Contrast-enhanced ultrasound for lymphatic mapping: a comprehensive review

Contrast-enhanced ultrasound (CEUS) offers vascular-based real-time visualization of anatomy and pathology while maintaining the advantages of ultrasound: no radiation exposure and cost-effectiveness. This review provides an overview of the past, the current technology, and the future prospects of using CEUS to evaluate the lymphatic system. It has been demonstrated that lymphatic vessels and the lymph nodes they drain to can be successfully identified in patients who have undergone CEUS lymphography. For lymphaticovenous anastomosis (LVA) surgery planning, CEUS has shown capability in identifying target lymphatic vessels, sometimes outperforming conventional indocyanine green (ICG) fluorescent lymphography. While these preliminary findings are encouraging, further research is needed to establish standardized protocols and validate long-term outcomes. This review suggests that CEUS technology holds significant potential for advancing lymphatic imaging and improving surgical outcomes in lymphedema management.