Abstract: Three-Dimensional Analysis of Superficial Lymphatic Vessels in Patients with Lower Extremity Lymphedema Using Photoacoustic Imaging (Plastic Surgery The Meeting (September 28

Saturday, September 29, 2018: 9:00 AM

Shiho Watanabe, MD , Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan

Hiroki Kajita, MD , Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan

Anna Oh, MD , Department of Plastic and Reconstructive Surgery, Tachikawa Hospital, Tokyo, Japan

Hisashi Sakuma, MD, PhD , Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan

Keisuke Okabe, MD, PhD , Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan

Noriko Aramaki-Hattori, MD, PhD , Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan

Nobuko Konishi, RPT , Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Tetsuya Tsuji, MD, PhD , Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Nobuaki Imanishi, MD, PhD , Department of Anatomy, Keio University School of Medicine, Tokyo, Japan

Moemi Urano, MS , Department of Anatomy, Keio University School of Medicine, Tokyo, Japan

Yoshifumi Takatsume, MD , Department of Anatomy, Keio University School of Medicine, Tokyo, Japan

Hiroyuki Sekiguchi, PhD , Kyoto University, Kyoto, Japan

Yasufumi Asao, PhD , Japan Science and Technology Agency, ImPACT Program, Cabinet Office, Tokyo, Japan

Takayuki Yagi, MS , Japan Science and Technology Agency, ImPACT Program, Cabinet Office, Tokyo, Japan

Sadakazu Aiso, MD, PhD , Department of Anatomy, Keio University School of Medicine, Tokyo, Japan

Kazuo Kishi, MD, PhD , Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan

Purpose: Photoacoustic imaging (PAI) technology can clearly show three-dimensional images of superficial lymphatic vessels and the venous system. This study analyzed the morphological findings of lymphatic vessels in the affected extremities of patients with lymphedema.

Materials and Methods: We used the PAI-05 system with a semi-spherical detector array, which was made by Canon Inc. (Japan), Hitachi, Ltd. (Japan), and Japan Probe Co, Ltd.(Japan). Four patients (1 male, 3 females) with lower extremity lymphedema, including one primary case and three secondary cases, underwent a PAI study. Indocyanine green (ICG), was administered subcutaneously at three sites in the dorsal aspect of the affected foot, and ICG fluorescent lymphography was performed using a near-infrared camera system, before PAI examination. In those patients in whom dermal backflow(DBF) was observed with fluorescent lymphography, lesions were also examined with PAI, if possible. 1), 2)

Results: More lymphatic collecting vessels were observed with PAI than with fluorescent lymphography. In PAI images, each lymphatic vessel in a lymphatic bundle was observed (fig. 1), which was detected as a diffuse line in fluorescent lymphography. PAI also revealed the depth of each vessel. DBF was visualized as dense interconnecting three-dimensional structures of lymphatic vessels comprising dilated precollectors or lymphatic capillaries above and collecting vessels below(fig.2).

Conclusions: PAI showed collecting lymphatic vessels that were not observed with fluorescent lymphography, as well as the three-dimensional structure of DBF. PAI is a promising imaging modality, especially for detection of morphological changes in lymphatic vessels during progression of lymphedema.

Acknowledgement: This work was funded by the ImPACT Program of the Council for Science, Technology, and Innovation (Cabinet Office, Government of Japan).

Reference:

Zackrisson S, van de Ven SMWY, Gambhir SS. Light In and Sound Out: Emerging Translational Strategies for Photoacoustic Imaging. Cancer Res. 2014;74(4):979-1004.
Forbrich A, Heinmiller A, Zemp RJ. Photoacoustic imaging of lymphatic pumping. J. Biomed. Opt. 2017;22(10), 106003. doi: 10.1117/1.JBO.22.10.106003.

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37009 Three-Dimensional Analysis of Superficial Lymphatic Vessels in Patients with Lower Extremity Lymphedema Using Photoacoustic Imaging