1
|
Fujiyoshi T, Mikami T, Hashimoto K, Asano S, Adachi E, Kagimoto S, Yabuki Y, Kitayama S, Matsubara S, Maegawa J, Iwai T, Ishibe A, Miyagi E, Kaneta T. Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images. Lymphat Res Biol 2021; 20:144-152. [PMID: 34415778 PMCID: PMC9081006 DOI: 10.1089/lrb.2021.0040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In patients with secondary upper limb lymphedema, positive correlations have been observed between the dermal back flow (DBF) type and visualization of lymph nodes around the clavicle, between the former and the lymph flow pathway type, and between the latter and the visualization of lymph nodes around the clavicle when using single photon-emission computed tomography/computed tomography/lymphoscintigraphy (SPECT-CT LSG). Methods and Results: We analyzed the associations between the visualization of inguinal lymph nodes, the lymph flow pathway type, and the DBF type using SPECT-CT LSG in 81 patients with unilateral secondary lower limb lymphedema by statistical analysis using Fisher's exact test. We revealed that the lymph flow pathways in the lower limb can be classified into nine types because the type in the lower leg is not always equal to the type in the thigh. Associations were observed between the visualization of inguinal lymph nodes and types of DBF (p < 0.01), between the types of lymph flow pathway in the thighs and visualization of the inguinal lymph nodes (p = 0.02), and between the lymph flow pathway types in the thighs and lower legs (p < 0.01). Conclusion: Detriment to the superficial lymph flow pathways in the lower limb appears to usually start from the proximal side, and deep pathways are considered to become dominant from a compensatory perspective as lymphedema severity increases.
Collapse
Affiliation(s)
| | - Taro Mikami
- Department of Plastic and Reconstructive Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
- Address correspondence to: Taro Mikami, MD, PhD, Department of Plastic and Reconstructive Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki 253-0042, Japan
| | - Koukichi Hashimoto
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Saori Asano
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Eiko Adachi
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Shintaro Kagimoto
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yuichiro Yabuki
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Shinya Kitayama
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Shinobu Matsubara
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Jiro Maegawa
- Department of Plastic and Reconstructive Surgery and School of Medicine, Yokohama City University, Yokohama, Japan
| | - Toshinori Iwai
- Department of Maxillofacial Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery and Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomohiro Kaneta
- Department of Advanced Molecular Imaging, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|