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Primary lymphedema of the lower limb: the clinical utility of single photon emission computed tomography/CT.

Weiss M, Baumeister RG, Frick A, Wallmichrath J, Bartenstein P, Rominger A - Korean J Radiol (2015)

Bottom Line: 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).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%).The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.

ABSTRACT

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.

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46-year-old female patient with clinically swelling of right leg suspicious for primary lymphedema. Planar lymphoscintigraphy clearly depicted diffuse distribution of radiopharmaceutical at right lower leg and upper leg. In comparison to contralateral side, likely decreased number of inguinal lymph nodes could be suspected, which was reliably confirmed with three-dimensional anatomical correlation by means of single photon emission computed tomography/CT (SPECT/CT). While planar scintigraphy is limited to functionally demonstrate (inguinal) lymph nodes, CT-component of SPECT/CT serves to verify morphological presence of lymph nodes in this area. Physiological lymph transport and distinct visualization of inguinal lymph nodes of left leg.
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Figure 2: 46-year-old female patient with clinically swelling of right leg suspicious for primary lymphedema. Planar lymphoscintigraphy clearly depicted diffuse distribution of radiopharmaceutical at right lower leg and upper leg. In comparison to contralateral side, likely decreased number of inguinal lymph nodes could be suspected, which was reliably confirmed with three-dimensional anatomical correlation by means of single photon emission computed tomography/CT (SPECT/CT). While planar scintigraphy is limited to functionally demonstrate (inguinal) lymph nodes, CT-component of SPECT/CT serves to verify morphological presence of lymph nodes in this area. Physiological lymph transport and distinct visualization of inguinal lymph nodes of left leg.

Mentions: In total, planar lymphoscintigraphy including the calculation of TI (TI ≥ 10) (Table 2) detected a total of 28 limbs presenting as lymphatic disorders; in comparison to pathological planar scintigraphic findings, SPECT/CT provided relevant additional information in 27/28 (96.4%) of the lower extremities. In 64% (18/28) of the lower limbs presenting with pathological planar scintigraphic findings, we obtained additional information using SPECT/CT regarding the exact anatomic allocation of lymphatic disorders, based on anatomic margins. In 86% (24/28) of the lower limbs, SPECT/CT was informative about the presence of diffuse distribution of the radiopharmaceutical due to dermal backflow; this additional value was derived from the three-dimensional depiction and superior spatial resolution of SPECT/CT. In 4% (1/28) of the lower limbs, there was a faint visualization of lymph vessels by SPECT/CT. Thirteen of 28 (46%) lower limbs showed an increasing or reduced number of inguinal lymph nodes; while planar scintigraphy could only functionally demonstrate the inguinal lymph nodes, the CT-component of SPECT/CT served to verify the morphology and the presence or absence of lymph nodes in the corresponding area. Table 1 presents the number of tomographically investigated anatomic sites, as well as the improvements of diagnostic value due to the additional use of SPECT/CT. Representative examples are depicted in Figures 1,2,3.


Primary lymphedema of the lower limb: the clinical utility of single photon emission computed tomography/CT.

Weiss M, Baumeister RG, Frick A, Wallmichrath J, Bartenstein P, Rominger A - Korean J Radiol (2015)

46-year-old female patient with clinically swelling of right leg suspicious for primary lymphedema. Planar lymphoscintigraphy clearly depicted diffuse distribution of radiopharmaceutical at right lower leg and upper leg. In comparison to contralateral side, likely decreased number of inguinal lymph nodes could be suspected, which was reliably confirmed with three-dimensional anatomical correlation by means of single photon emission computed tomography/CT (SPECT/CT). While planar scintigraphy is limited to functionally demonstrate (inguinal) lymph nodes, CT-component of SPECT/CT serves to verify morphological presence of lymph nodes in this area. Physiological lymph transport and distinct visualization of inguinal lymph nodes of left leg.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296269&req=5

Figure 2: 46-year-old female patient with clinically swelling of right leg suspicious for primary lymphedema. Planar lymphoscintigraphy clearly depicted diffuse distribution of radiopharmaceutical at right lower leg and upper leg. In comparison to contralateral side, likely decreased number of inguinal lymph nodes could be suspected, which was reliably confirmed with three-dimensional anatomical correlation by means of single photon emission computed tomography/CT (SPECT/CT). While planar scintigraphy is limited to functionally demonstrate (inguinal) lymph nodes, CT-component of SPECT/CT serves to verify morphological presence of lymph nodes in this area. Physiological lymph transport and distinct visualization of inguinal lymph nodes of left leg.
Mentions: In total, planar lymphoscintigraphy including the calculation of TI (TI ≥ 10) (Table 2) detected a total of 28 limbs presenting as lymphatic disorders; in comparison to pathological planar scintigraphic findings, SPECT/CT provided relevant additional information in 27/28 (96.4%) of the lower extremities. In 64% (18/28) of the lower limbs presenting with pathological planar scintigraphic findings, we obtained additional information using SPECT/CT regarding the exact anatomic allocation of lymphatic disorders, based on anatomic margins. In 86% (24/28) of the lower limbs, SPECT/CT was informative about the presence of diffuse distribution of the radiopharmaceutical due to dermal backflow; this additional value was derived from the three-dimensional depiction and superior spatial resolution of SPECT/CT. In 4% (1/28) of the lower limbs, there was a faint visualization of lymph vessels by SPECT/CT. Thirteen of 28 (46%) lower limbs showed an increasing or reduced number of inguinal lymph nodes; while planar scintigraphy could only functionally demonstrate the inguinal lymph nodes, the CT-component of SPECT/CT served to verify the morphology and the presence or absence of lymph nodes in the corresponding area. Table 1 presents the number of tomographically investigated anatomic sites, as well as the improvements of diagnostic value due to the additional use of SPECT/CT. Representative examples are depicted in Figures 1,2,3.

Bottom Line: 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).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%).The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus