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Lionel Arrivé - One of the best experts on this subject based on the ideXlab platform.
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Non-contrast MR Lymphography of the lymphatic system of the liver
European Radiology, 2019Co-Authors: Lionel Arrivé, Laurence Monnier-cholley, Nora Cazzagon, Dominique Wendum, Edouard Chambenois, Sanaâ MouhadiAbstract:This review shows the images obtained with non-contrast MR Lymphography in different pathologic conditions affecting the liver. Non-contrast MR Lymphography is obtained with a free-breathing 3D high spatial resolution fast-recovery fast spin-echo sequence similar to that used for 3D MR cholangiopancreatography. The liver is the largest lymph-producing organ generating approximately half of the body’s lymphatic fluid and is the most important part of the lymphatic system from a functional point of view. Therefore, understanding the anatomy, physiology, and physiopathology of the lymphatics of the liver is important. However, its anatomy and pathology are relatively unknown because of the absence of commonly used imaging techniques. We describe the anatomy, the physiology, and the pathophysiology of the lymphatic system of the liver and the possibility of identifying dilated lymphatic vessels in various liver diseases and conditions. Disruption of normal lymphatic structure and function is observed in various disease conditions. Liver lymph flow is directly correlated with portal venous pressure. Therefore, a dilatation of liver lymphatics is observed in portal hypertension as well as in increased pressure in hepatic veins. After liver transplantation, ligation of lymphatic vessels at the hilum reduces chylous ascites and results in lymphatic dilatation which is easily observed. In severe long-standing biliary stenosis, dilated lymphatic vessels are commonly demonstrated with non-contrast MR Lymphography. In hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and some metastases, lymphatic vessels are abundant in the immediate vicinity of the tumour. These various lymphatic abnormalities can be demonstrated with non-contrast MR Lymphography. Key Points • Anatomy and pathology of the lymphatics of the liver are relatively unknown, partly because of lack of current imaging technique. • Non-contrast MR Lymphography is obtained with a free-breathing 3D high spatial resolution fast spin-echo sequence similar to that used for 3D MR cholangiopancreatography. • Non-contrast MR Lymphography may participate to the understanding of several abnormal liver conditions including portal hypertension, biliary diseases, and malignant hepatic tumours.
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primary lower limb lymphoedema classification with non contrast mr Lymphography
European Radiology, 2018Co-Authors: Lionel Arrivé, Yves Menu, S Derhy, B Dahan, El S Mouhadi, L Monniercholley, Corinne BeckerAbstract:The purpose of the present study was to analyse the performance of non-contrast MR Lymphography for the classification of primary lower limb lymphoedema in 121 consecutive patients with 187 primary lower limb lymphoedemas. 121 consecutive patients with clinically diagnosed primary lower limb lymphoedema underwent non-contrast MR Lymphography with a free-breathing 3D fast spin-echo sequence with a very long TR/TE (4000/884 ms). MR examinations were retrospectively reviewed for severity of lymphoedema (absent, mild, moderate, severe) and characteristics of inguinal lymph nodes and iliac and inguinal lymphatic trunks graded as aplasic (no lymph nodes or lymphatic trunks), hypoplasic (less lymph nodes or lymphatic trunks), normal and hyperplasic (more lymph nodes or more and/or dilated trunks). There was an excellent correlation between clinical stage and severity of lymphoedema (Cramer’s V of 0,73 (p < 0.001)). Differentiation was feasible between inguinal lymphatic vessel aplasia (21%), hypoplasia (15%), normal pattern (53%) and hyperplasia (11%). Severe lymphoedema was observed in 46% of aplasic patterns and in 37% of hyperplasic patterns, but in only 15% of hypoplasic patterns and never observed in normal patterns (p < 0.001). Non-contrast MR Lymphography is able to classify primary lower limb lymphoedemas into hyperplasic, aplasic, hypoplasic and normal patterns. • Non-contrast MR Lymphography is able to classify primary lower limb lymphoedemas. • Lymphoedema can be classified in hyperplasic, aplasic, hypoplasic and normal patterns. • Non-contrast MR Lymphography can optimize clinical management of primary lower limb lymphoedemas.
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Non-contrast 3D MR Lymphography of retroperitoneal lymphatic aneurysmal dilatation: a continuous spectrum of change from normal variants to cystic lymphangioma
Insights into Imaging, 2013Co-Authors: Sarah Derhy, Sanaâ Mouhadi, Ana Ruiz, Louisa Azizi, Yves Menu, Lionel ArrivéAbstract:Objective Our objective was to demonstrate the characteristic features of retroperitoneal lymphatic aneurysmal dilatation with three-dimensional (3D) magnetic resonance (MR) Lymphography. Conclusion Three-dimensional MR Lymphography demonstrates that retroperitoneal lymphatic aneurysmal dilatation exhibits a continuous spectrum of change from normal variants to lymphatic aneurysmal dilatation and so-called cystic lymphangioma. Main Message Non-contrast MR Lymphography with very heavily T2-weighted fast spin echo sequences is a useful non-invasive technique without the need of contrast medium injection to obtain a unique evaluation of the lymphatic system To prove the lymphatic origin of a cystic formation, it is essential to demonstrate the communication with retroperitoneal lymphatic vessels 3D MR Lymphography demonstrates that retroperitoneal lymphatic aneurysmal dilatation exhibits a continuous spectrum of change from normal variants to lymphatic aneurysmal dilatation and so-called cystic lymphangioma
Isao Koshima - One of the best experts on this subject based on the ideXlab platform.
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visualization of accessory lymphatic pathways in secondary upper extremity lymphedema using indocyanine green Lymphography
Annals of Plastic Surgery, 2017Co-Authors: Kensuke Tashiro, Isao Koshima, Shuji Yamashita, Shimpei MiyamotoAbstract:INTRODUCTION The anatomical variations in accessory lymphatic pathways around the axillary region may work as a drainage route for excess lymphatic fluid accumulation in secondary upper extremity lymphedema. In this report, accessory lymphatic pathways extending to the shoulder, neck, and breast regions in secondary upper extremity lymphedema patients are shown using indocyanine green (ICG) Lymphography. PATIENTS AND METHODS Between January 2012 and May 2015, 30 limbs of 29 patients with upper extremity lymphedema after malignant tumor resection were evaluated. ICG Lymphography was performed after chronic lymphedema formation. RESULTS Of the 30 limbs, accessory lymphatic pathways were identified across the axillary region in 3 patients using ICG Lymphography. In 2 of these 3 patients, accessory drainage lymphatics were connected to the cervical lymph nodes. In regard to the distribution of dermal backflow patterns, dermal backflow appeared in 26 patients-in the forearm in 26 patients and in the upper arm in 20 patients. CONCLUSIONS Accessory lymphatic pathways are thought to be the drainage routes in the affected arm, which may prevent edema progression to the terminal stage. Variations in the lymphatic system are easily visualized using ICG Lymphography. Understanding of accessory lymphatic routes in lymphedema patients may provide new insight for further understanding the pathophysiology of lymphedema.
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Indocyanine Green Lymphography Findings in Limb Lymphedema
Journal of reconstructive microsurgery, 2015Co-Authors: Mitsunaga Narushima, Makoto Mihara, Takumi Yamamoto, Hidehiko Yoshimatsu, Fusa Ogata, Isao KoshimaAbstract:Background and Methods Indocyanine green (ICG) Lymphography is one of several methods of Lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display. Results ICG Lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG Lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG Lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area. Conclusion In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.
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Indocyanine Green Lymphography Findings in Primary Leg Lymphedema
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2015Co-Authors: Takumi Yamamoto, Mitsunaga Narushima, Nana Yamamoto, Hidehiko Yoshimatsu, Akitatsu Hayashi, Isao KoshimaAbstract:Objectives Indocyanine green (ICG) Lymphography has been reported to be useful for the evaluation of secondary lymphedema, but no study has reported characteristic findings of ICG Lymphography in primary lymphedema. This study aimed to classify characteristic ICG Lymphography patterns in primary lymphedema. Methods The study was a retrospective observational study. Thirty one primary lower extremity lymphedema (LEL) patients with a total of 62 legs were studied. ICG Lymphography patterns were categorized according to the visibility of lymphatics and dermal backflow (DB) extension. Clinical demographics were compared with categorized ICG Lymphography patterns. Results All symptomatic legs showed abnormal patterns, and all asymptomatic legs showed normal patterns on ICG Lymphography. Abnormal lymphographic patterns could be classified into proximal DB (PDB), distal DB (DDB), less enhancement (LE), and no enhancement (NE) patterns. There were significant differences between PDB (16 patients), DDB (6 patients), LE (4 patients), and NE patterns (5 patients) in age (37.3 ± 18.3 vs. 61.8 ± 19.2 vs. 50.8 ± 27.7 vs. 29.2 ± 18.0 years, p = .035), onset of edema (23.9 ± 19.4 vs. 46.8 ± 27.0 vs. 43.0 ± 31.3 vs. 6.6 ± 14.2 years, p = .020), laterality (bilateral; 18.8% vs. 66.7% vs. 75.0% vs. 0%, p = .016), cellulitis history (56.3% vs. 100% vs. 25.0% vs. 0%, p = .007), and LEL index (292.2 ± 32.8 vs. 254.2 ± 28.6 vs. 243.3 ± 9.4 vs. 295.2 ± 44.8, p = .016). Conclusions ICG Lymphography findings in primary lymphedema could be classified into four patterns with different patient characteristics.
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near infrared illumination system integrated microscope for supermicrosurgical lymphaticovenular anastomosis
Microsurgery, 2014Co-Authors: Takumi Yamamoto, Mitsunaga Narushima, Nana Yamamoto, Shuchi Azuma, Hidehiko Yoshimatsu, Yukio Seki, Isao KoshimaAbstract:Background: Lymphatic supermicrosurgery, lymphaticovenular anastomosis (LVA), is becoming a treatment option for progressive lymphedema with its effectiveness and minimal invasiveness. It is important to detect and anastomose large functional lymphatic vessels for LVA surgery. This study aimed to evaluate usefulness of a near-infrared illumination system-integrated microscope for lymphatic supermicrosurgery. Methods: We performed LVA on 12 lower extremity lymphedema (LEL) patients with or without intraoperative microscopic indocyanine green (ICG) Lymphography guidance. An operating microscope equipped with an integrated near-infrared illumination system (OME-9000; Olympus, Tokyo, Japan) was used for intraoperative microscopic ICG Lymphography guidance. Feasibility, anastomosis patency, and treatment effect of the method were evaluated. Results: Forty LVAs were performed (24 LVAs with intraoperative microscopic ICG Lymphography-guidance on 7 limbs, and 16 LVAs without the guidance on 5 limbs). Lymphatic vessels were enhanced by intraoperative microscopic ICG Lymphography in 11 of 12 skin incision sites. Time required for detection and dissection of lymphatic vessels in cases with intraoperative microscopic ICG Lymphography guidance was significantly shorter than that in cases without the guidance (2.3 ± 1.7 min vs. 6.5 ± 4.0 min, P = 0.010). There was no statistically significant difference in LEL index reduction between cases with and without intraoperative microscopic ICG Lymphography guidance (18.3 ± 5.5 vs. 15.0 ± 5.5, P = 0.337). Conclusions: Intraoperative microscopic ICG Lymphography visualized lymphatic vessels, which helps a lymphatic supermicrosurgeon to find and dissect lymphatic vessels earlier. © 2013 Wiley Periodicals, Inc. Microsurgery 34:23–27, 2014.
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indocyanine green Lymphography for evaluation of genital lymphedema in secondary lower extremity lymphedema patients
Journal of vascular surgery. Venous and lymphatic disorders, 2013Co-Authors: Takumi Yamamoto, Mitsunaga Narushima, Nana Yamamoto, Hidehiko Yoshimatsu, Shinya Hayami, Isao KoshimaAbstract:Objective Treatment of genital lymphedema (GL) is challenging, and early diagnosis and intervention is important to prevent progression of GL. However, early treatment of GL is difficult due to a lack of appropriate evaluation methods allowing early diagnosis. We sought to develop a novel pathophysiological evaluation method for early diagnosis of GL using indocyanine green (ICG) Lymphography. Methods This was a retrospective observational study set in a teaching hospital. Patient characteristics and ICG Lymphography findings of 68 lower limb lymphedema patients secondary to gynecologic cancer treatments were reviewed. The clinical data and dermal backflow (DB) stages based on ICG Lymphography findings were analyzed to compare between the left and right region with and without symptomatic GL. Results Twenty-two of 136 lateralities were symptomatic GL. Univariate analyses revealed statistically significant differences between lateralities with (n = 22) and without GL (n = 114) in the duration of leg edema (6.3 ± 1.1 vs 3.8 ± 0.5 years; P = .032), International Society of Lymphology stage (stage 0/1/2/3: 0/4/15/3 vs 40/32/32/10; P = .001), leg DB stage (stage 0/I/II/III/IV/V: 0/0/7/9/4/2 vs 6/35/23/29/18/3; P = .002), and genital DB stage (stage 0/I/II/III/IV: 0/0/0/20/2 vs 27/43/28/16/0; P Conclusions ICG Lymphography can clearly visualize abnormal lymph circulation in the lower abdominal and genital region. Genital DB stage based on ICG Lymphography findings allows early diagnosis of GL before symptom manifestation. Further studies are needed to clarify that ICG Lymphography is a key evaluation for prevention and early intervention of GL.
C. Parsons - One of the best experts on this subject based on the ideXlab platform.
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Lymphography--current role in oncology.
The British journal of radiology, 1991Co-Authors: E Moskovic, I N Fernando, P R Blake, C. ParsonsAbstract:Abstract A review of the use of Lymphography at this hospital, a major oncology centre, is presented. The advent of computed tomography has brought a dramatic reduction in the number of lymphograms currently performed for diseases such as lymphoma, testicular tumours and gynaecological malignancies. This study analyses the reasons for this decline, and concludes that valuable information can still be obtained from Lymphography in certain selected groups of patients.
Jinna Kim - One of the best experts on this subject based on the ideXlab platform.
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mr Lymphography for sentinel lymph node detection in patients with oral cavity cancer preliminary clinical study
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2018Co-Authors: Sohi Bae, Hojoon Lee, Woong Nam, Yoon Woo Koh, Eun Chang Choi, Jinna KimAbstract:BACKGROUND The purpose of this study was to evaluate the feasibility of MR Lymphography with interstitial injection of a gadolinium-based contrast agent for identifying sentinel lymph nodes in patients with oral cavity cancer and clinically negative neck. METHODS Pretreatment MR Lymphography with a differential subsampling with cartesian ordering (DISCO) sequence was performed in 26 patients with resectable oral cavity cancer and clinically negative neck, after peritumoral injection of 1-mL diluted gadobutrol. The accuracy of sentinel lymph node identification by MR Lymphography was assessed and compared with the final histopathological results. RESULTS The MR Lymphography consistently visualized the 44 sentinel lymph nodes in all 26 patients. In all but 1 patient with pathologically positive neck, assumed sentinel lymph nodes revealed metastatic involvement. CONCLUSION Pretreatment MR Lymphography is a safe and feasible imaging technique that can help clinicians identify sentinel lymph nodes with a high risk of occult metastases in patients with oral cavity cancer, enabling focused preoperative biopsy in these high-risk patients.
Takumi Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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Indocyanine Green (ICG) Lymphography
Congenital Vascular Malformations, 2017Co-Authors: Takumi YamamotoAbstract:Primary lymphedema is caused by various lymphatic malformations and has a wide variety of etiology. Lymphatic image is important to understand underlying pathophysiology of primary lymphedema. Indocyanine green (ICG) Lymphography allows very clear superficial lymph flow visualization in real time, which can be performed less invasively without radiation exposure. With progression of lymphedema, ICG Lymphography finding changes from linear pattern to splash, to stardust, and finally to diffuse pattern. Different ICG Lymphography pattern represents different lymphatic vessel conditions; lymphatic vessel becomes more sclerotic with progression of ICG Lymphography findings. Primary lymphedema can be classified into four patterns based on ICG Lymphography findings; proximal dermal backflow (PDB), distal dermal backflow (DDB), less enhancement (LE), and no enhancement (NE) patterns. In PDB and DDB patterns, lymph flow obstruction is a main cause of lymphedema, and lymphatic bypass operation can be a useful therapeutic option for compression-refractory lymphedema. In LE pattern, non-obstructive mechanism such as lymph pump dysfunction is considered a cause of lymphedema, and strict compression therapy is recommended. In NE pattern, whole limb severe hypoplasia or aplasia is suspected, and vascularized lymph node transfer may be better indicated than lymphatic bypass operation. ICG Lymphography is useful not only for lymphedema evaluation but also for navigation of lymphatic surgery.
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Near-Infrared Fluorescent Lymphography
Lymphedema, 2017Co-Authors: Takumi YamamotoAbstract:Near-infrared fluorescent Lymphography or indocyanine green (ICG) Lymphography is becoming popular in the management of lymphedema. ICG Lymphography can clearly visualize superficial lymph flows in real time without radiation exposure. ICG Lymphography findings change from normal «linear» pattern to abnormal «dermal backflow (DB)» patterns (mild DB, «splash» pattern; moderate DB, «stardust» pattern; severe DB, «diffuse» pattern) with progression of lymphedema. Splash pattern represents reversible change; on the other hand «stardust» and «diffuse» patterns represent irreversible change. ICG Lymphography-based DB stages [arm DB (ADB) stage, leg DB (LDB) stage, genital DB (GDB) stage, and facial DB (FDB) stage] allow pathophysiological severity staging for secondary lymphedema. ICG Lymphography also allows classification of primary lymphedema: proximal DB (PDB), distal DB (DDB), less enhancement (LE), and no enhancement (NE) patterns. ICG velocity, representing lymph pump function, decreases with lymphedema progression. ICG Lymphography is also used as pre- and intraoperative navigation for lymphatic surgeries such as lymphaticovenular anastomosis, lymph node transfer, and liposuction. In «linear» pattern region, a surgeon can easily find lymphatic vessels. Progression of ICG Lymphography pattern represents lymphosclerosis progression. Dynamic ICG Lymphography, dual-phase Lymphography, allows pathophysiological severity staging, evaluation of lymph pump function, and navigation for lymphatic surgery with only one ICG injection. Dynamic ICG Lymphography is useful for the evaluation and treatments of primary and secondary lymphedema.
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Comprehensive Lymphedema Evaluation Using Dynamic ICG Lymphography
ICG Fluorescence Imaging and Navigation Surgery, 2016Co-Authors: Takumi YamamotoAbstract:Indocyanine green (ICG) Lymphography is becoming popular in lymphedema management, since it can visualize superficial lymph flows in real time without radiation exposure. With lymphedema progression, ICG Lymphography pattern changes from normal linear pattern to abnormal dermal backflow (DB) patterns (splash, stardust, and diffuse patterns). Splash represents mild DB and reversible change; on the other hand, stardust/diffuse represents moderate/severe DB and irreversible change. DB stages [leg DB (LDB) stage, arm DB (ADB) stage, genital DB (GDB) stage, and facial DB (FDB) stage] allow pathophysiological lymphedema severity staging based on ICG Lymphography findings. ICG velocity, lymph pump function, decreases as lymphedema progresses. ICG Lymphography is also used as pre- and intraoperative navigation for lymphatic supermicrosurgery such as lymphaticovenular anastomosis. A surgeon can easily find lymphatic vessels in linear pattern. Progression of ICG Lymphography pattern represents progression of lymphosclerosis; the more severe DB pattern is detected on ICG Lymphography, the more sclerotic lymphatic vessels are. Dynamic ICG Lymphography, dual-phase Lymphography, allows pathophysiological severity staging, evaluation of lymph transportation capacity, and navigation for lymphatic surgery with one ICG injection. Dynamic ICG Lymphography is useful for evaluation of lymphedema prognosis and therapeutic interventions.
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Indocyanine Green Lymphography Findings in Limb Lymphedema
Journal of reconstructive microsurgery, 2015Co-Authors: Mitsunaga Narushima, Makoto Mihara, Takumi Yamamoto, Hidehiko Yoshimatsu, Fusa Ogata, Isao KoshimaAbstract:Background and Methods Indocyanine green (ICG) Lymphography is one of several methods of Lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display. Results ICG Lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG Lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG Lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area. Conclusion In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.
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Indocyanine Green Lymphography Findings in Primary Leg Lymphedema
European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2015Co-Authors: Takumi Yamamoto, Mitsunaga Narushima, Nana Yamamoto, Hidehiko Yoshimatsu, Akitatsu Hayashi, Isao KoshimaAbstract:Objectives Indocyanine green (ICG) Lymphography has been reported to be useful for the evaluation of secondary lymphedema, but no study has reported characteristic findings of ICG Lymphography in primary lymphedema. This study aimed to classify characteristic ICG Lymphography patterns in primary lymphedema. Methods The study was a retrospective observational study. Thirty one primary lower extremity lymphedema (LEL) patients with a total of 62 legs were studied. ICG Lymphography patterns were categorized according to the visibility of lymphatics and dermal backflow (DB) extension. Clinical demographics were compared with categorized ICG Lymphography patterns. Results All symptomatic legs showed abnormal patterns, and all asymptomatic legs showed normal patterns on ICG Lymphography. Abnormal lymphographic patterns could be classified into proximal DB (PDB), distal DB (DDB), less enhancement (LE), and no enhancement (NE) patterns. There were significant differences between PDB (16 patients), DDB (6 patients), LE (4 patients), and NE patterns (5 patients) in age (37.3 ± 18.3 vs. 61.8 ± 19.2 vs. 50.8 ± 27.7 vs. 29.2 ± 18.0 years, p = .035), onset of edema (23.9 ± 19.4 vs. 46.8 ± 27.0 vs. 43.0 ± 31.3 vs. 6.6 ± 14.2 years, p = .020), laterality (bilateral; 18.8% vs. 66.7% vs. 75.0% vs. 0%, p = .016), cellulitis history (56.3% vs. 100% vs. 25.0% vs. 0%, p = .007), and LEL index (292.2 ± 32.8 vs. 254.2 ± 28.6 vs. 243.3 ± 9.4 vs. 295.2 ± 44.8, p = .016). Conclusions ICG Lymphography findings in primary lymphedema could be classified into four patterns with different patient characteristics.
