title: Ultrasound visualization of the lymphatic vessels in the lower leg.
abstract: BACKGROUND
  Identification of lymphatic vessels for lymphaticovenular anastomosis (LVA), which is an effective surgical treatment for obstructive lymphedema, is important. Indocyanine green (ICG) lymphography is useful for that purpose, but is not common in many institutions. Although ultrasound is a very common modality, no research has yet underlined the feasibility of the device to detect the lymphatic vessels.
  
  
  METHODS
  First, identification of lymphatic vessels in the lower legs using ultrasound was performed in non-edematous limbs with linear-pattern on ICG lymphography (n = 12). The imaging findings and characteristic of the lymphatic vessels in ultrasonography were investigated on transverse scans. Second, to assess the ultrasound detection technique, ICG was injected to healthy volunteers after identification and marking of the lymphatic vessels using ultrasound (n = 14). Sensitivity and specificity of the examination were calculated.
  
  
  RESULTS
  In the first part, the lymphatic vessels were detected by ultrasound in all cases. Characteristic ultrasonography findings of lymphatic vessels included homogeneous, hypoechoic and spicular misshapen images in all cases. In the second part, the overall sensitivity and specificity were 95.5 and 92.9%, respectively.
  
  
  CONCLUSIONS
  Ultrasonography can identify lymphatic vessels of the lower leg with precision and may aid lymphatic microsurgery for lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:397-401, 2016.
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Akitatsu
authors: A
authors: Hayashi
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Takumi
authors: T
authors: Yamamoto
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Hidehiko
authors: H
authors: Yoshimatsu
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Nobuko
authors: N
authors: Hayashi
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Megumi
authors: M
authors: Furuya
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Mitsunobu
authors: M
authors: Harima
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Mitsunaga
authors: M
authors: Narushima
authors: Department of Plastic and Reconstructive Surgery, the University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
authors: Isao
authors: I
authors: Koshima