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Assessment of Lymphatic Contractile Function After Manual Lymphatic Drainage Using Near-Infrared Fluorescence Imaging

  • I-Chih Tan
    Affiliations
    Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX

    Formerly, Department of Radiology, Baylor College of Medicine, Houston, TX
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  • Erik A. Maus
    Affiliations
    Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX

    Memorial Hermann Center for Lymphedema Management, Houston, TX
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  • John C. Rasmussen
    Affiliations
    Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX

    Formerly, Department of Radiology, Baylor College of Medicine, Houston, TX
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  • Milton V. Marshall
    Affiliations
    Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX

    Formerly, Department of Radiology, Baylor College of Medicine, Houston, TX
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  • Kristen E. Adams
    Affiliations
    Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX

    Formerly, Department of Radiology, Baylor College of Medicine, Houston, TX
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  • Caroline E. Fife
    Affiliations
    Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX

    Memorial Hermann Center for Lymphedema Management, Houston, TX
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  • Latisha A. Smith
    Affiliations
    Division of Cardiology and Hyperbaric Medicine, Department of Internal Medicine, The University of Texas Health Science Center, Houston, TX

    Memorial Hermann Center for Lymphedema Management, Houston, TX
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  • Wenyaw Chan
    Affiliations
    Division of Biostatistics, University of Texas School of Public Health, Houston, TX
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  • Eva M. Sevick-Muraca
    Correspondence
    Correspondence to Eva M. Sevick-Muraca, PhD 1825 Pressler St, SRB 330A, Houston, TX 77030
    Affiliations
    Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX

    Formerly, Department of Radiology, Baylor College of Medicine, Houston, TX
    Search for articles by this author

      Abstract

      Tan I-C, Maus EA, Rasmussen LC, Marshall MV, Adams KE, Fife CE, Smith LA, Chan W, Sevick-Muraca EM. Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging.

      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.

      Key Words

      List of Abbreviations:

      ANOVA (analysis of variance), CDT (complete decongestive therapy), ICG (indocyanine green), LE (lymphedema), MLD (manual lymphatic drainage), NIR (near-infrared), PCD (pneumatic compression device)
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