Lower-Limb Lymphatic Drainage Pathways and Lymph Nodes: A CT Lymphangiography Cadaver Study.

Autor:	Shinaoka A; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Koshimune S; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Suami H; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Yamada K; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Kumagishi K; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Boyages J; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Kimata Y; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.)., Ohtsuka A; From the Department of Human Morphology (A.S., K.K., A.O.) and Department of Plastic and Reconstructive Surgery (A.S., S.K., K.Y., Y.K.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi 700-8558, Japan; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia (H.S., J.B.).
Jazyk:	angličtina
Zdroj:	Radiology [Radiology] 2020 Jan; Vol. 294 (1), pp. 223-229. Date of Electronic Publication: 2019 Nov 19.
DOI:	10.1148/radiol.2019191169
Abstrakt:	Background Most lymphatic imaging examinations of the lower limb require intradermal or subcutaneous injection of tracer material into the foot to demonstrate the lymphatic vessels; however, no standard protocol exists, and single or multiple injections are applied at different sites. Purpose To determine the three-dimensional relationships between each lymphatic group of the lower limb and corresponding regional lymph nodes. Materials and Methods A total of 130 lower limbs (55 from men and 75 from women) from 83 fresh human cadavers were studied. Lymphatic vessels were first visualized by using indocyanine green fluorescent lymphography with 19 injection sites in the foot, classified into four distinct lymphatic groups (anteromedial, anterolateral, posteromedial, and posterolateral); dilute oil-based contrast material was then injected. Next, specimens were scanned with CT and three-dimensional images were analyzed. Results The anteromedial and anterolateral lymphatic groups of the lower-leg lymphatic vessels were independent of each other and connected to different regional lymph nodes in the inguinal region. The posteromedial group and the anteromedial group in the lower leg drained to the same inguinal lymph nodes. Only the posterolateral group of lymphatic vessels in the lower leg drained to the popliteal lymph nodes. Leg lymphatic drainage pathways were independent of genital pathways. Conclusion Standard injection sites at the web spaces between the toes did not help visualize some lymph nodes of the lower leg. Additional injection sites in the medial, lateral, and posterior aspect of the foot would be better for evaluating the whole lymphatic pathways and regional lymph nodes and for improving understanding of leg lymphedema. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Weiss and Liddel in this issue.
Databáze:	MEDLINE
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