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3.
Medicine (Baltimore) ; 99(34): e21725, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846791

RESUMO

Reports on lymphatic intervention for chylothorax complicating thoracic aortic surgery are limited. We aimed to evaluate technical and clinical outcomes of lymphangiography and thoracic duct embolization (TDE) for chylothorax complicating thoracic aortic surgery.Nine patients (mean age, 38.9 years) who underwent chylothorax interventions after thoracic aortic surgery (aorta replacement [n = 7] with [n = 2] or without [n = 5] lung resection, and vascular ring repair [n = 2]) were reviewed retrospectively. Magnetic resonance (MR) lymphangiograms were obtained in 5 patients. The median interval between surgery and conventional lymphangiography was 9 days (range, 4-28 days). TDE clinical success was defined as lymphatic leakage resolution with chest tube removal within 2 weeks.MR lymphangiograms revealed contrast leakage from the thoracic duct (n = 4) or no definite leakage (n = 1), which correlated well with conventional lymphangiogram findings. The technical success rate of conventional lymphangiography was 88.9% (8/9); 8 patients showed contrast leakage, while the patient without definite leakage on MR lymphangiography had small inguinal lymph nodes, and thoracic duct visualization by conventional lymphangiography failed. The technical success rates of antegrade and retrograde TDE via pleural access were 75% (6/8) and 100% (3/3), respectively. Clinical outcomes after embolization, as judged by the tube-removal day, were similar between low- (<500 mL/day) and high-output (≥500 mL/day) chylothorax patients. The drainage amount decreased significantly after lymphangiography/TDE, from 710.0 mL/day to 109.7 mL/day (p < .05). The clinical success rate of TDE was 87.8% (7/8).Conventional lymphangiography and TDE yielded high technical success rates and demonstrated encouraging clinical outcomes for chylothorax complicating thoracic aortic surgery.


Assuntos
Aorta Torácica/cirurgia , Quilotórax/terapia , Embolização Terapêutica/métodos , Linfografia/métodos , Complicações Pós-Operatórias/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adulto Jovem
4.
Kyobu Geka ; 73(6): 462-465, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32475974

RESUMO

A 74-year-old man underwent right upper lobectomy and systemic lymph node dissection with video-assisted thoracoscopic surgery. Chylothorax occurred on postoperative day (POD) 1st. Under fasting management, the patient underwent pleurodesis on POD 5th and 7th, subcutaneous octreotide acetate injection on POD 6th, and lymphangiography on POD 9th. The amount of drainage decreased on POD 10th, and the drainage tube was removed on POD 12nd. Lymphangiography has been reported as one of effective procedures to treat postoperative chylothorax. The present case is also considered to be successfully treated by lymphangiography.


Assuntos
Quilotórax , Linfografia/efeitos adversos , Complicações Pós-Operatórias , Idoso , Quilotórax/etiologia , Humanos , Excisão de Linfonodo , Masculino , Pleurodese , Cirurgia Torácica Vídeoassistida
5.
Medicine (Baltimore) ; 99(24): e20432, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541464

RESUMO

To ascertain the relationship between the perimetric differences obtained between the limbs and the type of fluoroscopic pattern observed by Indocyanine green (ICG) lymphography in patients with upper limb lymphedema.A correlational descriptive study was carried out in 19 patients with upper limb lymphedema secondary to breast cancer. The perimetric increase was recorded in 11 anatomical regions after ICG injection, fluoroscopic patterns were identified using an infrared camera. The ICG patterns were categorized into worse (stardust, diffuse) or better (linear, splash) patterns.The pattern coincidence between the anterior and posterior regions of the edematous extremities was 45%. At the wrist level, a difference of 2 cm was associated with the presence of a worse fluoroscopic pattern, whereas perimeter differences of 4.25 cm in the elbow and 2.25 cm in the arm (12 cm from the epicondyle) were associated with the presence of a better fluoroscopic pattern.The perimetric differences observed between the healthy and affected upper limbs in 4 specific anatomical areas allowed us to predict the type of fluoroscopic pattern. ICG lymphography has facilitated the study of the posterior regions of edema, which are difficult to visualize using other imaging techniques.


Assuntos
Verde de Indocianina/administração & dosagem , Vasos Linfáticos/diagnóstico por imagem , Linfedema/etiologia , Linfografia/métodos , Testes de Campo Visual/métodos , Adulto , Idoso , Neoplasias da Mama/complicações , Estudos de Casos e Controles , Estudos de Avaliação como Assunto , Feminino , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Humanos , Vasos Linfáticos/patologia , Linfedema/classificação , Linfedema/patologia , Pessoa de Meia-Idade , Espanha/epidemiologia , Extremidade Superior/anatomia & histologia , Extremidade Superior/diagnóstico por imagem
7.
Radiol Clin North Am ; 58(4): 693-706, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471538

RESUMO

Dynamic contrast-enhanced magnetic resonance lymphangiography is a novel technique to image central conducting lymphatics. It is performed by injecting contrast into groin lymph nodes and following passage of contrast through lymphatic system using T1-weighted MR images. Currently, it has been successfully applied to image and plan treatment of thoracic duct pathologies, lymphatic leaks, and other lymphatic abnormalities such as plastic bronchitis. It is useful in the assessment of chylothorax and chyloperitoneum. Its role in other areas such as intestinal lymphangiectasia and a variety of lymphatic anomalies is likely to increase.


Assuntos
Doenças Linfáticas/diagnóstico por imagem , Linfografia/métodos , Imagem por Ressonância Magnética , Humanos
8.
Ann R Coll Surg Engl ; 102(6): e115-e117, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32233848

RESUMO

The lymphatic system is a vital network of lymphatic vessels that carries liquid fluids, long-chain fatty acids and proteins from capillaries back to the vascular system and clears interstitial debris and bacteria. Lymphatic leakage is a condition not uncommon after many abdominal surgeries. It can lead to immunodeficiency and nutritional abnormalities. Moreover, it has high morbidity and mortality, ranging between 40% and 70%, depending on the presence of an underlying condition. A few lymphatic leakage cases after bariatric surgery have been reported in the literature. We report the first case of lymphatic leakage after sleeve gastrectomy, which was treated with conservative treatment.


Assuntos
Cirurgia Bariátrica/efeitos adversos , Ascite Quilosa/terapia , Tratamento Conservador/métodos , Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/terapia , Adulto , Cirurgia Bariátrica/métodos , Ascite Quilosa/diagnóstico , Ascite Quilosa/etiologia , Nutrição Enteral , Feminino , Gastrectomia/métodos , Fármacos Gastrointestinais/administração & dosagem , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/lesões , Linfografia , Obesidade Mórbida/cirurgia , Octreotida , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia
9.
Clin Imaging ; 64: 43-49, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32311633

RESUMO

PURPOSE: Percutaneous thoracic duct embolization (TDE) is an accepted treatment for leaks of the central lymphatic ducts. In this study, we correlate the imaging findings on pre-procedural MRI lymphangiography with findings on conventional lymphangiography, and with operator ability to perform a technically successful TDE. The aim was to examine whether MRI is a good screening mechanism to support an invasive procedure in strong candidates, and avert one in poor candidates. MATERIALS AND METHODS: MRI and conventional lymphangiograms of 96 patients (62 male and 34 female; mean age 63 ± 11 years, range 29-92 years) were retrospectively reviewed. The diameter and level of the best target for access were assessed for each study. Technical success rates were evaluated with respect to presence of a cisterna chyli, target duct size, and target level concordance. RESULTS: Presence of a cisterna chyli on MRI significantly increased the likelihood of a successful TDE (68% vs. 42%, p = 0.03). Presence of a duct 4 mm or larger, by either modality, significantly improved the chance of successful TDE (for MRI, 65% vs. 41%, p = 0.04; for lymphangiography, 70% vs. 44%, p = 0.03). MRI was not helpful for localizing a lymphatic target, as less than half were seen within one and one-half vertebrae of the predicted level. There was a weak correlation (Pearson coefficient = +0.30) between duct size as measured on the two modalities. 95% of those without an identifiable target on MRI had a viable target on lymphangiography, and successful TDE was performed in 47% of those patients. CONCLUSIONS: Identification of a cisterna chyli and/or 4 mm or greater target on pre-procedural MRI indicated higher likelihood of technically successful TDE. MRI did not help predict unsuccessful TDE procedures. Better target level concordance was not associated with improved technical outcomes.


Assuntos
Quilotórax/diagnóstico por imagem , Embolização Terapêutica/métodos , Imagem por Ressonância Magnética , Ducto Torácico/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfografia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
10.
Radiol Med ; 125(8): 798-799, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32180151

RESUMO

MR lymphangiography (MRL) is an emerging technique focalized on a noninvasive or minimally invasive imaging of lymphatics with the goal to treat and plan lymphedema. Doctor Cellina M. and colleagues clearly underlined the possible role of MRL with volume calculation as an objective mark also in evaluating response to treatment. In this Letter to the Editor, we would like to highlight the rising role of MRL, pointing out the advantages of both the non-contrast and contrast-enhanced approach, in lymphatic vessels study.


Assuntos
Vasos Linfáticos , Linfedema , Humanos , Linfografia , Imagem por Ressonância Magnética
11.
Radiology ; 295(2): 467-468, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32208965
14.
Radiology ; 295(2): 469-474, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32096709

RESUMO

Background Detailed visualization of the lymphatic vessels would greatly assist in the diagnosis and monitoring of lymphatic diseases and aid in preoperative planning of lymphedema surgery and postoperative evaluation. Purpose To evaluate the usefulness of photoacoustic imaging (PAI) for obtaining three-dimensional images of both lymphatic vessels and surrounding venules. Materials and Methods In this prospective study, the authors recruited healthy participants from March 2018 to January 2019 and imaged lymphatic vessels in the lower limbs. Indocyanine green (5.0 mg/mL) was injected into the subcutaneous tissue of the first and fourth web spaces of the toes and below the lateral malleolus. After confirmation of the lymphatic flow with near-infrared fluorescence (NIRF) imaging as the reference standard, PAI was performed over a field of view of 270 × 180 mm. Subsequently, the number of enhancing lymphatic vessels was counted in both proximal and distal areas of the calf and compared between PAI and NIRF. Results Images of the lower limbs were obtained with PAI and NIRF in 15 participants (three men, 12 women; average age, 42 years ± 12 [standard deviation]). All participants exhibited a linear pattern on NIRF images, which is generally considered a reflection of good lymphatic function. A greater number of lymphatic vessels were observed with PAI than with NIRF in both the distal (mean: 3.6 vessels ± 1.2 vs 2.0 vessels ± 1.1, respectively; P < .05) and proximal (mean: 6.5 vessels ± 2.6 vs 2.6 vessels ± 1.6; P < .05) regions of the calf. Conclusion Compared with near-infrared fluorescence imaging, photoacoustic imaging provided a detailed, three-dimensional representation of the lymphatic vessels and facilitated an increased understanding of their relationship with the surrounding venules. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Lillis and Krishnamurthy in this issue.


Assuntos
Extremidade Inferior/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Linfografia/métodos , Técnicas Fotoacústicas/métodos , Adulto , Feminino , Fluorescência , Voluntários Saudáveis , Humanos , Imageamento Tridimensional , Verde de Indocianina , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
J Surg Oncol ; 121(6): 964-966, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32103507

RESUMO

BACKGROUND: Near-infrared (NIR) fluorescence imaging has recently been introduced to the sentinel lymph node (SLN) mapping because of the benefits of the SLN biopsy, such as providing real-time and high-resolution optical guidance. Methylene blue is available and less expensive as an SLN mapping tracer. Our study aims to identify SLN through the NIR fluorescence imaging system mediated by blue dye. METHODS: Early-stage breast cancer patients were prospectively enrolled. All participants received a subareolar or peritumoral injection of 1 mL methylene blue (MB) before surgery. The MB fluorescence system was set immediately after injection. SLNs were searched and removed under the guidance of fluorescence and blue dye. RESULTS: We identified SLN adequately with the help of real-time lymphography and blue dye. Symbolic lymphatic drainage patterns were also observed. CONCLUSION: NIR fluorescence imaging mediated by blue dye has benefits on the identification of lymph vessels, the location of SLN, and the patterns of breast lymphatic flow.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Azul de Metileno , Linfonodo Sentinela/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Neoplasias da Mama/patologia , Corantes , Sistemas Computacionais , Feminino , Humanos , Linfografia/métodos , Estadiamento de Neoplasias , Linfonodo Sentinela/patologia , Espectrometria de Fluorescência/métodos
17.
PLoS One ; 15(1): e0227814, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940420

RESUMO

BACKGROUND: Previously, we showed that lymphatic vessels (LVs) formed detours after lymphatic obstruction, contributing to preventing lymphedema. In this study, we developed detours using lymphatic ligation in mice and we identified the detours histologically. METHODS AND RESULTS: Under anesthesia, both hindlimbs in mice were subcutaneously injected with Evans blue dye to detect LVs. We tied the right collecting LV on the abdomen that passes through the inguinal lymph node (LN) at two points. The right and left sides comprised the operation and sham operation sides, respectively. Lymphography was performed to investigate the lymph flow after lymphatic ligation until day 30, using a near-infrared fluorescence imaging system. Anti-podoplanin antibody and 5-ethynyl-2'-deoxyuridine (EdU) were used to detect LVs and lymphangiogenesis. Within 30 days, detours had developed in 62.5% of the mice. Detours observed between two ligation sites were enlarged and irregular in shape. Podoplanin+ LVs, which were located in the subcutaneous tissue of the upper panniculus carnosus muscle, connected to collecting LVs at the upper portion from the cranial ligation site and at the lower portion from the caudal ligation site. EdU+ cells were not observed in these detours. The sham operation side showed normal lymph flow and did not show enlarged pre-collecting LVs until day 30. CONCLUSIONS: Detours after lymphatic ligation were formed not by lymphangiogenesis but through an enlargement of pre-collecting LVs that functioned as collecting LVs after lymphatic ligation. Further studies are required to explore the developmental mechanism of the lymphatic detour for treatment and effective care of lymphedema in humans.


Assuntos
Linfangiogênese , Vasos Linfáticos/diagnóstico por imagem , Linfedema/diagnóstico por imagem , Animais , Ligadura , Linfografia , Masculino , Camundongos , Camundongos Endogâmicos C57BL
18.
Radiology ; 294(1): 223-229, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31746690

RESUMO

Background Most lymphatic imaging examinations of the lower limb require intradermal or subcutaneous injection of tracer material into the foot to demonstrate the lymphatic vessels; however, no standard protocol exists, and single or multiple injections are applied at different sites. Purpose To determine the three-dimensional relationships between each lymphatic group of the lower limb and corresponding regional lymph nodes. Materials and Methods A total of 130 lower limbs (55 from men and 75 from women) from 83 fresh human cadavers were studied. Lymphatic vessels were first visualized by using indocyanine green fluorescent lymphography with 19 injection sites in the foot, classified into four distinct lymphatic groups (anteromedial, anterolateral, posteromedial, and posterolateral); dilute oil-based contrast material was then injected. Next, specimens were scanned with CT and three-dimensional images were analyzed. Results The anteromedial and anterolateral lymphatic groups of the lower-leg lymphatic vessels were independent of each other and connected to different regional lymph nodes in the inguinal region. The posteromedial group and the anteromedial group in the lower leg drained to the same inguinal lymph nodes. Only the posterolateral group of lymphatic vessels in the lower leg drained to the popliteal lymph nodes. Leg lymphatic drainage pathways were independent of genital pathways. Conclusion Standard injection sites at the web spaces between the toes did not help visualize some lymph nodes of the lower leg. Additional injection sites in the medial, lateral, and posterior aspect of the foot would be better for evaluating the whole lymphatic pathways and regional lymph nodes and for improving understanding of leg lymphedema. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Weiss and Liddel in this issue.


Assuntos
Imageamento Tridimensional/métodos , Extremidade Inferior/diagnóstico por imagem , Linfonodos/irrigação sanguínea , Linfonodos/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Linfografia/métodos , Cadáver , Meios de Contraste , Feminino , Humanos , Verde de Indocianina , Masculino , Tomografia Computadorizada por Raios X
20.
AJR Am J Roentgenol ; 214(1): 105-113, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31613660

RESUMO

OBJECTIVE. The objective of our study was to evaluate the utility of ferumoxytol-enhanced MR lymphography (MRL) in detection of metastatic lymph nodes (LNs) in patients with prostate, bladder, and kidney cancer. SUBJECTS AND METHODS. This phase 2 single-institution study enrolled patients with confirmed prostate (arm 1), bladder (arm 2), and kidney (arm 3) cancer and evidence of suspected LN involvement. Participants underwent ferumoxytol-enhanced MRL 24 and 48 hours after IV injection of 7.5 mg Fe/kg of ferumoxytol. A retrospective quantitative analysis was performed to determine the optimal timing for ferumoxytol-enhanced MRL using percentage change in normalized signal intensity (SI) from baseline to 24 and 48 hours after injection, which were estimated using the linear mixed-effects model in which time (24 vs 48 hours), diseases status, and time and disease status interaction were the fixed-effects independent variables. Differences in normalized SI values between subgroups of lesions were estimated by forming fixed-effects contrasts and tested by the Wald test. RESULTS. Thirty-nine patients (n = 30, arm 1; n = 6, arm 2; n = 3, arm 3) (median age, 65 years) with 145 LNs (metastatic, n = 100; benign, n = 45) were included. LN-based sensitivity, specificity, positive predictive value, and negative predictive value of ferumoxytol-enhanced MRL was 98.0%, 64.4%, 86.0%, and 93.5%, respectively. Sensitivity and specificity of ferumoxytol-enhanced MRL did not vary by LN size. Metastatic LNs showed a significantly higher percentage decrease of normalized SI on MRL at 24 hours after ferumoxytol injection than at 48 hours after ferumoxytol injection (p = 0.023), whereas the normalized SI values for nonmetastatic LNs were similar at both imaging time points (p = 0.260). CONCLUSION. Ferumoxytol-enhanced MRL shows high sensitivity in the detection of metastatic LNs in genitourinary cancers independent of LN size. The SI difference between benign and malignant LNs on ferumoxytol-enhanced MRL appears similar 24 and 48 hours after ferumoxytol injection, suggesting that imaging can be performed safely within 1 or 2 days of injection. Although ferumoxytol-enhanced MRL can be useful in settings without an available targeted PET agent, issues of iron overload and repeatability of ferumoxytol-enhanced MRL remain concerns for this method.


Assuntos
Óxido Ferroso-Férrico , Neoplasias Renais/patologia , Metástase Linfática/diagnóstico por imagem , Linfografia/métodos , Imagem por Ressonância Magnética , Neoplasias da Próstata/patologia , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
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