Skip to main content
SpringerLink
Log in

Radionuclide Lymphoscintigraphies

  • Chapter
  • First Online:
Lymphedema

  • 2824 Accesses

Abstract

In the diagnosis and management of lymephedemas, lymphoscintigraphies occupy a central place. They have to be well understood by clinicians who request these examinations and by patients for whom they are proposed. Lymphoscintigraphies must be performed with care and thought, using available materials in the most appropriate ways, with the best applied methodological approaches, and always analyzed and interpreted taking into account the specific patient’s situation and expectations as well as the clinician’s demands. In this chapter, we will review all the basic and practical problems useful to their understanding (and to the understanding of the literature), and we will illustrate their use in the management of the edematous situations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Highlighted References

  1. Fowler JC, Britton TB, Provenzano E, Ravichandran D, Lawrence D, Solanki CK, Ballinger JR, Douglas-Jones A, Mortimer PS, Purushotham AD, Peters AM. Measurement of lymph node function from the extraction of immunoglobulin in lymph. Scand J Clin Lab Invest. 2010;70(2):112–5.

    Article  CAS  PubMed  Google Scholar 

  2. Burnand KM, Glass DM, Mortimer PS, Peters AM. Lymphatic dysfunction in the apparently clinically normal contralateral limbs of patients with unilateral lower limb swelling. Clin Nucl Med. 2012;37(1):9–13.

    Google Scholar 

  3. Bourgeois P, Leduc O, Belgrado JP, Leduc A. Scintigraphic investigations of the superficial lymphatic system: quantitative differences between intradermal and subcutaneous injections. Nucl Med Commun. 2009;30(4):270–4.

    Article  PubMed  Google Scholar 

  4. Bourgeois P. Scintigraphic investigations of the lymphatic system: the influence of the injected volume and quantity of labeled colloidal tracer. J Nucl Med. 2007;48:693–5.

    Article  PubMed  Google Scholar 

  5. Bourgeois P, Belgrado JP, Aerens C. La lymphoscintigraphie dans la prise en charge thérapeutique des œdèmes des membres par les soins de santé en Belgique. Médecine Nucléaire. 2010;34(12):675–82.

    Article  Google Scholar 

References

  1. Bourgeois P, Leduc O, Belgrado JP, Leduc A. Imaging techniques in the prevention and management of post-therapeutic upper limb edemas? Cancer. 1998;83:2805–13.

    Article  CAS  PubMed  Google Scholar 

  2. Bourgeois P. Combined role of Lymphoscintigraphy, X-ray computed tomography, magnetic resonance imaging and positron emission tomography in the management of lymphadematous diseases. In: Lee BB, Bergan JJ, Rockson SG, editors. Lymphedema: a concise compendium of theory and practice. London: Springer; 2011.

    Google Scholar 

  3. Bourgeois P. Imaging the lymphatic system in 2011–2012. Lymphology. 2012;45:56–60.

    Google Scholar 

  4. Bourgeois P, Munck D, Leduc O, Leduc A. Oedème des membres et lymphoscintigraphies. Rev Med Brux. 2003;24(1):20–8. Review. French.

    Google Scholar 

  5. Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44:43–57.

    PubMed  Google Scholar 

  6. Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphoedema. Br J Radiol. 2007;80:219–26.

    Article  CAS  PubMed  Google Scholar 

  7. Pecking AP, Albérini JL, Wartski M, Edeline V, Cluzan RV. Relationship between lymphoscintigraphy and clinical findings in lower limb lymphedema: towards a comprehensive staging. Lymphology. 2008;41:1–10.

    CAS  PubMed  Google Scholar 

  8. Baulieu F, Bourgeois P, Maruani A, Belgrado JP, Tauveron V, Lorette G, Vaillant L. Contributions of SPECT/CT imaging to the lymphoscintigraphic investigations of the lower limb lymphedema. Lymphology. 2013;46:106–19.

    CAS  PubMed  Google Scholar 

  9. Mortimer PS, Simmonds R, Rezvani M, Robbins R, Hopewell JW, Ryan TJ. The measurement of skin lymph flow by isotope clearance- reliability, reproducibility and the effect of massage. J Investigative Derm. 1990;95:677–82.

    Article  CAS  Google Scholar 

  10. Modi S, Stanton AWB, Svensson WE, Peters AM, Mortimer PS, Levick JR. Human lymphatic pumping measured in healthy and lymphedematous arms by lymphatic congestion lymphoscintigraphy. J Physiol. 2007;583:271–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. O'Mahony S, Rose SL, Chilvers AJ, Ballinger JR, Solanki CK, Barber RW, Mortimer PS, Purushotham AD, Peters AM. Finding an optimal method for imaging lymphatic vessels of the upper limb. Eur J Nucl Med Mol Imaging. 2004 Apr;31(4):555–63.

    Google Scholar 

  12. Bourgeois P, Munck D, Becker C, Leduc O, Leduc A. Evaluation of a three-phase lymphoscintigraphic investigation protocol of the lower limbedemas. Eur J Lymphol Related Probl. 1997;VI/21:22–8.

    Google Scholar 

  13. a) https://www.bordet.be/fichiers_web/lymphologie/scintigraphic_investigations_superficial_lymphatic_system_with_limb_edemas_2017.pdf; b) http://belnuc.be/content/methodological-protocol-lymphoscintigraphy-limb-edema-prof-bourgeois-0.

  14. Bourgeois P. Critical analysis of the literature on lymphoscintigraphic investigations of limbedemas. Eur J Lymphol Related Probl. 1997;VI/21:1–21.

    Google Scholar 

  15. Bräutigam P, Hogerle S, Reunhardt M, Otte A, Van Scheidt W, Föedli E, Moser E. The quantitative two-compartment Lymphoscintigraphy for evaluation of the lower limb edema. Eur J Lymphol Related Probl. 1997;VI/21:47–51.

    Google Scholar 

  16. Wolfe JHN, Kinmonth JB. The Prognosis of Primary Lymphedema of the Lower Limbs. Arch Surg. 1981;116(9):1157–60. doi:10.1001/archsurg.1981.01380210037007.

    Article  CAS  PubMed  Google Scholar 

  17. Kleinhans E, Baumeister RGH, Hahn D, Siuda S, Büll U, Moser E. Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med. 1985;10:349–52.

    Article  CAS  PubMed  Google Scholar 

  18. Nawaz MK, Hamad MM, Abdel-Dayem HM, Sadek S, Eklof BGH. Lymphoscintigraphy in lymphedema of the lower limbs using 99mTc-HSA. Angiology. 1992;43(2):147–54.

    Article  CAS  PubMed  Google Scholar 

  19. The 2007 Recommendations of the International Commission on Radiological Protection, ICRP Publication 103. Ann ICRP 2007;37(2–4). http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103.

  20. Rappaport UNSCEAR UNSCEAR 2000, Annex D: Medical Radiation Exposures.

    Google Scholar 

  21. IAEA radiation protection of patient (RPOP) : information on PET/CT Scanning.

    Google Scholar 

  22. RAPPORT UNSCEAR 2000: Annex B: Exposures from natural radiation sources.

    Google Scholar 

  23. National Vital Statistics Reports, Vol. 61N°6 10 Oct 2012.

    Google Scholar 

  24. U.S. Department of Labor, Bureau of Labor Statistics (BLS)-Census of Fatal Occupational Injuries. 2014.

    Google Scholar 

  25. “WHO Disease and injury country estimates”. World Health Organization. 2004. Retrieved 11 Nov 2009.

    Google Scholar 

  26. Franco A, Comet M, beani JC, Doucet J, Meaulle PY, Guidicelli H. La lymphoscintigraphie indirect: son intérêt pour le diagnostic étiologique des oedèmes des membres inférieurs de cause non générale. J Biophys Et Med Nucl. 1980;4:299–303.

    Google Scholar 

  27. Carena M, Campini R, Zelaschi G, Rossi G, Aprile C, Paroni G. Quantitative lymphoscintigraphy. Eur J Nucl Med. 1988;14(2):88–92.

    Article  CAS  PubMed  Google Scholar 

  28. Golueke PJ, Montgomery RA, Petronis JD, Minken SL, Perler BA, Williams GM. Lymphoscintigraphy to confirm the clinical diagnosis of lymphedema. J Vasc Surg. 1989;10(3):306–12.

    Article  CAS  PubMed  Google Scholar 

  29. Ter SE, Alavi A, Kim CK, Merli G. Lymphoscintigraphy. A reliable test for the diagnosis of lymphedema. Clin Nucl Med. 1993;18(8):646–54.

    Article  CAS  PubMed  Google Scholar 

  30. Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology. 1988;167(3):729–35.

    Article  CAS  PubMed  Google Scholar 

  31. Cambria RA, Gloviczki P, Naessens JM, Wahner HW. Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386 extremities. J Vasc Surg. 1993;18(5):773–82.

    Article  CAS  PubMed  Google Scholar 

  32. Moghimi SM, Bonnemain B. Subcutaneous and intravenous delivery of diagnostic agents to the lymphatic system: applications in lymphoscintigraphy and indirect lymphography. Adv Drug Deliv Rev. 1999;37(1–3):295–312.

    Article  CAS  PubMed  Google Scholar 

  33. Strand SE, Bergqvist L. Radiolabeled colloids and macromolecules in the lymphatic system. Crit Rev Ther Drug Carrier Syst. 1989;6(3):211–38.

    CAS  PubMed  Google Scholar 

  34. Frantz C, Stewart KM, Weaver VM. The extracellular matrix at a glance. J Cell Sci. 2010;123(Pt 24):4195–200.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Kafejian-Haddad AP, Perez JM, Castiglioni ML, Miranda Júnior F, de Figueiredo LF. Lymphscintigraphic evaluation of manual lymphatic drainage for lower extremity lymphedema. Lymphology. 2006;39(1):41–8.

    CAS  PubMed  Google Scholar 

  36. Caplan I. Anastomoses between the superficial and deep lymphatic systems in the lower limb. Phlebologie. 1980;33(3):537–45.

    CAS  PubMed  Google Scholar 

  37. Malek P, Belan A, Kocandrle V. The superficial and deep lymphatic system of the lower extremities and their mutual relationships under physiological and pathological conditions. J Cardiovasc Surg. 1964;5:686–90.

    CAS  Google Scholar 

  38. Burnand KM, Glass DM, Sundaraiya S, Mortimer PS, Peters AM. Popliteal node visualization during standard pedal lymphoscintigraphy for a swollen limb indicates impaired lymph drainage. AJR Am J Roentgenol. 2011;197(6):1443–8.

    Article  PubMed  Google Scholar 

  39. Shelley S, Manokaran G, Indirani M, Gokhale S, Anirudhan N. Lymphoscintigraphy as a diagnostic tool in patients with lymphedema of filarial origin--an Indian study. Lymphology. 2006;39(2):69–75.

    CAS  PubMed  Google Scholar 

  40. Jensen MR, Simonsen L, Karlsmark T, Bülow J. The washout rate of a subcutaneous 99mTc-HSA depot in lower extremity lymphoedema. Clin Physiol Funct Imaging. 2012;32(2):126–32.

    Article  CAS  PubMed  Google Scholar 

  41. Tartaglione G, Rubello D. The evolving methodology to perform limb lymphoscintigraphy: from rest to exercise acquisition protocol. Microvasc Res. 2010;80(3):540–4.

    Article  PubMed  Google Scholar 

  42. Mosbeck A, Partsch H. Examens de lymphographie isotopique dans le syndrome post-thrombotique. Phlebologie. 1991;44(1):227–35.

    CAS  PubMed  Google Scholar 

  43. Clément C, Hannequin P, Nicaise H, Valeyre J. Value of exploring the deep lymphatic system of the lower limbs using lymphoscintigraphy. Preliminary study of 18 patients with arteritis. J Mal Vasc. 1987;12(4):334–9.

    PubMed  Google Scholar 

  44. Bräutigam P, Földi E, Schaiper I, Krause T, Vanscheidt W, Moser E. Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy. Lymphology. 1998;31(2):43–55.

    PubMed  Google Scholar 

  45. Bräutigam P, Vanscheidt W, Földi E, Krause T, Moser E. The importance of the subfascial lymphatics in the diagnosis of lower limb edema: investigations with semiquantitative lymphoscintigraphy. Angiology. 1993;44(6):464–70.

    Article  PubMed  Google Scholar 

  46. Tosatti E. New pathogenetic interpretation, classification and surgical treatment of the more serious chronic lymphatic and venous edemas of the limbs. Omnia Med Ther. 1967;45(4):655–720.

    CAS  PubMed  Google Scholar 

  47. Tosatti E. Editorial: the unsolved problem of peripheral lymphedema. Lymphology. 1973;6(3):167–8.

    CAS  PubMed  Google Scholar 

  48. Iimura T, Fukushima Y, Kumita S, Ogawa R, Hyakusoku H. (99m)Tc-phytate lymphoscintigraphy with SPECT-CT in patients with lower-limb lymphedema. Plast Reconstr Surg Glob Open. 2015;3:e404. doi:10.1097/GOX.0000000000000375; Published online 20 May 2015.)

  49. Weiss M, Baumeister RG, Frick A, Wallmichrath J, Bartenstein P, Rominger A. Primary lymphedema of the lower limb: the clinical utility of single photon emission computed tomography/CT. Korean J Radiol. 2015;16(1):188–95.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Hoogendam JP, Veldhuis WB, Hobbelink MG, Verheijen RH, van den Bosch MA, Zweemer RP. 99mTc SPECT/CT versus planar Lymphoscintigraphy for preoperative sentinel lymph node detection in cervical cancer: a systematic review and Metaanalysis. J Nucl Med. 2015;56(5):675–80. doi:10.2967/jnumed.114.152439. Epub 2015 Apr 9.

  51. Valdés Olmos RA, Rietbergen DD, Vidal-Sicart S, Manca G, Giammarile F, Mariani G. Contribution of SPECT/CT imaging to radioguided sentinel lymph node biopsy in breast cancer, melanoma, and other solid cancers: from “open and see” to “see and open”. Q J Nucl Med Mol Imaging. 2014;58(2):127–39.

    PubMed  Google Scholar 

  52. Wagner T, Buscombe J, Gnanasegaran G, Navalkissoor S. SPECT/CT in sentinel node imaging. Nucl Med Commun. 2013;34(3):191–202.

    Article  CAS  PubMed  Google Scholar 

  53. Bennie G, Vorster M, Buscombe J, Sathekge M. The added value of a single-photon emission computed tomography-computed tomography in sentinel lymph node mapping in patients with breast cancer and malignant melanoma. World J Nucl Med. 2015;14(1):41–6.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Chapman BC, Gleisner A, Kwak JJ, Hosokawa P, Paniccia A, Merkow JS, Koo PJ, Gajdos C, Pearlman NW, McCarter MD, Kounalakis N. SPECT/CT improves detection of metastatic sentinel lymph nodes in patients with head and neck melanoma. Ann Surg Oncol. 2016;23(8):2652–7.

    Article  PubMed  Google Scholar 

  55. Sieira-Gil R, Paredes P, Martí-Pagés C, Ferrer-Fuertes A, García-Díez E, Cho-Lee GY, Tapias A, Mayoral M, Vidal-Sicart S. SPECT-CT and intraoperative portable gamma-camera detection protocol for sentinel lymph node biopsy in oral cavity squamous cell carcinoma. J Craniomaxillofac Surg. 2015;43(10):2205–13.

    Article  PubMed  Google Scholar 

  56. Naaman Y, Pinkas L, Roitman S, Ikher S, Oustinov N, Vaisbuch E, Yachnin A, Ben-Arie A. The added value of SPECT/CT in sentinel lymph nodes mapping for endometrial carcinoma. Ann Surg Oncol. 2016;23(2):450–5.

    Article  CAS  PubMed  Google Scholar 

  57. Belhocine TZ, Prefontaine M, Lanvin D, Bertrand M, Rachinsky I, Ettler H, Zabel P, Stitt LW, Sugimoto A, Urbain JL. Added-value of SPECT/CT to lymphatic mapping and sentinel lymphadenectomy in gynaecological cancers. Am J Nucl Med Mol Imaging. 2013;3(2):182–93.

    PubMed  PubMed Central  Google Scholar 

  58. Pecking AP, Wartski M, Cluzan RV, Bellet D, Albérini JL. SPECT-CT fusion imaging radionuclide lymphoscintigraphy: potential for limb lymphedema assessment and sentinel node detection in breast cancer. Cancer Treat Res. 2007;135:79–84.

    Article  CAS  PubMed  Google Scholar 

  59. Larcos G, Foster DR. Interpretation of lymphoscintigrams in suspected lymphoedema: contribution of delayed images. Nucl Med Commun. 1995;16(8):683–6.

    Article  CAS  PubMed  Google Scholar 

  60. Bourgeois P. Letter to the editor: about lymphoscintigraphies and pneumatic massages. European J Lymphol Related probl. 2013;69:18–24.

    Google Scholar 

  61. Liu NF, Lu Q, Liu PA, Wu XF, Wang BS. Comparison of radionuclide lymphoscintigraphy and dynamic magnetic resonance lymphangiography for investigating extremity lymphoedema. Br J Surg. 2010;97(3):359–65.

    Article  PubMed  Google Scholar 

  62. Patel HM, Boodle KM, Vaughan-Jones R. Assessment of the potential uses of liposomes for lymphoscintigraphy and lymphatic drug delivery. Failure of 99m-technetium marker to represent intact liposomes in lymph nodes. Biochim Biophys Acta. 1984;801(1):76–86.

    Article  CAS  PubMed  Google Scholar 

  63. Perez-Soler R, Lopez-Berestein G, Jahns M, Wright K, Kasi LP. Distribution of radiolabeled multilamellar liposomes injected intralymphatically and subcutaneously. Int J Nucl Med Biol. 1985;12(4):261–6.

    Article  CAS  PubMed  Google Scholar 

  64. Leong SP, Kim J, Ross M, Faries M, Scoggins CR, Metz WL, Cope FO, Orahood RC. A phase 2 study of (99m)Tc-tilmanocept in the detection of sentinel lymph nodes in melanoma and breast cancer. Ann Surg Oncol. 2011;18(4):961–9.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The author gratefully acknowledges:

Mr. Thomas-Baptiste De Brouwer for his «radio-physical» contribution for this text-chapter.

Mr. Romain Barbieux for his «innocent» reading and review of this chapter as physiotherapist.

Declaration of Conflict of Interest

The author declares no conflict of interest (except may be in the «regard» of some, to be specialist in nuclear medicine).

Author information

Authors and Affiliations

  1. Service of Nuclear Medicine and Multi-disciplinary Clinic of Lymphology, Group R&D Clinical Applications Fluorescence Imagings (GCAFI), Institute Jules Bordet, Université Libre de Bruxelles, 121, Bd de Waterloo, B-1000, Brussels, Belgium

    Pierre Bourgeois MD, PhD

Authors
  1. Pierre Bourgeois MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre Bourgeois MD, PhD .

Editor information

Editors and Affiliations

  1. Center for the Lymphedema and Vascular Malformations, Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA

    Byung-Boong Lee

  2. Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California, USA

    Stanley G. Rockson

  3. La Jolla, California, USA

    John Bergan

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bourgeois, P. (2018). Radionuclide Lymphoscintigraphies. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham. https://doi.org/10.1007/978-3-319-52423-8_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-52423-8_22

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52421-4

  • Online ISBN: 978-3-319-52423-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation