Clinical value of contrast-enhanced magnetic resonance lymphatic vessel imaging for precise localization of lymphatic vessels in patients with lymphaticovenous anastomosis.

Abstract

Magnetic resonance lymphangiography (MRL) is crucial for preoperative localization of lymphatic vessels for lymphaticovenous anastomosis (LVA), improving surgical success and treating limb lymphoedema. This study was performed to investigate the accuracy of indocyanine green (ICG) lymphography assisted by contrast-enhanced MRL (CE-MRL) in microsurgical incision planning and to evaluate the efficacy of LVA. From August 2023 to October 2024, 35 patients with secondary upper or lower extremity lymphoedema who underwent LVA were selected. All patients underwent preoperative ICG angiography and CE-MRL imaging. After ICG angiography, lymphatic vessels were marked and re-evaluated using MRL images. The accuracy of CE-MRL-assisted ICG angiography in detecting lymphatic vessels and the efficacy of LVA were assessed, and accuracy was compared with ICG angiography alone. The 35 patients comprised 34 women and 1 man, with a mean age of 63.83 ± 11.89 years. Preoperative CE-MRL imaging identified 151 lymphatic vessels, of which 150 were accurately located and anastomosed during surgery, resulting in an accuracy rate of 99% (95% CI 0.980-1.00) for CE-MRL-assisted ICG angiography. Compared with ICG angiography alone, CE-MRL increased the number of identified lymphatic vessels by 12%. The effective rate of LVA was 94% (95% CI 0.857-1.00). Four weeks postoperatively, the limb circumferential difference improved by 14% ± 8.32%, while the circumferential reduction rate reached 49% ± 19%. Contrast-enhanced MRL serves as a valuable complementary tool to ICG angiography in microsurgical LVA, enhancing the precision of lymphatic vessel localization. Lymphaticovenous anastomosis demonstrates a high effective cure rate, offering significant clinical benefits for patients with lymphoedema.