Abstract
Background Although several investigations have described the safety, utility, and precision
of magnetic resonance lymphography (MRL) as a preoperative examination for lymphaticovenular
anastomosis (LVA), it is unclear how much MRL assistance impacts LVA results. The
present study aimed to clarify the outcome of MRL-assisted LVA for leg lymphedema
using body water measurements obtained by bioelectrical impedance analysis.
Methods The water reductive effect of MRL-assisted LVA in female secondary leg lymphedema
patients was compared with that of non-MRL-assisted controls in this retrospective
study. In the MRL-assisted group, all LVA candidates underwent MRL prior to surgery,
and the lymphatic vessels to be anastomosed were primarily determined by MRL findings.
The body water composition of the treated legs was assessed before LVA and at 6 months
postoperatively using a multi-frequency bioelectrical impedance analyzer.
Results Twenty-three patients in the MRL-assisted study group and an equal number in the
non-MRL-assisted control group were analyzed. Although mean leg water volume before
LVA, mean excess water volume of the affected leg before LVA, and number of anastomoses
created were comparable between the groups, the water volume reduction (1.02 L versus
0.49 L; 95% confidence interval [CI]: 0.03–1.03, p < 0.05) and edema reduction rate (46.7% versus 27.2%; 95% CI: 3.7–35.5%, p < 0.05) in the MRL-assisted group were significantly greater than in controls.
Conclusion Preoperative MRL-assisted lymph vessel visualization and selection appeared to significantly
enhance the water reductive effect of LVA for International Society of Lymphology
classification stage 2 leg lymphedema. MRL also helped to reliably identify lymphatic
vessels for anastomosis. Without increasing the number of anastomoses, LVA could be
performed more effectively by better detecting stagnant lymphatic vessels using MRL.
Keywords
lymphaticovenular anastomosis - magnetic resonance lymphography - bioelectrical impedance
analysis
