Abstract
ICG lymphography is an invaluable tool in lymphedema management. Both immediate and delayed scans are needed when performing the study. The delayed scan needs to be performed at the time of the lymphographic plateau to appreciate the full extent of the pathology. Using a recumbent cross trainer, the lymphographic plateau can be achieved in 15 minutes following ICG injection. We have found this exercise enhanced ICG lymphography protocol worthwhile of adoption by high volume lymphedema centers to raise diagnostic accuracy and efficiency.
Highlights
Indocyanine green (ICG) lymphography is a non-radioactive, fluorophore-based imaging modality that provides functional imaging of the lymphatic system
Indocyanine green lymphography has been increasingly performed for diagnosis, severity staging, treatment planning, intra-operative guidance, and post-operative tracking of lymphedema
ICG lymphography is an invaluable tool in lymphedema management
Summary
Indocyanine green (ICG) lymphography is a non-radioactive, fluorophore-based imaging modality that provides functional imaging of the lymphatic system. Exercise has been shown to accelerate lymphatic drainage [1,2] Based on this phenomenon, we aimed to 1) determine if controlled exercise could shorten the time it takes for ICG lymphography to reach a plateau, and to 2) create a standardized protocol to increase efficiency and reliability of ICG lymphography to diagnose extremity lymphedema. When performing ICG lymphography, a delayed scan following ICG injection is necessary due to the delayed emergence of lymphographic dermal backflow patterns. Following the point of the plateau, further delayed scanning was performed every hour to identify the time point when the lymphographic patterns started to recede. Results: Following ICG injection, the lymphographic patterns evolved continually until plateauing after three cycles of exercise (15 minutes of exercise in total) in all limbs studied, and the dye was shown to start receding after 4 hours. The study can be accelerated to only taking minutes while further increasing the accuracy and reproducibility of the study with the addition of exercise
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