Skip to main content
SpringerLink
Log in

Radionuclide venography of lower limbs by subcutaneous injection: Comparison with venography by intravenous injection

  • Original
  • Published:
Annals of Nuclear Medicine Aims and scope Submit manuscript

Abstract

We have proved that subcutaneous injection (SC) of a small dose of Tc-99m pertechnetate (1 to 2 mCi: 37 to 74 MBq) at acupuncture points (K-3 and B-60) may offer an alternative method of radionuclide venography (RNV) of the lower limbs. In this study, we compared intraveneous (IV) RNV and SC-RNV in 22 consecutive cases with typical signs and symptoms suggesting venous abnormality of the lower limb(s)_from March to May 1988. They are 11 male and 11 female, aged 47.7±15.7 years.

Among the 44 limbs of the 22 cases, 4 were normal, 12 (27.3 %) were found to have varicose veins in the legs only, 18 (40.9%) had partial stenosis of the deep veins (14 poplito-tibial and 4 superficial femoral), and 13 (29.6%) had complete stenosis of the deep veins (4 poplitotibial, 1 superficial femoral and 8 ilio-femoral. SC-RNV showed almost the same results as IV-RNV in 21 (47.7%), superior to IV-RNV in 22 (50%) (including 4.6% failure of IV-RNV), and inferior to IV-RNV in 1 (2.3 %).

We conclude that SC-RNV is definitely an alternative method of lower-limb venography. Since it is in most cases superior to IV-RNV, we suggest that it can take the place of IV-RNV in routine work.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sevitt S: Venous thrombosis and pulmonary embolism.Am J Med 33: 703–704, 1962

    Article  CAS  PubMed  Google Scholar 

  2. Dalen JE, Alpert JS: Natural history of pulmonary embolism.Prog Cardiovasc 17: 259–270, 1975

    Article  CAS  Google Scholar 

  3. Lundh B, Fagher B: The clinical picture of deep vein thrombosis correlated to the frequency of pulmonary embolism.Acta Med Scand 210: 353–356, 1981

    CAS  PubMed  Google Scholar 

  4. Haeger K: Problems of acute deep venous thrombosis: I. The interpretation of signs and symptoms.Angiology 20: 219–223, 1969

    Article  CAS  PubMed  Google Scholar 

  5. Lund F, Diener L, Ericsson J: Postmortem intraosseous phlebography as an aid in studies of venous thromboembolism.Angiology 1: 723–724, 1969

    Google Scholar 

  6. Cranley JJ, Canos AJ, Sull WJ: The diagnosis of deep venous thrombosis; Fallibility of clinical symptoms and signs.Arch Surg 111: 34–36, 1976

    CAS  PubMed  Google Scholar 

  7. Simpson FG, Robinson PJ, Bark M, et al: Prospective study of thrombophlebitis and pseudothrombophlebitis.Lancet i: 331–333, 1980

    Article  Google Scholar 

  8. O’Donnell TF Jr, Abbott WM, Athanasoulis CA, et al: Diagnosis of deep venous thrombosis in the outpatient by venography.Surg Gynecol Obstet 150: 69–74, 1980

    PubMed  Google Scholar 

  9. Hull R, Hirsch J, Sackett DL, et al: Cost effectiveness of clinical diagnosis, venography and non-invasive testing in patients with symptomatic deep vein thrombosis.N Eng J Med 304: 1561–1567, 1981

    Article  CAS  Google Scholar 

  10. Rabinov K, Paulin S: Roentgen diagnosis of venous thrombosis in the leg.Arch Surg 104: 134–144, 1972

    CAS  PubMed  Google Scholar 

  11. Thomas ML: Phlebography.Arch Surg 104: 145–151, 1972

    CAS  PubMed  Google Scholar 

  12. Albrechtsson U, Olsson CG: Thrombotic side-effects of lower-limb phlebography.Lancet i: 723–724, 1976

    Article  Google Scholar 

  13. Bettman MA, Paulin S: Leg phlebography: the incidence, nature, and modification of undesirable side effects.Radiology 122: 101–104, 1977

    Google Scholar 

  14. Bettman MA: Contrast phlebography: Methods in hematology, in Hirsh J (ed):Venous Thrombosis and Pulmonary Embolism Diagnostic Methods. New, York, Churchill Livingstone Inc, 1987, pp. 20–32

    Google Scholar 

  15. Browse N: Diagnosis of deep vein thrombosis.Br Med Bulletin 34: 163–167, 1978

    CAS  Google Scholar 

  16. Rosenthall L: Combined inferior vena cavography, iliac venography and lung imaging with99mTc albumin macroaggregates.Radiology 98: 623–626, 1971

    CAS  PubMed  Google Scholar 

  17. Kakkar VV, Nicolaides AN, Renney JTG, et al:125I-labelled fibrinogen test adapted for routine screening for deep-vein thrombosis.Lancet i: 540–542, 1970

    Article  Google Scholar 

  18. Kakkar V: The diagnosis of deep-vein thrombosis using the I-125 fibrinogen test.Arch Surg 104: 152–159, 1972

    CAS  PubMed  Google Scholar 

  19. DeNardo SJ, DeNardo GL: Iodine-123 fibrinogen scintigraphy.Semin Nucl Med 7: 245–251, 1977

    Article  CAS  PubMed  Google Scholar 

  20. Sy WM, Lao RS, Bay R, et al:99mTc-pertechnetate radionuclide venography-large volume injection without tourniquet.J Nucl Med 19: 1001–1006, 1978

    CAS  PubMed  Google Scholar 

  21. Sy WM, Seo IS: Radionuclide venography: Imaging monitor in deep-vein thrombosis of the pelvis and lower extremities.Br J Radiol 59: 325–328, 1986

    Article  CAS  PubMed  Google Scholar 

  22. Pavel DG, Zimmer AM, Patterson VW:In vivo labeling of red blood cells with99mTc: A new approach to blood pool visualization.J Nucl Med 18: 305–308, 1977

    CAS  PubMed  Google Scholar 

  23. Beswick W, Chimel R, Booth R, et al: Detection of deep venous thrombosis by scanning of99mTc-labelled red-cell venous pool.Br Med J 1: 82–84, 1979

    Article  CAS  PubMed  Google Scholar 

  24. Lubin E, Zelikovski A, Trumper J, et al: Saphenous vein varicosities: The use of Tc-99m RBC blood pool imaging for evaluation and follow up.J Nucl Med 19: 1090–1091, 1979

    Google Scholar 

  25. Lisbona R, Stern J, Derbekyan V: Tc-99m red blood cell venography in deep vein thrombosis of the leg: A correlation with contrast venography.Radiology 143: 771–773, 1982

    CAS  PubMed  Google Scholar 

  26. Lisbona R, Derbekyan V, Novales-Diaz J, et al: Tc-99m red blood cell venography in deep venous thrombosis of the lower limb: An overview.Clin Nucl Med 10: 208–224, 1985

    Article  CAS  PubMed  Google Scholar 

  27. Evans DS: The early diagnosis of thromboembolism by ultrasound.Ann R Coll Surg Engl 49: 225–249, 1971

    CAS  PubMed  Google Scholar 

  28. Strandness DE Jr, Sumner DS: Ultrasonic velocity detector in the diagnosis of thrombophlebitis.Arch Surg 104: 180–183, 1972

    PubMed  Google Scholar 

  29. Flanigan DP, Coodreau JJ, Burnham SJ, et al: Vascular-laboratory diagnosis of clinically suspected acute deep vein thrombosis.Lancet ii: 331–334, 1978

    Article  Google Scholar 

  30. Sumner DS, Lambeth A: Reliability of Doppler ultrasound in the diagnosis of acute venous thrombosis both above and below the knee.Am J Surg 138: 205–210, 1979

    Article  CAS  PubMed  Google Scholar 

  31. Schroeder PJ, Dunn E: Mechanical plethysmography and Doppler ultrasound diagnosis of deep-venous thrombosis.Arch Surg 117: 300–303, 1982

    CAS  PubMed  Google Scholar 

  32. Effeney DJ, Friedman MB, Gooding GAW. Iliofemoral venous thrombosis: Real-time ultrasound diagnosis: Normal criteria and clinical application.Radiology 150: 787–792, 1984

    CAS  PubMed  Google Scholar 

  33. Raghavendra NB, Rosen RJ, Lam S, et al: Deep venous thrombosis: Detection by high resolution realtime ultrasonography.Radiology 152: 789–793, 1984

    CAS  PubMed  Google Scholar 

  34. Sullivan ED, Peter DJ, Cranley JJ: Real-time B-mode venous ultrasound.J Vascular Surg i: 465–471, 1984

    Article  Google Scholar 

  35. Ragjavendra BN, Horvi SC, Hilton S, et al: Deep venous thrombosis: detection by probe compression of veins.J Ultrasound Med 5: 89–95, 1986

    Google Scholar 

  36. Cronan JJ, Dorfman GS, Scola FH, et al: Deep venous thrombosis: US assessment using vein compression.Radiology 162: 191–194, 1987

    CAS  PubMed  Google Scholar 

  37. Appelman AT, DeJons TE, Lampmen LE: Deep venous thrombosis of the leg: US findings.Radiology 163: 743–746, 1987

    CAS  PubMed  Google Scholar 

  38. Vogel P, Laing FC, Jeffrey RB, et al: Deep venous thrombosis of the lower extremity: US evaluation.Radiology 163: 747–751, 1987

    CAS  PubMed  Google Scholar 

  39. O’Leary DH, Kane RA, Chase BM: A prospective study of the efficacy of B-Scan sonography in the detection of deep venous thrombosis in the lower extremities.J Clin Ultrasound 16: 1–8, 1988

    Article  PubMed  Google Scholar 

  40. Wheeler HB, Pearson D, O’Connell D, et al: Impedance plethysmography.Arch Surg 104: 164–169, 1972

    CAS  PubMed  Google Scholar 

  41. Wheeler HB, O’Donnell JA, Anderson FA Jr, et al: Occlusive impedance phlebography: a diagnostic procedure for venous thrombosis and pulmonary embolism.Prog Cardiovasc Dis 17: 199–205, 1974

    Article  CAS  PubMed  Google Scholar 

  42. Hull R, van Aken WG, Hirsch J: Impedance plethysmography using the occlusive cuff technique in the diagnosis of venous thrombosis.Circulation 53: 696–700, 1976

    CAS  PubMed  Google Scholar 

  43. Moser KM, Brach BB, Dolan GF: Clinically suspected deep venous thrombosis of the lower extremities: A comparison of venography, impedance plethysmography, and radiolabelled fibrinogen.JAMA 237: 2195–2198, 1977

    Article  CAS  PubMed  Google Scholar 

  44. Hull R, Taylor DW, Hirsch J, et al: Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximal vein thrombosis.Circulation 58: 898–902, 1978

    CAS  PubMed  Google Scholar 

  45. Wheeler HB, Anderson FA: Impedance plethysmography: the diagnosis of venous thrombosis by occlusive impedance plethysmography. In: Bernstein EF, ed,Noninvasive diagnostic techniques in vascular disease, 2nd ed, St. Louis, CV Mosby, 1982, 482–496

    Google Scholar 

  46. Hull RD, Hirsh J, Carter CJ, et al: Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis: A randomized trial.Ann Intern Med 102: 21–28, 1985

    CAS  PubMed  Google Scholar 

  47. Huisman MV, Buller HR, ten Cate JW, et al: Serial impedance plethysmography for suspected deep venous thrombosis in outpatients.N Engl J Med 314: 823–828, 1986

    CAS  PubMed  Google Scholar 

  48. Huisman MV, Buller HR, ten Cate JW: Utility of impedance plethysmography in the diagnosis of recurrent deep-vein thrombosis.Arch Intern Med 148: 681–683, 1988

    Article  CAS  PubMed  Google Scholar 

  49. Hull R, Hirsch J, Sackett DL, et al: Combined use of leg scanning and impedance plethysmography in suspected venous thrombosis: an alternative to venography.N Engl J Med 296: 1497–1500, 1977

    CAS  PubMed  Google Scholar 

  50. Hull R, Hirsch J, Sackett DL: Replacement of venography in suspected venous thrombosis by impedance plethysmography and125I-fibrinogen leg scanning: A less invasive approach.Ann Intern Med 94: 12–15, 1981

    CAS  PubMed  Google Scholar 

  51. Anderson DC, Baitaxe HA, Wolf GL: Inability to show clot: one limitation of ultrasonography of the abdominal aorta.Radiology 132: 693–696, 1979

    CAS  PubMed  Google Scholar 

  52. Comerota AJ, White JV, Katz ML: Diagnostic methods for deep vein thrombosis: Venous Doppler examination, phleborheography, iodine-125 fibrinogen uptake, and phlebography.Am J Surg 150: 14–24, 1985

    CAS  PubMed  Google Scholar 

  53. Ramchandani P, Soulen R, Fedulo L, et al: Deep vein thrombosis: significant limitations of non-invasive tests.Radiology 156: 47–49, 1985

    CAS  PubMed  Google Scholar 

  54. Aikken AGF, Godden DJ: Real-time ultrasound diagnosis of deep vein thrombosis: A comparison with venography.Clin Radiol 38: 309–313, 1987

    Article  Google Scholar 

  55. Rosner NH, Doris PE: Diagnosis of femoropopliteal venous thrombosis: comparison of duplex sonography and plethysmography.Am J Roentgenol 150: 623–627, 1988

    CAS  Google Scholar 

  56. Wu CC, Jong SB: Subcutaneous injection of Tc-99m pertechnetate: an alternative method of venography.Ann Nucl Med (Taiwan, ROC) 1: 157–162, 1988

    Google Scholar 

  57. Ennis JT, Dowsett DJ (ed): Radionuclide venography. In:Vascular Radionuclide Imaging: A clinical atlas. John Wiley & Sons, Chichester, New York, Brisbane, Toronto, Singapore, 1983 pp. 5–41

    Google Scholar 

  58. Mosen KM, LeMoin JR: Is embolic risk conditioned by location of deep venous thrombosis? Part I.Ann Intern Med 94: 439–444, 1981

    Google Scholar 

  59. White EM: Duplex sonography of the lower extremity venous system. In:Duplex sonography, edited by Grant EG and White EM. Springer-Verlag, New York, Berlin, Heidelberg, London, Paris, Tokyo, 1988, pp. 239–259

    Google Scholar 

  60. Plummer JP: Anatomical findings at acupuncture loci.Am J Chinese Med 8: 170–180, 1980

    Article  CAS  Google Scholar 

  61. Dung HC: Anatomical features contributing to the formation of acupuncture points.Am J Acupuncture 12: 139–143, 1984

    Google Scholar 

  62. Watari N, Hotta Y, Mabuchi Y, et al: Morphological study of acupuncture points observed by light and electron microscopy. In:Proceedings of 4th International Congress of Oriental Medicine, Kyoto, Japan, 1985, pp. 278–279 (Abstract)

Download references

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Kaohsiung Medical College, 80708, Kaohsiung, Taiwan, R.O.C.

    Chung-Chieng Wu & Shiang-Bin Jong

  2. 16, 335 Lane, Chung-Chieng St., 80712, Kaohsiung, Taiwan, ROC

    Chung-Chieng Wu

Authors
  1. Chung-Chieng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiang-Bin Jong
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wu, CC., Jong, SB. Radionuclide venography of lower limbs by subcutaneous injection: Comparison with venography by intravenous injection. Ann Nucl Med 3, 125–133 (1989). https://doi.org/10.1007/BF03178298

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03178298

Key words

Search

Navigation