MRI-CEUS Fusion-Guided Lymphatic Mapping as a Preoperative Strategy for Lymphedema Patients Undergoing Lymphaticovenous Anastomosis Surgery

Yongfeng Li; Jinglan Tang; Dewang Mao; Mihnea P Dragomir; Ying Li; Kewang Sun; Zhenye Lv; Xiaozhen Liu; Xuli Meng; Kefeng Lu

doi:10.1016/j.jvsv.2024.101907

MRI-CEUS Fusion-Guided Lymphatic Mapping as a Preoperative Strategy for Lymphedema Patients Undergoing Lymphaticovenous Anastomosis Surgery

J Vasc Surg Venous Lymphat Disord. 2024 May 15:101907. doi: 10.1016/j.jvsv.2024.101907. Online ahead of print.

Authors

Yongfeng Li¹, Jinglan Tang², Dewang Mao³, Mihnea P Dragomir⁴, Ying Li¹, Kewang Sun¹, Zhenye Lv¹, Xiaozhen Liu¹, Xuli Meng¹, Kefeng Lu⁵

Affiliations

¹ General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 314408 Zhejiang, China.
² Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 314408 Zhejiang, China.
³ Cancer Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 314408 Zhejiang, China.
⁴ Institute of Pathology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu, Berlin, Berlin, Germany; German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; Berlin Institute of Health, Berlin, Germany.
⁵ Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, 314408 Zhejiang, China. Electronic address: lukefeng@hmc.edu.cn.

PMID: 38759752
DOI: 10.1016/j.jvsv.2024.101907

Abstract

Objectives: Contrast-enhanced ultrasound (CEUS) is useful in mapping lymphatic vessels in upper limb lymphedema, this study was aimed to evaluate its efficiency in lower limb lymphedema and investigate whether magnetic resonance lymphangiography (MRL) enhance the efficiency of CEUS.

Methods: This retrospective study enrolled 48 patients with lymphedema undergoing lymphaticovenous anastomosis (LVA) surgery who received MRL and/or CEUS in addition to conventional indocyanine green (ICG) lymphangiography. The number of anastomotic sites and the duration per site (DPS) for LVA surgery were described and compared.

Results: Among the 48 patients subjected to analysis, it was observed that 12 (25%), 20 (41.67%), and 16 (33.33%) of them received ICG, ICG+CEUS, and ICG+CEUS+MRL, respectively. The ICG+CEUS group demonstrated a significant increase in the number of LVAs (median, 5 [range, 4 - 7]), compared to the ICG group (median, 2 [range, 1 - 4]) (p < .001). Moreover, the ICG+CEUS+MRL group exhibited a higher number of LVAs (median, 8 [range, 7 - 8.25]) compared to both the ICG+CEUS and ICG groups (p < .001). For lower limb lymphedema, the ICG+CEUS+MRL group displayed an elevated number of LVAs (median, 8 [interquartile range, 7 - 9]) (p = .003), in contrast to the ICG group (median, 3 [interquartile range, 1.75 - 4.25]). Furthermore, the DPS in the ICG+CEUS+MRL group (median, 50.56 [interquartile range, 48.13 - 59.29]) (p = .005) exhibited a remarkable decrease when compared to the ICG group (median, 131.25 [interquartile range, 86.75 - 198.13]).

Conclusion: MRL-CEUS fusion demonstrates superior performance in the identification of lymphatic vessel for lymphedema.

Keywords: MRI; lymphedema; lymphography; surgery; ultrasound.