Sampathirao N, Indirani M, Manokaran G, Jaykanth A, Patel A, Simon S
Department of Nuclear Medicine and PET/CT, Apollo Hospitals, Chennai, Tamil Nadu, India.
Department of Plastic Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India.
Lymphology. 2021;54(2):92-105.
Lymphoscintigraphy with combined qualitative and quantitative analysis is reported to be a more sensitive approach to diagnose lymphedema in comparison with the conventional clinical analysis. Our study seeks to evaluate the diagnostic performance of lower limb lymphoscintigraphy with amalgamation of qualitative and quantitative analysis by measuring the ilio-inguinal nodal uptake. This prospective observational study was comprised of 86 patients (172 limbs) diagnosed with lower limb lymphedema. After a thorough clinical grading of edema, radionuclide lymphoscintigraphy was performed as per a dedicated institutional protocol. Ilio-inguinal nodal quantification of tracer uptake was computed along with the visual study of the scans. Additionally, the corresponding mean nodal uptake percentage for each grade of lymphedema was assessed and a cut off nodal uptake percentage to differentiate between normal and abnormal limbs was defined. Although quantitative analysis with nodal uptake percentage provides objective criteria to diagnose lymphedema, it can only act as an adjunct to qualitative method without replacing it. Finally, standardization of procedure for quantitative lymphoscintigraphy is needed including the potential for combining both rate of clearance of tracer from injection site and nodal uptake for quantification.
据报道，与传统临床分析相比，结合定性和定量分析的淋巴闪烁造影术是诊断淋巴水肿更敏感的方法。我们的研究旨在通过测量髂腹股沟淋巴结摄取，评估结合定性和定量分析的下肢淋巴闪烁造影术的诊断性能。这项前瞻性观察性研究包括86例诊断为下肢淋巴水肿的患者（172条肢体）。在对水肿进行全面临床分级后，按照专门的机构方案进行放射性核素淋巴闪烁造影术。计算髂腹股沟淋巴结对示踪剂摄取的定量，并对扫描进行视觉研究。此外，评估了每个淋巴水肿等级相应的平均淋巴结摄取百分比，并定义了区分正常和异常肢体的淋巴结摄取百分比临界值。尽管用淋巴结摄取百分比进行定量分析为诊断淋巴水肿提供了客观标准，但它只能作为定性方法的辅助手段，而不能取代定性方法。最后，需要对定量淋巴闪烁造影术的程序进行标准化，包括结合示踪剂从注射部位清除率和淋巴结摄取进行定量的可能性。
