title: Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography.
abstract: OBJECTIVE
  To evaluate the use of ultrasound elastography as a basis for determining the most appropriate sites for lymphaticovenular anastomosis (LVA) for treatment of lymphoedema.
  
  
  METHODS
  Preoperative elastography and LVA were performed in 11 patients (11 legs) with leg lymphoedema, including two cases of primary oedema and nine of secondary oedema.
  
  
  RESULTS
  The mean number of LVAs applied per leg was 4.4 (range 3-7). The mean reduction in the leg circumference was 91.7%, and 10 of the 11 cases (90.0%) were improved. Hardness was reduced from a mean of 1.6 before surgery to 0.9 after surgery, and improvement was also noted in 10 cases (90.9%). The severity of oedema was determined in five regions in each leg, and was classified as elastography stage (ES) 0 in 11 regions, ES1 in 23, ES2 in 15, and ES3 in six.
  
  
  CONCLUSIONS
  These results demonstrate the value of ultrasound elastography for the diagnosis of early-stage lymphoedema and determination of LVA sites. This is the first report of diagnosis of lymphoedema using elastography and the findings suggest that this procedure followed by LVA could be used as a new therapeutic method for early-stage lymphoedema.
authors.affiliation: Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Tokyo 113-8655, Japan. mihara@keiseigeka.name
authors.forename: M
authors.initials: M
authors.lastname: Mihara
authors.forename: Y
authors.initials: Y
authors.lastname: Hayashi
authors.forename: N
authors.initials: N
authors.lastname: Murai
authors.forename: H
authors.initials: H
authors.lastname: Moriguchi
authors.forename: T
authors.initials: T
authors.lastname: Iida
authors.forename: H
authors.initials: H
authors.lastname: Hara
authors.forename: T
authors.initials: T
authors.lastname: Todokoro
authors.forename: M
authors.initials: M
authors.lastname: Narushima
authors.forename: G
authors.initials: G
authors.lastname: Uchida
authors.forename: I
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging / Q000601:surgery*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014699:Venules / Q000000981:diagnostic imaging / Q000601:surgery*