Primary lymphedema of the limbs is a chronic， progressive disorder arising from congenital abnormalities of

the lymphatic system. Its complex etiology and heterogeneous clinical manifestations make diagnosis difficult and contribute to treatment delays. With advances in imaging—particularly lymphoscintigraphy （LSG） ， indocyanine green （ICG） lymphography， ultrasound， magnetic resonance imaging （MRI）， and computed tomography （CT）—substantial progress has been made in the diagnosis， classification， and management of primary limb lymphedema. This review summarizes recent advances in the clinical application of these imaging modalities to aid surgeons in selecting the most appropriate techniques for diagnosis and phenotyping， thereby enabling more rational， individualized treatment planning.

Primary lymphedema, Imaging, Lymphatic system