Dataset Information

Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography.

ABSTRACT: BACKGROUND:Anatomic variations in lymphatic drainage pathways of the upper arm may have an important role in the pathophysiology of lymphedema development. The Mascagni-Sappey (M-S) pathway, initially described in 1787 by Mascagni and then again in 1874 by Sappey, is a lymphatic drainage pathway of the upper arm that normally bypasses the axilla. Utilizing modern lymphatic imaging modalities, there is an opportunity to better visualize this pathway and its potential clinical implications. METHODS:A retrospective review of preoperative indocyanine green (ICG) lymphangiograms of consecutive node-positive breast cancer patients undergoing nodal resection was performed. Lymphography targeted the M-S pathway with an ICG injection over the cephalic vein in the lateral upper arm. RESULTS:In our experience, the M-S pathway was not visualized in 22% (n = 5) of patients. In the 78% (n = 18) of patients where the pathway was visualized, the most frequent anatomic destination of the channel was the deltopectoral groove in 83% of patients and the axilla in the remaining 17%. CONCLUSION:Our study supports that ICG injections over the cephalic vein reliably visualizes the M-S pathway when present. Further study to characterize this pathway may help elucidate its potential role in the prevention or development of upper extremity lymphedema.

SUBMITTER: Johnson AR

PROVIDER: S-EPMC7281680 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography.

Johnson Anna Rose AR Granoff Melisa D MD Suami Hiroo H Lee Bernard T BT Singhal Dhruv D

Cancers 20200508 5

<h4>Background</h4>Anatomic variations in lymphatic drainage pathways of the upper arm may have an important role in the pathophysiology of lymphedema development. The Mascagni-Sappey (M-S) pathway, initially described in 1787 by Mascagni and then again in 1874 by Sappey, is a lymphatic drainage pathway of the upper arm that normally bypasses the axilla. Utilizing modern lymphatic imaging modalities, there is an opportunity to better visualize this pathway and its potential clinical implications ...[more]

PMID: 32397246

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Project description:BackgroundSmall bowel malperfusion (SBM) can cause high morbidity and severe surgical consequences. However, there is no standardized objective measuring tool for the quantification of SBM. Indocyanine green (ICG) imaging can be used for visualization, but lacks standardization and objectivity. Hyperspectral imaging (HSI) as a newly emerging technology in medicine might present advantages over conventional ICG fluorescence or in combination with it.MethodsHSI baseline data from physiological small bowel, avascular small bowel and small bowel after intravenous application of ICG was recorded in a total number of 54 in-vivo pig models. Visualizations of avascular small bowel after mesotomy were compared between HSI only (1), ICG-augmented HSI (IA-HSI) (2), clinical evaluation through the eyes of the surgeon (3) and conventional ICG imaging (4). The primary research focus was the localization of resection borders as suggested by each of the four methods. Distances between these borders were measured and histological samples were obtained from the regions in between in order to quantify necrotic changes 6 h after mesotomy for every region.ResultsStO2 images (1) were capable of visualizing areas of physiological perfusion and areas of clearly impaired perfusion. However, exact borders where physiological perfusion started to decrease could not be clearly identified. Instead, IA-HSI (2) suggested a sharp-resection line where StO2 values started to decrease. Clinical evaluation (3) suggested a resection line 23 mm (±7 mm) and conventional ICG imaging (4) even suggested a resection line 53 mm (±13 mm) closer towards the malperfused region. Histopathological evaluation of the region that was sufficiently perfused only according to conventional ICG (R3) already revealed a significant increase in pre-necrotic changes in 27% (±9%) of surface area. Therefore, conventional ICG seems less sensitive than IA-HSI with regards to detection of insufficient tissue perfusion.ConclusionsIn this experimental animal study, IA-HSI (2) was superior for the visualization of segmental SBM compared to conventional HSI imaging (1), clinical evaluation (3) or conventional ICG imaging (4) regarding histopathological safety. ICG application caused visual artifacts in the StO2 values of the HSI camera as values significantly increase. This is caused by optical properties of systemic ICG and does not resemble a true increase in oxygenation levels. However, this empirical finding can be used to visualize segmental SBM utilizing ICG as contrast agent in an approach for IA-HSI. Clinical applicability and relevance will have to be explored in clinical trials.Level of evidenceNot applicable. Translational animal science. Original article.

Project description:Mixed reality (MR) enables a novel way to visualize virtual objects on real scenarios considering physical constraints. This technology arises with other significant advances in the field of sensors fusion for human-centric 3D capturing. Recent advances for scanning the user environment, real-time visualization and 3D vision using ubiquitous systems like smartphones allow us to capture 3D data from the real world. In this paper, a disruptive application for assessing the status of indoor infrastructures is proposed. The installation and maintenance of hidden facilities such as water pipes, electrical lines and air conditioning tubes, which are usually occluded behind the wall, supposes tedious and inefficient tasks. Most of these infrastructures are digitized but they cannot be visualized onsite. In this research, we focused on the development of a new application (GEUINF) to be launched on smartphones that are capable of capturing 3D data of the real world by depth sensing. This information is relevant to determine the user position and orientation. Although previous approaches used fixed markers for this purpose, our application enables the estimation of both parameters with a centimeter accuracy without them. This novelty is possible since our method is based on a matching process between reconstructed walls of the real world and 3D planes of the replicated world in a virtual environment. Our markerless approach is based on scanning planar surfaces of the user environment and then, these are geometrically aligned with their corresponding virtual 3D entities. In a preprocessing phase, the 2D CAD geometry available from an architectural project is used to generate 3D models of an indoor building structure. In real time, these virtual elements are tracked with the real ones modeled by using ARCore library. Once the alignment between virtual and real worlds is done, the application enables the visualization, navigation and interaction with the virtual facility networks in real-time. Thus, our method may be used by private companies and public institutions responsible of the indoor facilities management and also may be integrated with other applications focused on indoor navigation.

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Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography.

Publications

Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography.

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