Pieper Claus C
Sektion für minimal invasive Lymphgefäßtherapie, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
Radiologie (Heidelb). 2025 May;65(5):316-324. doi: 10.1007/s00117-025-01451-z. Epub 2025 Apr 17.
The armamentarium of lymphatic imaging techniques and treatment concepts available at specialized centers has significantly increased in recent years. The rarity and complexity of lymphatic vascular diseases presents the particular challenge of implementing these methods in a meaningful and targeted manner in patient care; however, there are currently no generally accepted diagnostic guidelines.
Which lymphatic imaging technique is useful in which clinical situations?
This article provides an overview of clinical and technical considerations that are relevant for a targeted evaluation of indications for lymphatic imaging in a multidisciplinary diagnostic and therapeutic approach.
The lymphatic vascular system can be affected by a wide range of primary and secondary pathologies, which often lead to relatively uniform clinical presentations (especially localized swellings, chylolymphatic effusions). In general, dedicated imaging should be discussed if a lymphatic vascular disease is suspected based on such a typical presentation. The choice of imaging strategy is then individually determined by the urgency of treatment, suspected localization and etiology of the pathology, comorbidities, specific properties of the imaging techniques, the treatment strategy pursued and local availability. When interpreting imaging and planning treatment, in addition to the large spectrum of different pathologies, the individual variability of the lymphatic system must also be taken into account.
An individual pretherapeutic assessment of lymphatic flow should nowadays be mandatory in order to be able to optimize the therapeutic approach for each patient with a suspected lymphatic vascular disease. Interdisciplinary patient care is of decisive importance.
近年来,专业中心可用的淋巴成像技术和治疗理念显著增加。淋巴血管疾病的罕见性和复杂性给在患者护理中以有意义且有针对性的方式应用这些方法带来了特殊挑战;然而,目前尚无普遍接受的诊断指南。
哪种淋巴成像技术在哪些临床情况下有用?
本文概述了在多学科诊断和治疗方法中,与有针对性地评估淋巴成像适应证相关的临床和技术考量。
淋巴血管系统可受到多种原发性和继发性病变的影响,这些病变常导致相对一致的临床表现(尤其是局部肿胀、乳糜淋巴积液)。一般来说,如果基于这种典型表现怀疑有淋巴血管疾病,就应讨论进行专门的成像检查。然后,成像策略的选择由治疗的紧迫性、病变的可疑定位和病因、合并症、成像技术的特定属性、所采用的治疗策略以及当地的可及性来单独确定。在解读成像结果和规划治疗方案时,除了要考虑大范围的不同病变外,还必须考虑淋巴系统的个体变异性。
如今,对淋巴流动进行个体化的治疗前评估应成为必需,以便能够为每位疑似淋巴血管疾病的患者优化治疗方法。跨学科的患者护理至关重要。