Nuclear Medicine Unit, Department of Health Sciences, Polyclinic Hospital "San Martino" IRCCS, IST, University of Genoa, Italy.
Department of Plastic and Reconstructive Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
Clin Nucl Med. 2019 Feb;44(2):91-98. doi: 10.1097/RLU.0000000000002400.
The current study aimed to determine the utility of including the study of deep subfascial lymphatic vessels in a 2-compartment lymphoscintigraphy for the diagnosis of lymphedema in patients with limb swelling. Lymphoscintigraphy is a valuable imaging tool for the timely diagnosis of peripheral lymphedema. However, there is a lack of standardization in its application, especially regarding which type of lymphatic vessels to examine (superficial, deep, or both).
Two hundred fifty-eight patients with lymphedema underwent segmental lymphoscintigraphy. The transport index (TI) was calculated to categorize the flow of the superficial and deep vessels as normal (<10) or pathological (≥10). The scores from 248 patients (48 unilateral arm, 86 unilateral leg, 114 bilateral leg) were tested with a 3-way analysis of variance to examine the relationship between affected limb, deep or superficial pathways, and primary or secondary lymphedema. The relationship between clinical presentation and TI was also investigated.
In general, primary and secondary lymphedema patients had similar patterns of lymphoscintigraphic lymphatic abnormalities. Patients with unilateral clinical presentation can have bilateral TI abnormalities. The vast majority of patients (88%-98%) had either the deep subfascial vessels alone, or both the superficial and deep vessels, with a pathological TI.
A 2-compartment lymphoscintigraphy is able to accurately detect lymphatic flow abnormalities in patients with limb swelling. Given that the vast majority of patients had deep lymphatic vessels abnormalities, inclusion of these vessels in the lymphoscintigraphic diagnostic protocol is recommended.
本研究旨在确定在 2 compartment 淋巴闪烁显像中研究深筋膜下淋巴管对肢体肿胀患者淋巴水肿的诊断价值。淋巴闪烁显像术是一种用于诊断外周淋巴水肿的有价值的影像学工具。然而，在其应用中缺乏标准化，特别是关于要检查哪种类型的淋巴管（浅层、深层或两者）。
258 例淋巴水肿患者行节段性淋巴闪烁显像术。计算转运指数（TI），将浅层和深层淋巴管的血流分为正常（<10）或病理（≥10）。对 248 例患者（单侧上肢 48 例，单侧下肢 86 例，双侧下肢 114 例）的评分进行 3 因素方差分析，以检验受累肢体、深或浅途径以及原发性或继发性淋巴水肿之间的关系。还研究了临床表型与 TI 的关系。
总体而言，原发性和继发性淋巴水肿患者的淋巴闪烁显像淋巴异常模式相似。单侧临床表现的患者可能存在双侧 TI 异常。绝大多数患者（88%-98%）存在深筋膜下淋巴管异常，且 TI 异常。
2 compartment 淋巴闪烁显像术能够准确检测肢体肿胀患者的淋巴流动异常。鉴于绝大多数患者存在深淋巴管异常，建议将这些淋巴管纳入淋巴闪烁显像诊断方案中。
