High-Resolution Imaging of Lymphatic Vessels with Photoacoustic Lymphangiography

HomeRadiologyVol. 292, No. 1 PreviousNext Reviews and CommentaryFree AccessImages In RadiologyHigh-Resolution Imaging of Lymphatic Vessels with Photoacoustic LymphangiographyHiroki Kajita , Kazuo KishiHiroki Kajita , Kazuo KishiAuthor AffiliationsFrom the Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.Address correspondence to H.K. (e-mail: [email protected]).Hiroki Kajita Kazuo KishiPublished Online:Apr 30 2019https://doi.org/10.1148/radiol.2019190241MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Online supplemental material is available for this article.A 54-year-old man with a history of right axillary lymph node dissection for malignant lymphoma presented with a 7-year history of progressively worsening right arm edema (Figure, A). Radionuclide lymphoscintigraphy showed delayed axillary visualization and dermal backflow (Figure, B). A clinical diagnosis of acquired lymphedema was made.Eighteen days later, photoacoustic lymphangiography was performed (1) after subcutaneous injection of 0.5 mL of indocyanine green. Three-dimensional reconstruction of lymphatic vessels (Figure, C, and Movie 1 [online]) or both lymphatic and venous vessels (Figure, B, and Movie 2 [online]) showed the complicated network of dilated lymphatic vessels and their relationship with the superficial veins of the patient’s right forearm.Get the Flash Player to see this video.Movie 1: Rotation of enlarged three-dimensional image of lymphatic vessels shown using photoacoustic lymphangiography.Download Original Video (11.9 MB)Get the Flash Player to see this video.Movie 2: Rotation of enlarged three-dimensional image showing lymphatic vessels (blue) and veins (yellow) shown using photoacoustic lymphangiography.Download Original Video (11.9 MB)Photoacoustic lymphangiography is based on photoacoustic technology (1,2). The light-absorbing substances (eg, hemoglobin and indocyanine green) cause transient thermoelastic expansion when irradiated with a pulsed nanosecond-long near-infrared laser beam. This expansion produces pressure waves, which can be detected with hemispherical ultrasonic transducers and converted into three-dimensional images. Arteries and veins in the superficial regions less than 20 mm in depth can be visualized noninvasively with high spatial resolution. The use of two different laser wavelengths enables the differentiation of lymphatic channels from blood vessels because the reaction patterns of indocyanine green and hemoglobin to the lasers are different.The patient underwent lymphatic-to-venous anastomosis 6 months later, and lymphatic obstruction in the affected arm resolved.A, Photograph shows right arm edema in 54-year-old man with a history of right axillary lymph node dissection for malignant lymphoma. B, Image from bilateral upper extremity nuclear medicine lymphangiography (with 50 MBq of 99m-labeled technetium human serum albumin) shows dermal backflow in right upper extremity after right axillary lymph node dissection. C, D, Images from photoacoustic lymphangiography of the affected forearm after subcutaneous injection of 0.5 mL of indocyanine green show, C, dilated dermal lymphatics (blue) and, D, superficial veins (green).Download as PowerPointOpen in Image Viewer Disclosures of Conflicts of Interest: H.K. disclosed no relevant relationships. K.K. disclosed no relevant relationships.AcknowledgmentsThe authors are grateful to Sadakazu Aiso, MD, PhD, and Nobuaki Imanishi, MD, PhD, for useful discussions. We also thank Takayuki Yagi, MS, and Yasufumi Asao, PhD, for technical assistance and Masahiro Jinzaki, MD, PhD, for collaboration and advice.Supported by ImPACT Program of Council for Science, Technology and Innovation (Cabinet Office, Government of Japan).References1. Nagae K, Asao Y, Sudo Y, et al. Real-time 3D photoacoustic visualization system with a wide field of view for imaging human limbs. F1000 Res 2018;7:1813. Crossref, Medline, Google Scholar2. Zackrisson S, van de Ven SMWY, Gambhir SS. Light in and sound out: emerging translational strategies for photoacoustic imaging. Cancer Res 2014;74(4):979–1004. Crossref, Medline, Google ScholarArticle HistoryReceived: Jan 31 2019Revision requested: Feb 19 2019Revision received: Mar 3 2019Accepted: Mar 12 2019Published online: Apr 30 2019Published in print: July 2019 FiguresReferencesRelatedDetailsCited ByMeasurement of lymphatic vessel depth using photoacoustic imagingYushiSuzuki, HirokiKajita, MoemiUrano, ShihoWatanabe, MarikaOtaki, YoshifumiTakatsume, HisashiSakuma, NobuakiImanishi, KazuoKishi2023 | Lasers in Surgery and Medicine, Vol. 55, No. 2Towards in vivo photoacoustic human imaging: Shining a new light on clinical diagnosticsZhiyangWang, FeiYang, WuyuZhang, KediXiong, SihuaYang2023 | Fundamental ResearchMRI of LymphedemaBetsa ParsaiSalehi, Robert CarsonSibley, RosieFriedman, GeunwonKim, DhruvSinghal, Andreas MarkusLoening, Leo L.Tsai2023 | Journal of Magnetic Resonance Imaging, Vol. 57, No. 4Long‐Duration and Non‐Invasive Photoacoustic Imaging of Multiple Anatomical Structures in a Live Mouse Using a Single Contrast AgentAnjulKhadria, Chad D.Paavola, YangZhang, Samuel P. 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