McNeill G C, Witte M H, Witte C L, Williams W H, Hall J N, Patton D D, Pond G D, Woolfenden J M
Department of Diagnostic Radiology, University of Arizona Health Sciences Center, Tucson 85724.
Radiology. 1989 Aug;172(2):495-502. doi: 10.1148/radiology.172.2.2748831.
In 20 patients with congenital and acquired lymphedema in either upper or lower extremities and in four patients without extremity edema, human serum albumin labeled with technetium-99m was injected intradermally into a digital web space of the hand or foot. With a digital gamma camera that permitted a "sweep" of the torso, serial extremity and whole-body lymphagioscintigraphy (LAS) of the peripheral lymphatic system was performed. In 11 patients with acquired lymphedema, a well-defined obstructive pattern was seen, characterized by discrete peripheral lymphatic trunks, delayed or absent depiction of regional nodes, and delayed but extensive soft-tissue tracer extravasation. Five of nine patients with congenital lymphedema showed hypoplasia characterized by poorly defined lymphatic trunks, delayed depiction of regional nodes, and early and extensive extravasation of tracer. The other four patients showed aplasia, with absence of trunks, no depiction of nodes, and little or no tracer extravasation. LAS is technically simple to perform and requires no special training. Radiation exposure is minuscule, and the procedure is safe and without apparent side effects. For these reasons, whole-body LAS should be the preferred method for the initial assessment of congenital or acquired lymphedema.
在20例患有先天性和后天性上肢或下肢淋巴水肿的患者以及4例无肢体水肿的患者中，将用锝-99m标记的人血清白蛋白皮内注射到手或足的指蹼间隙。使用能够“扫描”躯干的数字γ相机，对周围淋巴系统进行连续的肢体和全身淋巴闪烁显像（LAS）。在11例后天性淋巴水肿患者中，可见明确的阻塞性模式，其特征为周围淋巴管离散、区域淋巴结延迟显示或未显示以及示踪剂在软组织中延迟但广泛的外渗。9例先天性淋巴水肿患者中有5例表现为发育不全，其特征为淋巴管不明确、区域淋巴结显示延迟以及示踪剂早期广泛外渗。其他4例患者表现为发育不全，无淋巴管、无淋巴结显示且几乎没有或没有示踪剂外渗。LAS技术操作简单，无需特殊培训。辐射暴露极小，该检查安全且无明显副作用。基于这些原因，全身LAS应成为先天性或后天性淋巴水肿初始评估的首选方法。
