Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, Connecticut, USA.
Microsurgery. 2021 May;41(4):384-390. doi: 10.1002/micr.30731. Epub 2021 Mar 12.
In recent years, magnetic resonance imaging lymphangiography (MRL) has emerged as a way to predict if patients are candidates for lymphedema surgery, particularly lymphovenous anastomosis (LVA). Our goal was to conduct a systematic review of the literature on the use of MRL for preoperative planning in lymphedema surgery. We hypothesized that MRL could add valuable information to the standard preoperative evaluation of lymphedema patients.
On February 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, and Embase databases, without time frame or language limitations, to identify articles on the use of MRL for preoperative planning of lymphedema surgery. We excluded studies that investigated other applications of magnetic resonance imaging, such as lymphedema diagnosis and treatment evaluation. The primary outcome was the examination capacity to identify lymphatic anatomy and the secondary outcome was the presence of adverse effects.
Of 372 potential articles identified with the search, nine studies fulfilled the eligibility criteria. A total of 334 lymphedema patients were enrolled in these studies. Two studies compared MRL findings with those of other standard examinations (indocyanine green lymphography [ICG-L] or lymphoscintigraphy). No adverse effects due to MRL were reported. A study shown that MRL had higher sensitivity to detect lymphatic vessel abnormalities compared with lymphoscintigraphy and a statistically higher chance of successful LVA was observed when the results of MRL agreed with those of ICG-L (p < .001).
MRL could be useful for preoperative planning in lymphedema surgery. The scientific evidence has been limited, so further studies with greater numbers of patients and cost analysis are necessary to justify the addition of MRL to current preoperative protocols.
近年来，磁共振成像淋巴造影术（MRL）已成为预测患者是否适合淋巴水肿手术（尤其是淋巴静脉吻合术，LVA）的一种方法。我们的目标是对 MRL 用于淋巴水肿手术术前规划的文献进行系统回顾。我们假设 MRL 可以为淋巴水肿患者的标准术前评估提供有价值的信息。
2020 年 2 月 17 日，我们对 PubMed/MEDLINE、Cochrane 临床答案和 Embase 数据库进行了系统回顾，不设时间限制和语言限制，以确定关于 MRL 用于淋巴水肿手术术前规划的文章。我们排除了研究其他磁共振成像应用的文章，如淋巴水肿的诊断和治疗评估。主要结局是检查识别淋巴解剖结构的能力，次要结局是是否存在不良反应。
通过搜索共确定了 372 篇潜在文章，其中 9 项研究符合入选标准。共有 334 例淋巴水肿患者纳入这些研究。其中两项研究将 MRL 结果与其他标准检查（吲哚菁绿淋巴造影术 [ICG-L] 或淋巴闪烁显像术）进行了比较。未报告因 MRL 而产生的不良反应。一项研究表明，MRL 检测淋巴管异常的敏感性高于淋巴闪烁显像术，当 MRL 结果与 ICG-L 结果一致时，LVA 成功的机会更高（p<0.001）。
MRL 可用于淋巴水肿手术的术前规划。由于科学证据有限，因此需要进行更多患者和成本分析的研究，以证明将 MRL 加入当前术前方案的合理性。
