Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging

Abstract

Objective: To investigate the feasibility of assessing the efficacy of manual lymphatic drainage (MLD), a method for lymphedema (LE) management, by using near-infrared (NIR) fluorescence imaging.

Design: Exploratory pilot study.

Setting: Primary care unit.

Participants: Subjects (N=10; age, 18-68y) with a diagnosis of grade I or II LE and 12 healthy control subjects (age, 22-59y).

Intervention: Indocyanine green (25 μg in 0.1 mL each) was injected intradermally in bilateral arms or legs of subjects. Diffused excitation light illuminated the limbs, and NIR fluorescence images were collected by using custom-built imaging systems. Subjects received MLD therapy, and imaging was performed pre- and posttherapy.

Main outcome measures: Apparent lymph velocities and periods between lymphatic propulsion events were computed from fluorescence images. Data collected pre- and post-MLD were compared and evaluated for differences.

Results: By comparing pre-MLD lymphatic contractile function against post-MLD lymphatic function, results showed that average apparent lymph velocity increased in both the symptomatic (+23%) and asymptomatic (+25%) limbs of subjects with LE and control limbs (+28%) of healthy subjects. The average lymphatic propulsion period decreased in symptomatic (-9%) and asymptomatic (-20%) limbs of subjects with LE, as well as in control limbs (-23%).

Conclusions: We showed that NIR fluorescence imaging could be used to quantify immediate improvement of lymphatic contractile function after MLD.

Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

NIR fluorescence images during MLD. (A) and (B), sequential images of a wave of fluorescent packets (indicated by arrows) in multiple vessels moving toward axillary lymph nodes resulting from MLD in a control arm (see supplemental video 1), and (C) and (D), sequential images of lymph in a vessel (indicated by arrow) being pushed toward ankle during MLD in a symptomatic leg (see supplemental video 4).

Figure 2

Lymphatic contractile function on arms. Average apparent lymph velocities and periods of lymphatic propulsion on different arms in lymphedema (symptomatic and asymptomatic) and control (left and right) subjects pre- and post- MLD. (*: p

Figure 3

Statistical results of lymphatic contractile function on arms. Average apparent lymph velocities and periods of lymphatic propulsion in different groups (symptomatic, asymptomatic, and control) pre- and post- MLD. The changes in percentage from pre- to post- MLD are labeled. (*: p

Figure 4

Lymphatic contractile function on legs. Average apparent lymph velocities and periods of lymphatic propulsion on different legs in lymphedema (symptomatic and asymptomatic) and control (left and right) subjects pre- and post- MLD. (*: p

Figure 5

Statistical results of lymphatic contractile function on legs. Average apparent lymph velocities and periods of lymphatic propulsion in different groups (symptomatic, asymptomatic, and control) pre- and post- MLD. The changes in percentage from pre- to post- MLD are labeled. (*: p