Ultra High-frequency Ultrasonographic Imaging with 70 MHz Scanner for Visualization of the Lymphatic Vessels

Akitatsu Hayashi, Guido Giacalone, Takumi Yamamoto, Florence Belva, Giuseppe Visconti, Nobuko Hayashi, Mayumi Handa, Hidehiko Yoshimatsu, Marzia Salgarello, Akitatsu Hayashi, Guido Giacalone, Takumi Yamamoto, Florence Belva, Giuseppe Visconti, Nobuko Hayashi, Mayumi Handa, Hidehiko Yoshimatsu, Marzia Salgarello

Abstract

Background: Identification and localization of functional lymphatic vessels are important for lymphaticovenular anastomosis. Conventional high-frequency ultrasound (CHFUS) has been reported to be useful for them, but it has some disadvantages. In this article, we present new capabilities of ultra high-frequency ultrasound (UHFUS) for imaging of the lymphatic vessels, which may overcome the weakness of CHFUS.

Methods: Thirty unaffected extremities in 30 unilateral secondary lymphedema patients (13 upper limbs and 17 lower limbs) were examined. Identification of the lymphatic vessels using UHFUS and CHFUS were performed at 3 sites in each unaffected extremity. Number and diameter of the detected lymphatic vessels were compared between UHFUS and CHFUS groups. At the same time, new characteristics of the lymphatic vessels seen with UHFUS were investigated.

Results: One hundred sixty-nine lymphatic vessels were detected with UHFUS, and 118 lymphatic vessels with CHFUS. The number of lymphatic vessels found in upper and lower extremities was significantly larger with UHFUS than with CHFUS. The diameter of lymphatic vessels found in upper and lower extremities was significantly smaller with UHFUS than with CHFUS. All lymphatic vessels that were detected in UFHUS were less likely to collapse when the transducer was against the skin of the examined sites.

Conclusions: Detection rate of the lymphatic vessels in nonlymphedematous extremities with UHFUS was higher than that with CHFUS. UHFUS provides images with extremely high resolution, demonstrating new characteristics of the lymphatic vessels.

Figures

Fig. 1.
Fig. 1.
A, The identified lymphatic vessels using UHFUS were marked as cross with a black pen, and ones using CHFUS were marked as circle with a black pen. B, After the identification of lymphatic vessels using ultrasound, ICG was injected subcutaneously into the extremity. C, Then, the marked points were checked with ICG lymphography.
Fig. 2.
Fig. 2.
A, CHFUS showed 2 lymphatic vessels (yellow arrow) and great saphenous vein (blue arrow) in the medial aspect of lower leg. B, UHFUS showed clearer image of them. The diameter of lymphatic vessels was around 0.3 mm.
Fig. 3.
Fig. 3.
A, CHFUS showed lymphatic vessels (yellow arrow), small saphenous vein (blue arrow), and sural nerve (red arrow) in the posterior aspect of lower leg. B, UHFUS showed clearer image of them. The diameter of lymphatic vessels was around 0.5 mm.
Fig. 4.
Fig. 4.
A, UHFUS showed clear image of lymphatic vessels (yellow arrow), great saphenous vein (blue arrow), and saphenous nerve (red arrow) in the medial aspect of lower leg. The diameter of lymphatic vessels was around 0.2 mm. B, Lymphatic vessel was not colored in color Doppler mode. C, Vein was collapsed when the transducer was pushed against skin of examined site, while lymphatic vessel was less likely to collapse.
Fig. 5.
Fig. 5.
A, UHFUS showed clear image of lymphatic vessels (yellow arrow) and cephalic vein (blue arrow) in the volar aspect of forearm. The diameter of lymphatic vessels was around 0.2 mm. B, Lymphatic vessel was not colored in color Doppler mode. C, Vein was collapsed when the transducer was pushed against skin of examined site, while lymphatic vessel was less likely to collapse.
Video Graphic 1.
Video Graphic 1.
See video, Supplemental Digital Content 1, which displays UHFUS in the medial aspect of lower leg showed that vein was collapsed when the transducer was pushed against skin of examined site, while lymphatic vessel was less likely to collapse, http://links.lww.com/PRSGO/A951.
Video Graphic 2.
Video Graphic 2.
See video, Supplemental Digital Content 2, which displays UHFUS in the volar aspect of forearm showed that vein was collapsed when the transducer was pushed against skin of examined site, while lymphatic vessel was less likely to collapse, http://links.lww.com/PRSGO/A952.
Video Graphic 3.
Video Graphic 3.
See video, Supplemental Digital Content 3, which displays UHFUS in the medial aspect of thigh showed that lymphatic fluid moving with valve functioning, http://links.lww.com/PRSGO/A953.

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Source: PubMed

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