Quantifying Lymphatic Contraction Using ICG Lymphography: A Novel Approach to Lymphedema Assessment
Bao Ngoc Tran, MD1, Echoe Bouta, PHD2, Bernard Lee, MD, MPH, MBA1, Timothy Padera, PhD2, Dhruv Singhal, MD1.
1Beth Israel Deaconess Medical Center, Boston, MA, USA, 2Massachusette General Hospital, Boston, MA, USA.
PURPOSE: Indocyanine Green (ICG) lymphography helps detect superficial lymphatic channels, and has become an instrumental component of lymphedema diagnosis and preoperative planning. ICG lymphography's signal intensity can also be used to calculate contraction frequency. This study aims to describe changes in lymphatic contractions in lymphedema using ICG lymphography.
METHODS: ICG lymphography videos were recorded over 3 minutes for both unaffected and affected limb in 4 subjects with upper extremity lymphedema. Videos were then stabilized in ImageJ and then StackReg plug-in. A region of interest was placed on a clear lymphatic vessel in each video and the signal intensity was recorded for the duration of the video. Peaks in signal intensity were used to calculate the contraction frequency per min. This process was performed for lymphatics of the dorsal hand/foot and forearm/calf.
RESULTS: Four subjects with upper extremity lymphedema presented with ILS Stage 1-3 and all underwent axillary lymph node dissection for their treatment of breast cancer. The mean contraction frequency of lymphatics in the dorsum of the hand/foot in the unaffected limb was 0.9 and the affected limb 2.8 (p=0.12). The mean contraction frequency of lymphatics in the forearm/calf in the unaffected limb was 1.3 and the affected limb 0 (p=0.04).
CONCLUSION: This is the first time ICG lymphography was used to measure lymphatic contraction frequency. The data suggested a potential increase in frequency with the more distal lymphatics. Further study with larger cohort of subjects is needed to observe possible correlation and patterns of lymphatic contraction and disease progression.
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