Klutmann S, Bohuslavizki K H, Höft S, Kröger S, Brenner W, Tinnemeyer S, Werner J A, Henze E
Klinik für Nuklearmedizin, Christian-Albrechts-Universität zu Kiel.
Laryngorhinootologie. 1997 Dec;76(12):740-4. doi: 10.1055/s-2007-997517.
Lymphoscintigraphy has been used since the early 1960s to demonstrate lymphatic drainage of head and neck tumors, but did not prove satisfactory. With the increasing importance of highly sophisticated neck dissection procedures, lymphoscintigraphy may have greater diagnostic impact. This assumes that lymphoscintigraphy will allow an accurate correlation of lymphatic drainage with anatomic structures. In this paper, we report on a method of lymphoscintigraphy with simultaneous body contouring.
Double-tracer lymphoscintigraphy was performed in 78 patients with squamous cell carcinoma. Patients received 100 MBq 99mTc-colloid in 0.1-0.2 ml in 3-4 peritumoral localizations. Ten patients were injected during surgery. Two milliliters of perchlorate solution were given orally in order to block the thyroid. Twenty minutes later patients received 50 MBq 99mTc-pertechnetate i.v. for body contouring. Planar images were obtained over 5 min each at 30 min and 4-6 h after injection from anterior, right lateral and left lateral using a LFOV-gamma camera.
The thyroid was not visualized in any of the patients. In 28 of 78 patients (36%), the injection site was the only focal activity seen. In 50 of 78 patients (64%), lymph drainage was observed. Thirty-six of 78 patients (46%) showed unilateral lymphatic drainage, and 14 of 78 (18%) showed bilateral drainage. In all 50 patients showing lymphatic drainage, lymph nodes could be easily assigned to the six cervical lymph node compartments described.
Double-tracer lymphoscintigraphy enables an accurate correlation of cervical lymph nodes and anatomic structures of the head and neck region. These findings suggest that the impact of these studies on the preoperative planning for neck dissection should be reevaluated.
自20世纪60年代初以来，淋巴闪烁造影术一直被用于显示头颈部肿瘤的淋巴引流情况，但效果并不理想。随着高度复杂的颈部清扫手术的重要性日益增加，淋巴闪烁造影术可能具有更大的诊断价值。这意味着淋巴闪烁造影术将能够准确地将淋巴引流与解剖结构相关联。在本文中，我们报告了一种同时进行身体轮廓描绘的淋巴闪烁造影术方法。
对78例鳞状细胞癌患者进行了双示踪剂淋巴闪烁造影术。患者在肿瘤周围3 - 4个部位接受0.1 - 0.2 ml含100 MBq 99mTc - 胶体的注射。10例患者在手术期间注射。口服2 ml高氯酸盐溶液以阻断甲状腺。20分钟后，患者静脉注射50 MBq 99mTc - 高锝酸盐进行身体轮廓描绘。使用大视野γ相机在注射后30分钟和4 - 6小时，分别从前位、右侧位和左侧位每隔5分钟获取平面图像。
所有患者的甲状腺均未显影。78例患者中有28例（36%），注射部位是唯一可见的局灶性活性区域。78例患者中有50例（64%）观察到淋巴引流。78例患者中有36例（46%）显示单侧淋巴引流，78例中有14例（18%）显示双侧引流。在所有50例显示淋巴引流的患者中，淋巴结可轻松归入所描述的六个颈部淋巴结分区。
双示踪剂淋巴闪烁造影术能够准确地将颈部淋巴结与头颈部区域的解剖结构相关联。这些发现表明，应重新评估这些研究对颈部清扫术前规划的影响。
