Pecking A P, Desprez-Curely J P, Cluzan R V
Service des isotopes, centre René-Huguenin, 35, rue Dailly, 92110 Saint-Cloud, France.
Rev Med Interne. 2002 Jun;23 Suppl 3:391s-397s. doi: 10.1016/s0248-8663(02)80381-2.
Methods for lymphatic imaging are numerous and can be roughly classified as anatomic or functional studies. Direct or indirect lymphographies provide useful informations in case of lymphostasis. Contrast lymphangiography is the only anatomical method giving precise informations either on lymphatic ducts or lymph nodes. Nevertheless this invasive method is no more indicated in cases of limb edemas. Indirect lymphographies study the spontaneous lymphatic drainage of inert particles injected into the dermis. The blue dye test is the most simple and the oldest indirect lymphography used in the positive diagnosis of a lymphostasis. It has been replaced with the indirect radionuclide lymphography which give more reliable informations. Fluorescence microlymphoangiography is an atraumatic method which permits the visualization of skin lymphatics. Indirect lymphangiography with contrast medium give reliable informations on the status of the initial lymphatics and is the best imaging method to differentiate between lipedema and lymphedema. Indirect radionuclide lymphoscintigraphy is a safe, non invasive and physiological method for the assessment of the limb lymphatic system used for morphological studies and objective measurement of the peripheral lymphatic function necessary to assess the lymphatic variation under therapy (decongestive physiotherapy, surgery, drugs).
淋巴成像方法众多，大致可分为解剖学或功能性研究。直接或间接淋巴管造影在淋巴淤滞情况下可提供有用信息。造影淋巴管造影是唯一能提供关于淋巴管或淋巴结精确信息的解剖学方法。然而，这种侵入性方法在肢体水肿病例中已不再适用。间接淋巴管造影研究注入真皮的惰性颗粒的自发淋巴引流。蓝色染料试验是用于淋巴淤滞阳性诊断的最简单、最古老的间接淋巴管造影方法。它已被间接放射性核素淋巴管造影所取代，后者能提供更可靠的信息。荧光显微淋巴管造影是一种无创方法，可使皮肤淋巴管可视化。用造影剂进行的间接淋巴管造影能提供关于初始淋巴管状态的可靠信息，是区分脂肪性水肿和淋巴水肿的最佳成像方法。间接放射性核素淋巴闪烁造影是一种安全、无创且生理性的方法，用于评估肢体淋巴系统，用于形态学研究以及客观测量评估治疗（减压物理治疗、手术、药物）下淋巴变化所需的外周淋巴功能。
