Application of contrast-enhanced ultrasound combined with ultra-high-frequency ultrasound in lymphaticovenous anastomosis

Preoperative identification of functional lymphatic vessels (LVs) and accurate measurement of their internal diameters can facilitate lymphaticovenous anastomosis (LVA). However, current single imaging methods cannot accurately measure LVs internal diameters while locating functional LVs. This study aims to demonstrate the accuracy and effectiveness of combining contrast-enhanced ultrasound (CEUS) with ultra-high-frequency ultrasound (UHFUS) for precisely locating functional LVs and measuring internal diameters. 24 patients with secondary upper or lower extremity lymphedema were included in this retrospective study, who underwent three localization methods respectively: CEUS combined with UHFUS (Group A), CEUS alone (Group B), and UHFUS alone (Group C). 24 patients were all female (mean age, 61.9 ± 7.1 years [SD]). Compared with UHFUS, CEUS can locate more functional LVs more quickly (3.00 (2.00,3.00) number vs. 5.88 ± 1.25 number, P < 0.001^b, 36.43 ± 8.62 min/each vs. 8.45 ± 4.25 min/each, P < 0.001^b). UHFUS can measure internal diameters of LVs more accurately compared to CEUS (0.10(0.10,0.10) mm vs. 0.30(0.20,0.34) mm, P < 0.001^b). Compared with CEUS alone, CEUS combined with UHFUS can measure internal diameters of LVs more accurately on the basis of quickly locating functional LVs (0.10 (0.10,0.10) mm vs. 0.30(0.20,0.34) mm P < 0.001^b). CEUS combined with UHFUS can locate more functional LVs more quickly compared to UHFUS alone (5.25 ± 0.89 number vs. 3.00 (2.00,3.00) number, P < 0.001^b, 9.88 ± 4.21 min/each vs. 36.43 ± 8.62 min/each, P < 0.001^b). The integrated approach combined the advantages of both CEUS and UHFUS. It can not only rapidly localize functional LVs, but also accurately measure internal diameters, which streamlines LVA and improves efficiency.