Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
Department of Plastic Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
Sci Rep. 2023 Nov 9;13(1):19494. doi: 10.1038/s41598-023-44471-2.
An added value of SPECT/CT over planar lymphoscintigraphy for initial staging in patients with secondary extremity lymphedema was investigated. Furthermore, we developed a hybrid SPECT/CT classification combining dermal backflow (DBF) of SPECT and honeycomb pattern (HP) of CT, correlated it with lymphoscintigraphic staging and clinical severity. Forty-one patients with secondary extremity lymphedema who underwent lymphoscintigraphy with SPECT/CT were included retrospectively. The severity of extremity lymphedema was assessed using CT volumetry. Lymphoscintigraphic findings were evaluated using the Taiwan Lymphoscintigraphy Staging (TLS), and CT-based and SPECT-based quantitative analysis were performed. TLS was performed by planar scintigraphy only and with SPECT/CT, respectively. The SPECT/CT findings were classified into DBF-/HP-, DBF+/HP-, DBF+/HP+, and DBF-/HP+. Based on these findings, patients were categorized into five classes: Class 1 = DBF-HP- entire limb, Class 2 = DBF+/HP- proximal/distal limb without DBF+/HP+ or DBF-/HP+, Class 3 = DBF+/HP+ proximal/distal limb without DBF-/HP+, Class 4 = Mixed DBF+/HP+ and DBF-/HP+ in proximal/distal limb, Class 5 = DBF-/HP+ entire limb. Adding SPECT/CT to planar scintigraphy showed a 15.4% modification rate in lymphoscintigraphic staging. HP volume ratio significantly increased as clinical severity and lymphoscintigraphic staging increased, while DBF volume ratio increased with severity and followed expected patterns according to lymphoscintigraphic staging. Hybrid SPECT/CT lymphoscintigraphic classification showed strong positive correlation with clinical severity and TLS. Our results demonstrated substantial modification of lymphoscintigraphic staging by adding SPECT/CT to a conventional planar scintigraphy. In addition, a hybrid SPECT/CT is expected to provide new indicators reflecting lymphoscintigraphic staging and clinical severity by providing both of functional DBF and anatomical HP information.
本研究旨在探讨 SPECT/CT 相对于平面淋巴闪烁显像术在继发性四肢淋巴水肿初始分期中的附加价值。此外，我们开发了一种 SPECT/CT 混合分类方法，结合 SPECT 的皮肤回流（DBF）和 CT 的蜂窝状模式（HP），并将其与淋巴闪烁显像术分期和临床严重程度相关联。回顾性纳入 41 例接受 SPECT/CT 淋巴闪烁显像术的继发性四肢淋巴水肿患者。使用 CT 体绘制评估肢体淋巴水肿的严重程度。使用台湾淋巴闪烁显像术分期（TLS）评估淋巴闪烁显像术结果，并进行 CT 基于和 SPECT 基于的定量分析。仅通过平面闪烁显像术和 SPECT/CT 进行 TLS。SPECT/CT 结果分为 DBF-/HP-、DBF+/HP-、DBF+/HP+和 DBF-/HP+。根据这些结果，将患者分为五类：1 类=DBF-HP-整个肢体，2 类=DBF+/HP-近端/远端肢体无 DBF+/HP+或 DBF-/HP+，3 类=DBF+/HP+近端/远端肢体无 DBF-/HP+，4 类=混合的 DBF+/HP+和 DBF-/HP+在近端/远端肢体，5 类=DBF-/HP+整个肢体。与平面闪烁显像术相比，SPECT/CT 的加入使淋巴闪烁显像术分期的改变率增加了 15.4%。HP 体积比随着临床严重程度和淋巴闪烁显像术分期的增加而显著增加，而 DBF 体积比随着严重程度的增加而增加，并按照预期的模式根据淋巴闪烁显像术分期进行增加。SPECT/CT 混合淋巴闪烁显像术分类与临床严重程度和 TLS 具有很强的正相关性。我们的结果表明，通过将 SPECT/CT 添加到常规平面闪烁显像术中，对淋巴闪烁显像术分期进行了实质性的修改。此外，SPECT/CT 混合方法有望通过提供功能 DBF 和解剖 HP 信息，为反映淋巴闪烁显像术分期和临床严重程度提供新的指标。
