Cambria R A, Gloviczki P, Naessens J M, Wahner H W
Division of Vascular Surgery, Mayo Clinic, Rochester, MN.
J Vasc Surg. 1993 Nov;18(5):773-82. doi: 10.1067/mva.1993.50510.
Lymphoscintigraphy has emerged as the diagnostic test of choice in patients with suspected lymphedema. To assess the lymphatic circulation of 386 extremities in 188 patients, we prospectively recorded a semiquantitative index of lymphatic transport in addition to visual evaluation of lymphoscintigraphy image patterns.
Sixty-one male and 127 female patients were studied (mean age 48 years, range 13 to 87 years). Twenty had upper extremity swelling, and 168 had lower extremity swelling. The disease was bilateral in 60 patients. Lymphoscintigraphy was performed by injecting a mean of 503 microCi of technetium 99m-antimony trisulfide colloid subcutaneously into the second interdigital space of the extremity. Time for transport to regional lymph nodes, appearance of lymph vessels and nodes and distribution pattern were scored. These scores were compiled into a modified Kleinhans transport index (TI). To assess the venous circulation, 155 patients underwent evaluation of the venous system by impedance plethysmography, ultrasonography, or contrast venography.
The mean TI (+/- SEM) in 79 asymptomatic extremities was 2.6 +/- 0.5, with 66 (83.5%) demonstrating normal lymphoscintigraphy pattern (TI < 5). Patients with clinical diagnosis of lymphedema (n = 124) had a mean TI of 23.8 +/- 1.5; 81.5% of these were greater than 5. Fifty-six patients (30%) had primary and 68 (36%) had secondary lymphedema. (TI of 26 +/- 3.5 and 22.1 +/- 1.9, respectively, p = NS). Patients without any lymphatic transport (TI of 45) were more likely to have cellulitis in their history (p < 0.05). Contrast lymphangiography in six patients correlated with lymphoscintigraphy. Sixty-four patients (34%) had swelling without lymphedema (venous edema, cardiac edema, lipedema, etc.; TI of 1.9 +/- 0.4, p < 0.001). Of the 41 patients with abnormal venous studies, 18 (44%) had an elevated TI.
Semiquantitative evaluation of the lymphatic transport with lymphoscintigraphy reliably depicts abnormalities in the lymphatic circulation. Lymphoscintigraphy excluded lymphedema as a cause of leg swelling in one third of our patients.
淋巴闪烁造影已成为疑似淋巴水肿患者的首选诊断检查方法。为评估188例患者386条肢体的淋巴循环，我们除了对淋巴闪烁造影图像模式进行视觉评估外，还前瞻性地记录了淋巴转运的半定量指标。
研究了61例男性和127例女性患者（平均年龄48岁，范围13至87岁）。20例有上肢肿胀，168例有下肢肿胀。60例患者为双侧患病。通过将平均503微居里的99m锝-三硫化二锑胶体皮下注射到肢体的第二指间间隙来进行淋巴闪烁造影。记录转运至区域淋巴结的时间、淋巴管和淋巴结的出现情况以及分布模式，并进行评分。这些评分被汇总为改良的克莱因汉斯转运指数（TI）。为评估静脉循环，155例患者通过阻抗体积描记法、超声检查或静脉造影对静脉系统进行了评估。
79条无症状肢体的平均TI（±标准误）为2.6±0.5，其中66条（83.5%）淋巴闪烁造影模式正常（TI<5）。临床诊断为淋巴水肿的患者（n = 124）平均TI为23.8±1.5；其中81.5%大于5。56例患者（30%）为原发性淋巴水肿，68例患者（36%）为继发性淋巴水肿（TI分别为26±3.5和22.1±1.9，p =无显著性差异）。无任何淋巴转运（TI为45）的患者更有可能有蜂窝织炎病史（p<0.05）。6例患者的对比淋巴管造影结果与淋巴闪烁造影结果相关。64例患者（34%）有肿胀但无淋巴水肿（静脉性水肿、心性水肿、脂肪性水肿等；TI为1.9±0.4，p<0.001）。在41例静脉检查异常的患者中，18例（44%）TI升高。
通过淋巴闪烁造影对淋巴转运进行半定量评估能够可靠地描绘淋巴循环中的异常情况。淋巴闪烁造影排除了三分之一患者腿部肿胀的原因是淋巴水肿。
