DOI QR코드

DOI QR Code

Primary Lymphedema of the Lower Limb: The Clinical Utility of Single Photon Emission Computed Tomography/CT

  • Weiss, Mayo (Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich) ;
  • Baumeister, Ruediger G.H. (Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich) ;
  • Frick, Andreas (Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich) ;
  • Wallmichrath, Jens (Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich) ;
  • Bartenstein, Peter (Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich) ;
  • Rominger, Axel (Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich)
  • 투고 : 2014.06.07
  • 심사 : 2014.11.04
  • 발행 : 2015.02.01

초록

Objective: The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb. Materials and Methods: For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65). Results: In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%). Conclusion: As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.

키워드

참고문헌

  1. Pecking AP, Alberini JL, Wartski M, Edeline V, Cluzan RV. Relationship between lymphoscintigraphy and clinical findings in lower limb lymphedema (LO): toward a comprehensive staging. Lymphology 2008;41:1-10
  2. Weiss M, Gildehaus FJ, Brinkbaumer K, Makowski M, Hahn K. [Lymph kinetics with technetium-99m labeled radiopharmaceuticals. Animal studies]. Nuklearmedizin 2005;44:156-165 https://doi.org/10.1055/s-0038-1625103
  3. Weiss M, Baumeister RG, Hahn K. Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study. Eur J Nucl Med Mol Imaging 2003;30:202-206 https://doi.org/10.1007/s00259-002-1020-1
  4. Baulieu F, Bourgeois P, Maruani A, Belgrado JP, Tauveron V, Lorette G, et al. Contributions of SPECT/CT imaging to the lymphoscintigraphic investigations of the lower limb lymphedema. Lymphology 2013;46:106-119
  5. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013;46:1-11
  6. Kleinhans E, Baumeister RG, Hahn D, Siuda S, Bull U, Moser E. Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med 1985;10:349-352
  7. Weiss M, Baumeister RG, Tatsch K, Hahn K. [Lymphoscintigraphy for non-invasive long term follow-up of functional outcome in patients with autologous lymph vessel transplantation]. Nuklearmedizin 1996;35:236-242 https://doi.org/10.1055/s-0038-1629782
  8. Bourgeois P. Scintigraphic investigations of the lymphatic system: the influence of injected volume and quantity of labeled colloidal tracer. J Nucl Med 2007;48:693-695 https://doi.org/10.2967/jnumed.107.039594
  9. Monnin-Delhom ED, Gallix BP, Achard C, Bruel JM, Janbon C. High resolution unenhanced computed tomography in patients with swollen legs. Lymphology 2002;35:121-128
  10. Baumeister RG, Seifert J, Hahn D. Autotransplantation of lymphatic vessels. Lancet 1981;1:147
  11. O'Mahony S, Rose SL, Chilvers AJ, Ballinger JR, Solanki CK, Barber RW, et al. Finding an optimal method for imaging lymphatic vessels of the upper limb. Eur J Nucl Med Mol Imaging 2004;31:555-563 https://doi.org/10.1007/s00259-003-1399-3
  12. Bocher M, Balan A, Krausz Y, Shrem Y, Lonn A, Wilk M, et al. Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images. Eur J Nucl Med 2000;27:619-627 https://doi.org/10.1007/s002590050555
  13. Wallmichrath J, Baumeister R, Giunta RE, Notohamiprodjo M, Frick A. [Update on special surgical approaches in the therapy for lymphedemas]. Handchir Mikrochir Plast Chir 2012;44:334-342 https://doi.org/10.1055/s-0032-1323840
  14. Weiss M, Landrock S, Wallmichrath J, Baumeister RG, Bartenstein P, Frick A. [The clinical yield of SPECT/CT for the assessment of lymphatic transport disorders. First experiences]. Nuklearmedizin 2013;52:235-243 https://doi.org/10.3413/Nukmed-0587-13-05

피인용 문헌

  1. Update March 2015 vol.13, pp.1, 2015, https://doi.org/10.1089/lrb.2015.1312
  2. Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol vol.53, pp.1, 2015, https://doi.org/10.1007/s13139-018-0565-2