LED-based photoacoustic imaging for preoperative visualization of lymphatic vessels in patients with secondary limb lymphedema

Saskia Van Heumen; Jonas J M Riksen; Mithun Kuniyil Ajith Singh; Gijs Van Soest; Dalibor Vasilic

doi:10.1016/j.pacs.2022.100446

LED-based photoacoustic imaging for preoperative visualization of lymphatic vessels in patients with secondary limb lymphedema

Photoacoustics. 2022 Dec 28:29:100446. doi: 10.1016/j.pacs.2022.100446. eCollection 2023 Feb.

Authors

Saskia Van Heumen^{1

2}, Jonas J M Riksen², Mithun Kuniyil Ajith Singh³, Gijs Van Soest², Dalibor Vasilic¹

Affiliations

¹ Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
² Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
³ Research and Business Development Division, Cyberdyne Inc., Rotterdam, the Netherlands.

Abstract

Lymphedema is the accumulation of protein-rich fluid in the interstitium (i.e., dermal backflow (DBF)). Preoperative imaging of the lymphatic vessels is a prerequisite for lymphovenous bypass surgical planning. We investigated the visualization of lymphatic vessels and veins using light-emitting diode (LED)-based photoacoustic imaging (PAI). Indocyanine-green mediated near-infrared fluorescence lymphography (NIRF-L) was done in fifteen patients with secondary limb lymphedema. Photoacoustic images were acquired in locations where lymphatic vessels and DBF were observed with NIRF-L. We demonstrated that LED-based PAI can visualize and differentiate lymphatic vessels and veins even in the presence of DBF. We observed lymphatic and blood vessels up to depths of 8.3 and 8.6 mm, respectively. Superficial lymphatic vessels and veins can be visualized using LED-based PAI even in the presence of DBF showing the potential for pre-operative assessment. Further development of the technique is needed to improve its usability in clinical settings.

Keywords: Extremities; Fluorescence Imaging; Lymphedema; Lymphography; Lymphovenous Anastomosis; Microsurgery; Photoacoustic Techniques.