title: Assessment of lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging.
abstract: 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.
  
  
  METHODS
  Exploratory pilot study.
  
  
  METHODS
  Primary care unit.
  
  
  METHODS
  Subjects (N=10; age, 18-68y) with a diagnosis of grade I or II LE and 12 healthy control subjects (age, 22-59y).
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Center for Molecular Imaging, The Brown Foundation Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, USA.
authors.forename: I-Chih
authors.initials: IC
authors.lastname: Tan
authors.forename: Erik A
authors.initials: EA
authors.lastname: Maus
authors.forename: John C
authors.initials: JC
authors.lastname: Rasmussen
authors.forename: Milton V
authors.initials: MV
authors.lastname: Marshall
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Adams
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Fife
authors.forename: Latisha A
authors.initials: LA
authors.lastname: Smith
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Eva M
authors.initials: EM
authors.lastname: Sevick-Muraca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm; D004396:Coloring Agents; D004322:Drainage / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007208:Indocyanine Green; D007866:Leg; D008198:Lymph Nodes / Q000503:physiopathology; D008208:Lymphatic System / Q000503:physiopathology*; D008209:Lymphedema / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green