko</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Murai</surname><given-names>Noriyuki</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mitsui</surname><given-names>Kito</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Okitsu</surname><given-names>Taro</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Koshima</surname><given-names>Isao</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Saitama, Japan</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Department of Rehabilitation Medicine, Keio University, Tokyo, Japan</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Gelovani</surname><given-names>Juri G.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">University of Texas, M.D. Anderson Cancer Center, United States of America</aff><author-notes><corresp id="cor1">* E-mail: <email>mihara@keiseigeka.name</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: MM HH. Performed the experiments: MM HH JA MN TY TI HY NM KM TO IK. Analyzed the data: MM HH KK. Contributed reagents/materials/analysis tools: MM HH. Wrote the paper: MM HH.</p></fn></author-notes><pub-date pub-type="collection"><year>2012</year></pub-date><pub-date pub-type="epub"><day>4</day><month>6</month><year>2012</year></pub-date><volume>7</volume><issue>6</issue><elocation-id>e38182</elocation-id><history><date date-type="received"><day>8</day><month>2</month><year>2012</year></date><date date-type="accepted"><day>1</day><month>5</month><year>2012</year></date></history><permissions><copyright-statement>Mihara et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</copyright-statement><copyright-year>2012</copyright-year></permissions><abstract><sec><title>Background</title><p>Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography.</p></sec><sec><title>Patients and Methods</title><p>Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35–81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis.</p></sec><sec><title>Results</title><p>The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases.</p></sec><sec><title>Conclusions</title><p>Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.</p></sec></abstract><counts><page-count count="9"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Japon</li></country><region><li>Région de Kantō</li></region><settlement><li>Tokyo</li></settlement><orgName><li>Université de Tokyo</li></orgName></list><tree><country name="Japon"><region name="Région de Kantō"><name sortKey="Mihara, Makoto" sort="Mihara, Makoto" uniqKey="Mihara M" first="Makoto" last="Mihara">Makoto Mihara</name></region><name sortKey="Araki, Jun" sort="Araki, Jun" uniqKey="Araki J" first="Jun" last="Araki">Jun Araki</name><name sortKey="Hara, Hisako" sort="Hara, Hisako" uniqKey="Hara H" first="Hisako" last="Hara">Hisako Hara</name><name sortKey="Iida, Takuya" sort="Iida, Takuya" uniqKey="Iida T" first="Takuya" last="Iida">Takuya Iida</name><name sortKey="Kikuchi, Kazuki" sort="Kikuchi, Kazuki" uniqKey="Kikuchi K" first="Kazuki" last="Kikuchi">Kazuki Kikuchi</name><name sortKey="Koshima, Isao" sort="Koshima, Isao" uniqKey="Koshima I" first="Isao" last="Koshima">Isao Koshima</name><name sortKey="Mitsui, Kito" sort="Mitsui, Kito" uniqKey="Mitsui K" first="Kito" last="Mitsui">Kito Mitsui</name><name sortKey="Murai, Noriyuki" sort="Murai, Noriyuki" uniqKey="Murai N" first="Noriyuki" last="Murai">Noriyuki Murai</name><name sortKey="Narushima, Mitsunaga" sort="Narushima, Mitsunaga" uniqKey="Narushima M" first="Mitsunaga" last="Narushima">Mitsunaga Narushima</name><name sortKey="Okitsu, Taro" sort="Okitsu, Taro" uniqKey="Okitsu T" first="Taro" last="Okitsu">Taro Okitsu</name><name sortKey="Yamamoto, Takumi" sort="Yamamoto, Takumi" uniqKey="Yamamoto T" first="Takumi" last="Yamamoto">Takumi Yamamoto (chirurgien)</name><name sortKey="Yoshimatsu, Hidehiko" sort="Yoshimatsu, Hidehiko" uniqKey="Yoshimatsu H" first="Hidehiko" last="Yoshimatsu">Hidehiko Yoshimatsu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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