Witte M H, Jamal S, Williams W H, Witte C L, Kumaraswami V, McNeill G C, Case T C, Panicker T M
Department of Surgery, University of Arizona, Tucson.
Arch Intern Med. 1993 Mar 22;153(6):737-44.
Investigation into filarial lymphedema has been hampered by the lack of a simple, safe, and easily repeated test to image the peripheral lymphatic system. Recent refinements in radionuclide lymphangioscintigraphy have established this noninvasive technique as the initial procedure of choice for visualizing lymphatics. Accordingly, we applied lymphangioscintigraphy to patients with filariasis and, for purposes of interpretation, compared the findings with those in patients with non-filarial lymphedema.
Thirty-three patients with classic symptoms or signs consistent with acute or chronic filariasis underwent lymphangioscintigraphy, and the findings were compared with those in five patients without lymphatic dysfunction and in 50 other patients with primary or secondary lymphedema without exposure to filariasis.
As in patients with nonfilarial lymphedema, scintigraphic abnormalities in the 33 patients with filariasis included delayed or absent tracer transport of the radiotracer (25 patients), tortuous and bizarre deep lymphatics (seven patients), dermal diffusion (15 patients), retrograde tracer flow (six patients), and faint or absent regional nodal visualization (14 patients). Even in patients with long-standing filarial lymphedema, peripheral trunks were often visualized (at least in part), and regional nodes and more central lymphatics sometimes filled after light exercise. In some of the latter patients, however, discrete lymphatic trunks were not detected.
Lymphangioscintigraphy is a simple, safe, reliable, noninvasive method with which to examine the peripheral lymphatic system, including truncal and nodal abnormalities, in endemic populations with occult and overt lymphatic filariasis.
由于缺乏一种简单、安全且易于重复的用于对外周淋巴系统成像的检测方法，丝虫性淋巴水肿的研究受到了阻碍。放射性核素淋巴闪烁造影术的最新改进已将这种非侵入性技术确立为可视化淋巴管的首选初始检查方法。因此，我们对丝虫病患者应用了淋巴闪烁造影术，并为了解读结果，将其与非丝虫性淋巴水肿患者的结果进行了比较。
33例有与急性或慢性丝虫病相符的典型症状或体征的患者接受了淋巴闪烁造影术，并将结果与5例无淋巴功能障碍的患者以及50例其他未接触过丝虫病的原发性或继发性淋巴水肿患者的结果进行了比较。
与非丝虫性淋巴水肿患者一样，33例丝虫病患者的闪烁造影异常包括放射性示踪剂转运延迟或缺失（25例患者）、深部淋巴管迂曲且形态怪异（7例患者）、真皮扩散（15例患者）、示踪剂逆流（6例患者）以及区域淋巴结显影模糊或缺失（14例患者）。即使是患有长期丝虫性淋巴水肿的患者，外周主干淋巴管通常也能（至少部分地）显影，轻度运动后区域淋巴结和更靠近中心的淋巴管有时会显影。然而，在部分后者患者中，未检测到离散的淋巴干。
淋巴闪烁造影术是一种简单、安全、可靠的非侵入性方法，可用于检查隐匿性和显性淋巴丝虫病流行地区人群的外周淋巴系统，包括主干和淋巴结异常。
