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Utility of 99mTc-Sulfur Colloid Lymphoscintigraphy and SPECT/CT in Chylothorax and Chylous Ascites

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Abstract

Purpose

To assess the diagnostic efficacy of 99mTc-sulfur colloid lymphoscintigraphy in chylothorax and chylous ascites, and the utility of single-photon emission computed tomography-computed tomography (SPECT/CT) in localizing the sites of leaks.

Methods

Data from patients who underwent lymphoscintigraphy for clinical suspicion of chylothorax or chylous ascites were retrospectively analyzed. Biochemical fluid analysis was taken as the reference standard. Pleural fluid triglyceride level > 110 mg/dL (with pleural fluid/serum ratio > 1) and a cholesterol level < 200 mg/dL (with pleural fluid/serum ratio < 1) were considered confirmatory for chylothorax. Ascitic fluid triglyceride level > 200 mg/dL with a low cholesterol level (ascites fluid/serum ratio < 1) was considered confirmatory for chylous ascites.

Results

26 patients (15 males, 57.7%) aged 9 months to 68 years were enrolled in the study. Based on the reference standard, 17 had chylothorax or chylous ascites (9 with surgical history). Lymphoscintigraphy was positive in 16 (with 1 false positive) and negative in 10 (with 2 false negatives). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of lymphoscintigraphy were 88.2% (63.6–98.5%), 88.9% (51.8–99.7%), 80.0% (51.6–93.8%), 93.8% (70.1–99.0%), and 88.5% (69.9–97.6%), respectively. SPECT/CT could localize sites of leaks in 61.5% (8/13) with a localization rate of 77.8% (7/9) and 25.0% (1/4) in patients with surgical and nonsurgical causes, respectively.

Conclusion

99mTc-sulfur colloid lymphoscintigraphy is a highly efficacious noninvasive modality to diagnose chylothorax or chylous ascites with a high positive predictive value. SPECT/CT could localize the sites of leaks more frequently in patients with surgical causes.

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Data availability

Original raw data is available on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

    Jasim Jaleel, Syeddharvesh Nasurudeen, Anushna Sunila Babu, Priyanka Gupta, Bangkim Chandra Khangembam, Chetan Patel & Rakesh Kumar

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  1. Jasim Jaleel
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  2. Syeddharvesh Nasurudeen
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Contributions

JJ contributed to the study concept and design, data mining, scan review, and prepared the first draft manuscript. SN, ASB, and PG contributed to data mining, material preparation, and data entry. BCK designed the study concept, contributed to scan review, performed the data analysis, and prepared the final manuscript. CP and RK contributed to the study concept and design, proofreading, and editing of the draft manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Bangkim Chandra Khangembam.

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Conflicts of Interest

Jasim Jaleel, Syeddharvesh Nasurudeen, Anushna Sunila Babu, Priyanka Gupta, Bangkim Chandra Khangembam, Chetan Patel, and Rakesh Kumar declare no conflict of interest.

Ethical Approval

All procedures involving human participants were in accordance with the Declaration of Helsinki 1964 as revised in 2013 and its later amendments or comparable ethical standards. The Institute Ethics Committee, All India Institute of Medical Sciences, New Delhi, approved the retrospective study (IEC-398/06.05.2022).

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The Institute Ethics Committee waived the requirement for informed written consent.

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Jaleel, J., Nasurudeen, S., Babu, A.S. et al. Utility of 99mTc-Sulfur Colloid Lymphoscintigraphy and SPECT/CT in Chylothorax and Chylous Ascites. Nucl Med Mol Imaging 57, 265–274 (2023). https://doi.org/10.1007/s13139-023-00813-6

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  • DOI: https://doi.org/10.1007/s13139-023-00813-6

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