What is ICG Lymphography and when should I get it done?
/ICG Lymphography (Indocyanine Green Lymphography) is a modern, minimally invasive imaging method used to visualise superficial lymphatic vessels in real time. It has become an increasingly important diagnostic and monitoring tool in the field of lymphology, particularly for assessing lymphoedema and the effects of Manual Lymph Drainage (MLD) and other therapeutic interventions.
What is ICG Lymphography?
ICG lymphography involves:
Injecting a small amount of Indocyanine Green dye just under the skin (intradermal injection).
Using near-infrared fluorescence imaging to track the movement of the dye through lymphatic vessels.
It allows practitioners to observe functional lymphatic pathways in real time, often with greater sensitivity than older methods (like lymphoscintigraphy), especially for early-stage or mild lymphatic dysfunction.
When do we consider using ICG Lymphography?
ICG lymphography is particularly useful when:
Diagnosing lymphoedema, especially in its early stages when structural changes are not yet visible via other imaging.
Monitoring the effectiveness of manual therapy, compression garments, or surgical interventions (e.g. lymphovenous bypass, VLNT).
Planning decongestive therapy, by identifying dominant or functional lymphatic pathways.
Assessing alternative drainage pathways that may develop over time (especially after long-term MLD or in response to surgery or trauma).
Preoperative assessment for supermicrosurgery in lymphoedema treatment.
What can it show?
ICG lymphography can reveal:
Normal linear lymphatic patterns (healthy function).
Dermal backflow patterns (signs of lymphatic overload or dysfunction).
The presence of alternative or collateral drainage pathways – often developed as a compensatory response to blockages or after long-term manual therapy.
Functional changes over time, which is helpful in documenting progress from manual lymphatic therapy or complex decongestive therapy.
Severity and extent of lymphoedema, often categorized into stages based on lymphatic architecture.
Clinical Insight: Relevance to Long-Term Manual Therapy
A study done by Mary Wakefield —“ICG Lymphography Confirms the Presence of an Alternative Lymph Drainage Pathway Following Long-Term Manual Therapy”—highlights that:
Manual Lymph Drainage (MLD) can help stimulate the development of compensatory drainage pathways.
ICG imaging confirms these changes visually and functionally.
This evidence supports the long-term benefits of consistent MLD and helps tailor future therapy by focusing on functioning pathways.
Summary
ICG Lymphography is a valuable tool for:
Accurate diagnosis and staging of lymphoedema.
Individualised treatment planning.
Visual confirmation of therapy outcomes, particularly long-term MLD.
It strengthens the role of manual therapy not just as symptom management, but as a catalyst for physiological adaptation and functional recovery in the lymphatic system.
