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Methodological Aspects of Lymphoscintigraphy: Bicompartmental Versus Monocompartmental Radiocolloid Administration

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Atlas of Lymphoscintigraphy and Sentinel Node Mapping

Abstract

Interstitial injection of radiolabeled compounds with sequential scanning imaging has been used since the 1950s to investigate the lymphatic system. This minimally invasive procedure, which simply requires intradermal or subcutaneous injection of a radiocolloid, has largely replaced the more invasive and technically difficult technique of lymphangiography [1].

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References

  1. Weissleder H, Weissleder R (1988) Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238. patients. Radiology 167:729–735.

    PubMed  CAS  Google Scholar 

  2. Cornford ME, Oldendorf WH (1993) Terminal endothelial cells of lymph capillaries as active transport structures involved in the formation of lymph in rat skin. Lymphology 26:67–78.

    PubMed  CAS  Google Scholar 

  3. Szuba A, Rockson SG (1997) Lymphedema: anatomy, physiology and pathogenesis. Vasc Med 2:321–326.

    PubMed  CAS  Google Scholar 

  4. Ikomi F, Schmid-Schönbein GW (1995) Lymph transport in the skin. Clin Dermatol 13:419–427.

    Article  PubMed  CAS  Google Scholar 

  5. Lubach D, LĂ¼demann W, Berens von Rautenfeld D (1996) Recent findings on the angioarchitecture of the lymph vessel system of human skin. Br J Dermatol 135:733–737.

    Article  PubMed  CAS  Google Scholar 

  6. Adair TH, Vance GA, Montani JP et al (1991) Effect of skin concavity on subcutaneous tissue fluid pressure. Am J Physiol Heart Circ Physiol 261:H349–353.

    CAS  Google Scholar 

  7. Aukland K, Reed RK (1993) Interstitial-lymphatic mechanisms in the control of extracellular fluid volume. Physiol Rev 73:1–78.

    PubMed  CAS  Google Scholar 

  8. Spiegel M, Vesti B, Shore A et al (1991) [Pressure measurement in lymph capillaries of the human skin.] Vasa Suppl 33:278

    PubMed  CAS  Google Scholar 

  9. Spiegel M, Vesti B, Shore A et al (1992) Pressure of lymphatic capillaries in human skin. Am J Physiol Heart Circ Physiol 262:H1208–1210.

    CAS  Google Scholar 

  10. Reddy NP, Patel K (1995) A mathematical model of flow through the terminal lymphatics. Med Eng Phys 17:134–140.

    Article  PubMed  CAS  Google Scholar 

  11. Ikomi F, Hunt J, Hanna G et al (1996) Interstitial fluid, plasma protein, colloid, and leukocyte uptake into initial lymphatics. J Appl Physiol 81:2060–2067.

    PubMed  CAS  Google Scholar 

  12. Olszewski WL, Jamal S, Manokaran G et al (1997) Bacteriologic studies of skin, tissue fluid, lymph, and lymph nodes in patients with filarial lymphedema. Am J Trop Med Hyg 57:7–15.

    PubMed  CAS  Google Scholar 

  13. Pecking AP (1999) Possibilities and restriction of isotopic lymphography for the assessment of therapeutic effects in lymphedema. Wien Med Wochenschr 149:105–106.

    PubMed  CAS  Google Scholar 

  14. Cambria RA, Gloviczki P, Naessens JM et al (1993) Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386. extremities. J Vasc Surg 18:773–782.

    Article  PubMed  CAS  Google Scholar 

  15. Mortimer PS (1995) Evaluation of lymphatic function: abnormal lymph drainage in venous disease. Int Angiol 14:32–35.

    PubMed  CAS  Google Scholar 

  16. Mostbeck A, Partsch H (1999) [Isotope lymphography — possibilities and limits in evaluation of lymph transport.] Wien Med Wochenschr 149:87–91.

    PubMed  CAS  Google Scholar 

  17. Ohtake E, Matsui K (1986) Lymphoscintigraphy in patients with lymphedema. A new approach using intradermal injections of technetium-99m human serum albumin. Clin Nucl Med 11:474–478.

    Article  PubMed  CAS  Google Scholar 

  18. McNeill GC, Witte MH, Witte CL et al (1989) Whole-body lymphangioscintigraphy: preferred method for initial assessment of the peripheral lymphatic system. Radiology 172:495–502.

    PubMed  CAS  Google Scholar 

  19. Nawaz MK, Hamad MM, Abdel-Dayem HM et al (1990) Tc-99m human serum albumin lymphoscintigraphy in lymphedema of the lower extremities. Clin Nucl Med 15:794–799.

    Article  PubMed  CAS  Google Scholar 

  20. Nawaz MK, Hamad MM, Abdel-Dayem HM et al (1992) Lymphoscintigraphy in lymphedema of the lower limbs using 99mTc HSA. Angiology 43:147–154.

    Article  PubMed  CAS  Google Scholar 

  21. Suga K, Uchisako H, Nakanishi T et al (1991) Lymphoscintigraphic assessment of leg oedema following arterial reconstruction using a load produced by standing. Nucl Med Commun 12:907–917.

    Article  PubMed  CAS  Google Scholar 

  22. Williams WH, Witte CL, Witte MH et al (2000) Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema. Clin Nucl Med 25:451–464.

    Article  PubMed  CAS  Google Scholar 

  23. Miranda F Jr, Perez MC, Castiglioni M et al (2001) Effect of sequential intermittent pneumatic compression on both leg lymphedema volume and on lymph transport as semi-quantitatively evaluated by lymphoscintigraphy. Lymphology 4:135–141.

    Google Scholar 

  24. Partsch H (1995) Assessment of abnormal lymph drainage for the diagnosis of lymphedema by isotopic lymphangiography and by indirect lymphography. Clin Dermatol 13:445–450.

    Article  PubMed  CAS  Google Scholar 

  25. Bräutigam P, Vanscheidt W, Földi E et al (1993) The importance of the subfascial lymphatics in the diagnosis of lower limb edema: investigations with semiquantitative lymphoscintigraphy. Angiology 44:464–470.

    Article  PubMed  Google Scholar 

  26. Bräutigam P, Földi E, Schaiper I et al (1998) Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy. Lymphology 31:43–55.

    PubMed  Google Scholar 

  27. Partsch H (2003) Practical aspects of indirect lymphography and lymphoscintigraphy. Lymphat Res Biol 1:71–74.

    Article  PubMed  Google Scholar 

  28. Jensen MR, Simonsen L, Karlsmark T et al (2010) Lymphoedema of the lower extremities-background, pathophysiology and diagnostic considerations. Clin Physiol Funct Imaging 30:389–398.

    Article  PubMed  Google Scholar 

  29. Ogawa Y, Hayashi K (1999) [99mTc-DTPA-HSA lymphoscintigraphy in lymphedema of the lower extremities: diagnostic significance of dynamic study and muscular exercise.] Kaku Igaku 36:31–36.

    PubMed  CAS  Google Scholar 

  30. Kataoka M, Kawamura M, Hamada K et al (1991) Quantitative lymphoscintigraphy using 99Tcm human serum albumin in patients with previously treated uterine cancer. Br J Radiol 64:1119–1121.

    Article  PubMed  CAS  Google Scholar 

  31. Rijke AM, Croft BY, Johnson RA et al (1990) Lymphoscintigraphy and lymphedema of the lower extremities. J Nucl Med 31:990–998.

    PubMed  CAS  Google Scholar 

  32. Kleinhans E, Baumeister RG, Hahn D et al (1985) Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med 10:349–352.

    Article  PubMed  CAS  Google Scholar 

  33. Ikomi F, Hanna GK, Schmid-Schönbein GW (1995) Mechanism of colloidal particle uptake into the lymphatic system: basic study with percutaneous lymphography. Radiology 196:107–113.

    PubMed  CAS  Google Scholar 

  34. Dabrowski J, Merkert R, Kuśmierek J (2008) Optimized lymphoscintigraphy and diagnostics of lymphatic oedema of the lower extremities. Nucl Med Rev Cent East Eur 11:26–29.

    PubMed  Google Scholar 

  35. Damstra RJ, van Steensel MA, Boomsma JH et al (2008) Erysipelas as a sign of subclinical primary lymphoedema: a prospective quantitative scintigraphic study of 40. patients with unilateral erysipelas of the leg. Br J Dermatol 158:1210–1215.

    Article  PubMed  CAS  Google Scholar 

  36. Gloviczki P, Calcagno D, Schirger A et al (1989) Noninvasive evaluation of the swollen extremity: experiences with 190. lymphoscintigraphic examinations. J Vasc Surg 9:683–690.

    PubMed  CAS  Google Scholar 

  37. Stanton AW, Svensson WE, Mellor RH et al (2001) Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema. Clin Sci (Lond) 101:131–40.

    Article  CAS  Google Scholar 

  38. Modi S, Stanton AW, Svensson WE et al (2007) Human lymphatic pumping measured in healthy and lymphoedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol 15:271–285.

    Article  Google Scholar 

  39. Pain SJ, Nicholas RS, Barber RW et al (2002) Quantification of lymphatic function for investigation of lymphedema: depot clearance and rate of appearance of soluble macromolecules in blood. J Nucl Med 43:318–324.

    PubMed  Google Scholar 

  40. Stamp GF, Peters AM (2012) Peripheral lymphovenous communication in lymphoedema. Nucl Med Commun 33:701–707.

    Article  PubMed  Google Scholar 

  41. Pecking AP (1995) Evaluation by lymphoscintigraphy of the effect of a micronized flavonoid (Daflon 500. mg) in the treatment of upper limb lymphedema. Int Angiol 14:39–43.

    PubMed  CAS  Google Scholar 

  42. Pecking AP, Fevrier B, Wargon C et al (1997) Efficacy of Daflon 500. mg in the treatment of lymphedema (secondary to conventional therapy of breast cancer). Angiology 48:93–98.

    Google Scholar 

  43. Svensson W, Glass DM, Bradley D et al (1999) Measurement of lymphatic function with technetium-99m-labelled polyclonal immunoglobulin. Eur J Nucl Med 26:504–510.

    Article  PubMed  CAS  Google Scholar 

  44. Havas E, Parviainen T, Vuorela J et al (1997) Lymph flow dynamics in exercising human skeletal muscle as detected by scintography. J Physiol 504:233–239.

    Article  PubMed  CAS  Google Scholar 

  45. Lane K, Worsley D, McKenzie D (2005) Lymphoscintigraphy to evaluate the effects of upper body dynamic exercise and handgrip exercise on radiopharmaceutical clearance from hands of healthy females. Lymphat Res Biol 3:16–24.

    Article  PubMed  Google Scholar 

  46. Lane K, Dolan L, Worsley D et al (2006) Lymphoscintigraphy to evaluate the effect of high versus low intensity upper body dynamic exercise on lymphatic function in healthy females. Lymphat Res Biol 4:159–165.

    Article  PubMed  Google Scholar 

  47. Bourgeois P, Munck, D, Becker C et al (1997) A three phase lymphoscintigraphic investigation protocol for the evaluation of lower limbedemas. Eur J Lymphol Rel Probl 21:10–21.

    Google Scholar 

  48. Ketterings C, Zeddeman S (1997) Use of the C-scan in evaluation of peripheral lymphedema. Lymphology 30:49–62.

    PubMed  CAS  Google Scholar 

  49. Proby CM, Gane JN, Joseph AE et al (1990) Investigation of the swollen limb with isotope lymphography. Br J Dermatol 123:29–37.

    Article  PubMed  CAS  Google Scholar 

  50. Suga K, Kume N, Matsunaga N et al (2001) Assessment of leg oedema by dynamic lymphoscintigraphy with intradermal injection of technetium-99m human serum albumin and load produced by standing. Eur J Nucl Med 28:294–303.

    Article  PubMed  CAS  Google Scholar 

  51. O’Mahony S, Rose SL, Chilvers AJ et al (2004) Finding an optimal method for imaging lymphatic vessels of the upper limb. Eur J Nucl Med Mol Imaging 31:555–63.

    Article  Google Scholar 

  52. O’Mahony S, Solanki CK, Barber RW et al (2006) Imaging of lymphatic vessels in breast cancer-related lymphedema: intradermal versus subcutaneous injection of 99mTc-immunoglobulin. Am J Roentgenol 186:1349–1355.

    Article  Google Scholar 

  53. Bourgeois P (2007) Scintigraphic investigations of the lymphatic system: the influence of injected volume and quantity of labeled colloidal tracer. J Nucl Med 48:693–695.

    Article  PubMed  Google Scholar 

  54. Bourgeois P, Leduc O, Belgrado JP et al (2009) Scintigraphic investigations of the superficial lymphatic system: quantitative differences between intradermal and subcutaneous injection. Nucl Med Commun 30:270–274.

    Article  PubMed  Google Scholar 

  55. Tartaglione G, Pagan M, Morese R et al (2010) Intradermal lymphoscintigraphy at rest and after exercise: a new technique for the functional assessment of the lymphatic system in patients with lymphoedema. Nucl Med Commun 31:547–551.

    PubMed  Google Scholar 

  56. Jensen MR, Simonsen L, Karlsmark T et al (2012) The washout rate of a subcutaneous 99mTc-HSA depot in lower extremity lymphoedema. Clin Physiol Funct Imaging 32:126–132.

    Article  PubMed  CAS  Google Scholar 

  57. Hung JC, Wiseman GA, Wahner HW et al (1995) Filtered technetium-99m-sulfur colloid evaluated for lymphoscintigraphy. J Nucl Med 36:1895–1901.

    PubMed  CAS  Google Scholar 

  58. Tartaglione G, Rubello D (2010) The evolving methodology to perform limb lymphoscintigraphy: from rest to exercise acquisition protocol. Microvasc Res 80:540–4.

    Article  PubMed  Google Scholar 

  59. Burnand KG, McGuinness CL, Lagattolla NR et al (2002) Value of isotope lymphography in the diagnosis of lymphoedema of the leg. Br J Surg 89:74–78.

    Article  PubMed  CAS  Google Scholar 

  60. Brorson H, Svensson H, Norrgren K et al (1998) Liposuction reduces arm lymphedema without significantly altering the already impaired lymph transport. Lymphology 31:156–172.

    PubMed  CAS  Google Scholar 

  61. Carena M, Campini R, Zelaschi G et al (1988) Quantitative lymphoscintigraphy. Eur J Nucl Med 14:88–92.

    Article  PubMed  CAS  Google Scholar 

  62. Bourgeois P, Dargent JL, Larsimont D et al (2009) Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema. Clin Nucl Med 34:405–409.

    Article  PubMed  Google Scholar 

  63. Noer I, Lassen NA (1979) Evidence of active transport (filtration?) of plasma proteins across the capillary walls in muscle and subcutis. Acta Physiol Scand Suppl 463:105–110.

    PubMed  CAS  Google Scholar 

  64. Stanton AW, Modi S, Bennett Britton TM et al (2009) Lymphatic drainage in the muscle and subcutis of the arm after breast cancer treatment. Breast Cancer Res Treat 117:549–557.

    Article  PubMed  Google Scholar 

  65. Stanton AW, Modi S, Mellor RH et al (2006) A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphoedema following breast cancer treatment. Clin Sci (Lond) 11:553–561.

    Google Scholar 

  66. Pain SJ, Barber RW, Ballinger JR et al (2004) Tissue-to-blood transport of radiolabelled immunoglobulin injected into the web spaces of the hands of normal subjects and patients with breast cancer-related lymphoedema. J Vasc Res 41:183–192.

    Article  PubMed  CAS  Google Scholar 

  67. Pain SJ, Barber RW, Ballinger JR et al (2003) Side-to-side symmetry of radioprotein transfer from tissue space to systemic vasculature following subcutaneous injection in normal subjects and patients with breast cancer. Eur J Nucl Med Mol Imaging 30:657–61.

    Article  PubMed  Google Scholar 

  68. Pain SJ, Barber RW, Ballinger JR et al (2004) Local vascular access of radioprotein injected subcutaneously in healthy subjects and patients with breast cancer-related lymphedema. J Nucl Med 45:789–796.

    PubMed  CAS  Google Scholar 

  69. Modi S, Stanton AW, Mellor RH et al (2005) Regional distribution of epifascial swelling and epifascial lymph drainage rate constants in breast cancer-related lymphedema. Lymphat Res Biol 3:3–15.

    Article  PubMed  CAS  Google Scholar 

  70. Gothard L, Stanton A, MacLaren J et al (2004) Non-randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema and tissue fibrosis after radiotherapy for early breast cancer. Radiother Oncol 70:217–224

    Article  PubMed  CAS  Google Scholar 

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Erba, P.A., Sollini, M., D’Errico, G., Mariani, G. (2013). Methodological Aspects of Lymphoscintigraphy: Bicompartmental Versus Monocompartmental Radiocolloid Administration. In: Mariani, G., Manca, G., Orsini, F., Vidal-Sicart, S., Valdés Olmos, R.A. (eds) Atlas of Lymphoscintigraphy and Sentinel Node Mapping. Springer, Milano. https://doi.org/10.1007/978-88-470-2766-4_4

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  • DOI: https://doi.org/10.1007/978-88-470-2766-4_4

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