99mTc-DX淋巴显像诊断肢体淋巴水肿的初步应用

目的：探讨淋巴显像对肢体淋巴水肿的诊断价值。材料和方法：61例病人行^99mTc-右旋糖酐（DX）全身显像。结果：将显像图分为正常、侧支回流、混合回流、皮肤回流和无回流等5种类型。在74个水肿肢体中，67个显示各种回流障碍，还发现5个无水肿肢体有淋巴回流异常。4例混合型和1例无回流型病人行淋巴管-静脉吻合术后痊愈，1例皮肤回流型计划行吻合术，但术中未找到有功能的淋巴管而改行局部病变组织切除术。结论：淋巴显像诊断淋巴水肿的灵敏度高，可显示肢体淋巴链结构和淋巴回流障碍等信息，对治疗方法选择有很大价值，但需注意质量控制。     

应用近红外荧光淋巴显像诊断正常肢体及淋巴水肿

目的应用近红外荧光(NIRF)显像评估正常肢体及淋巴水肿肢体的淋巴结构及功能。资料与方法肢体皮内注射吲哚青绿后,行动态NIRF淋巴显像,观测肢体的淋巴管结构及回流功能。结果正常肢体可见规则的淋巴管状结构及"弹丸"式淋巴回流,淋巴管外无NIRF显像剂滞留。淋巴水肿依据显像表现分为4级,诊断要点包括:淋巴管外染料聚集、弯曲的侧支淋巴管、毛细淋巴管网显影,淋巴回流减慢及逆流。结论 NIRF淋巴显像能正确地诊断肢体淋巴水肿,具有较大的临床应用潜力。     

MR淋巴造影在肢体淋巴水肿诊断中的价值

目的 评估MR淋巴造影(MRL)对肢体淋巴水肿的诊断价值.方法 运用3.0T MR对582例肢体淋巴水肿患者进行MRL.并对淋巴结形态及显影情况,淋巴管数目和淋巴速度等进行评估.结果 原发性与继发性淋巴水肿淋巴回流障碍MRL均显示或为淋巴结受累、或为淋巴管受累、或为两者均受累.根据MRL显示的淋巴管数目,原发性淋巴水肿可分为淋巴系统不发育、发育不全和淋巴系统增生3类;继发性淋巴水肿可分淋巴管闭塞减少型和淋巴管开放增多型.动态MRL显示原发性淋巴水肿受累肢体淋巴回流速度平均为(1.0±0.62)cm/min,显著慢于继发性受累肢体平均流速(2.22±1.64)cm/min(P<0.01).在原发性与继发性淋巴水肿中,对侧相比患侧淋巴结MRL均表现为显影数目少、显影延迟和显影信号低.结论 动态MRL能够评估肢体淋巴水肿淋巴系统形态及功能改变,为淋巴水肿诊断提供有力影像手段.     

核素淋巴显像诊断四肢淋巴水肿

应用核素淋巴显像诊断２５例四肢水肿。将显像图分为五种类型，即正常回流（４例）、侧支回流（２例）、混合回流（１３例）、皮肤回流（４例）和无回流型（２例）。８例行显微外科手术。结果表明，核素淋巴显像简便无创，安全可靠，能鉴别水肿性质、显示淋巴回流功能与梗阻程度，以及提供淋巴系统形态、分布变化等信息，对确定治疗方案和选择手术病人很有价值。     

99Tcm-DX淋巴显像对淋巴系统疾病的应用

目的　探讨99Tcm 右旋糖酐 (DX)淋巴显像对乳糜症、淋巴管炎、肢体淋巴性水肿及淋巴瘤等疾病的诊断价值。方法　根据病种及病变部位合理选择99Tcm DX注射部位。根据病种及临床要求 ,选用动态显像、全身显像或局部平面显像。结果　①99Tcm DX显像对 2 4例乳糜症患者诊断特异性为 80 % ,灵敏度为 89 1%。②对 41例淋巴管炎诊断特异性为 83 3% ,灵敏度为 88 5 % ,淋巴管呈放射性管状浓聚。③对 116例四肢淋巴性水肿的诊断特异性为 85 7% ,灵敏度为 91 5 % ,其影像呈以下几种类型 :水肿肢体呈弥漫性放射性浓集 ;水肿肢体淋巴管及淋巴结放射性浓集 ;水肿肢体淋巴管不显影 ;水肿肢体见淋巴侧支形成。④淋巴瘤有以下几种异常图形表现 :淋巴结融合、淋巴链断裂、淋巴结肿大、淋巴交通支形成。结论　99Tcm DX淋巴显像对淋巴系统疾病的诊断具有方法简便 ,图像清晰 ,灵敏度、特异性高等优点 ,临床诊断价值高。     

^99Tc^m—DX淋巴显像对淋巴系统疾病的应用

目的：探讨^99Tc^m-右旋糖酐（DX）淋巴显像对乳糜症,淋巴管炎,肢体淋巴性水肿及淋巴瘤等疾病的诊断价值。方法：根据病种及病变部位合理选择^99Tc^m-DX注射部位。根据病种及临床要求,选用动态显像,全身显像或局部平面显像。结果：（1）^99Tc^m-DX显像对24例乳糜症患者诊断特异性为80％,灵敏度为89．1％。（2）对41例淋巴管诊断特异性为83．3％,灵敏度为88．5％,淋巴管呈放射性管状浓聚。（3）对116例四肢淋巴性水肿的诊断特异性为85．7％,灵敏度为91．5％,其影像呈以下几种类型：水肿肢体呈弥漫性放射性浓集;水肿肢体淋巴管及淋巴结放射性浓度;水肿肢体淋巴管不显影;水肿肢体见淋巴侧支形成。（4）淋巴瘤有以下几种异常图形表现：淋巴结融合,淋巴链断裂,淋巴结肿大,淋巴交换支形成。结论：^99Tc^m-DX淋巴显像对淋巴系统疾病的诊断具有方法简便,图像清晰,灵敏度,特异性高等优点,临床诊断价值高。     

99Tcm-右旋糖酐淋巴显像评估乳腺癌相关性淋巴水肿

目的 探讨乳腺癌患者术后上肢淋巴显像的影像学特征和诊断方法,评估其对乳腺癌相关性淋巴水肿的诊断价值.方法 79例乳腺癌术后患者（上肢数158）,于患者双侧第1指间皮下注射99Tcm-右旋糖酐,分别于10 min和1,3,6 h行淋巴显像.以患侧上肢为研究组（上肢数79）,健侧为对照组（上肢数79）.计算淋巴显像对诊断淋巴水肿的灵敏度、特异性和准确性.结果 2组上肢淋巴显像在淋巴结显示数量、淋巴管完整性和显像剂回流方式等方面存在明显差异：对照组96.2%（76/79）上肢淋巴管显示完整,而研究组仅5.1%（4/79）显示完整.淋巴结显影差异较大,对照组腋窝和锁骨上淋巴结显示数量≥2枚者分别为87.3%（69/79）和74.7%（59/79）,研究组无腋窝淋巴结显示≥2枚者（0/79）,锁骨上淋巴结仅5.1%（4/79）显示≥2枚.研究组显像剂回流方式可见4种类型：正常型（2.5%,2/79）、淋巴管扩张型（55.7%,44/79）、弥漫型（36.7%,29/79）和无回流型（5.1%,4/79）.分别以＂显像剂回流异常＂和＂淋巴管不完整＂作为诊断乳腺癌相关性淋巴水肿的标准,则诊断灵敏度、特异性分别为94.8%（73/77）,100.0%（81/81）和97.5%（77/79）、96.2%（76/79）.两者结合,灵敏度和特异性均可提高到100%（77/77和81/81）.结论 核素淋巴显像因其准确、有效和无创的特点,是评估乳腺癌患者上肢淋巴管、淋巴结和淋巴引流情况的首选方法.     

肢体淋巴水肿MR间质淋巴成像技术初探

目的 评价MR间质淋巴成像技术的可行性.方法 对原发性淋巴水肿的31例患者40条下肢进行MR淋巴成像.在双足趾间皮内注入钆贝葡胺与利多卡因的混合液1 ml,采用三维容积内插扰相梯度回波序列成像,并行MIP重组显示强化淋巴管,分别测量计算显影淋巴管与增强静脉的信噪比与对比噪声比,其差异采用成组t检验比较.结果40条下肢中有36个小腿段、17个大腿段见扩张淋巴管显像;其信噪比和对比噪声比分别为257±130、207±113,而静脉强化后分别为218±129、152±113,两者强化前后差异均有统计学意义(噪声比t=-2.649,对比信噪比t=-3.404,P值均<0.01).有30个肢体腹股沟区可见淋巴结强化,26个肢体存在侧副管和淋巴反流.结论MR淋巴成像无创、安全易行,能够清晰展示淋巴水肿患者淋巴管的形态改变.     

肢体淋巴水肿MR淋巴造影与病理对照的实验研究

目的研究肢体水肿演变过程中不同时期的MR淋巴造影影像特征及其病理基础,探讨MR淋巴造影在肢体淋巴水肿方面的诊断价值。方法用改良的Danese手术方法在13只新西兰大白兔后肢一侧形成淋巴水肿模型,另一侧作为对照。在每只大白兔双侧后肢足背部趾蹼处注射0.2ml欧乃影,于淋巴水肿演变过程的不同时期进行三维MR淋巴造影。取肢体标本进行病理检查。结果MR淋巴造影能准确地确定淋巴管阻塞的部位,反映淋巴管形态、功能的状况。肢体淋巴水肿的不同时期,由于其病理基础不同,产生不同的MR淋巴造影表现。结论间质MR淋巴造影可以在解剖背景下敏感而又可靠地显示各期肢体淋巴水肿。     

超声造影诊断下肢淋巴水肿的研究进展

下肢淋巴水肿是一种慢性、进行性疾病,严重影响患者生活质量;早期诊断和治疗可延缓病情进展,有利于改善患者预后。目前常见的下肢淋巴水肿诊断技术均具有一定的缺点而使应用受限。超声造影具有无创、便捷、实时、重复性好的特点,能够增强淋巴管中淋巴液的显像,对浅表淋巴管显像具有较高敏感度,近年来逐渐应用于下肢淋巴水肿诊断。本文对超声造影在下肢淋巴水肿中的应用情况进行综述。     

Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients

Lymphoscintigraphy was performed in 128 patients with primary lymphedema, in 91 patients with secondary lymphedema, and in 19 healthy volunteers. A total of 457 extremities were examined. Technetium-99m-labeled human serum albumin was injected subcutaneously, and passive muscular exercise was standardized to reduce the variability of lymphatic function. The scintigrams were analyzed for visualization of lymph vessels and lymph nodes, dilatation of lymphatic vessels, existence of collateral vessels, and dermal backflow. With this qualitative interpretation alone, the diagnosis of lymphedema was established in 216 of 308 extremities (70.1%). Quantitative parameters derived from clearance data showed abnormal lymphatic function in all 308 extremities. Whereas qualitative lymphoscintigraphy allows the characterization of lymphatic morphology, quantitative lymphoscintigraphy is very accurate in detection of incipient lymphedema.     

Lymphoscintigraphy in patients with lymphedema. A new approach using intradermal injections of technetium-99m human serum albumin

Forty cases were examined by a new lymphoscintigraphic approach using intradermal injections of Tc-99m human serum albumin (HSA). Thirty-three patients had lymphedema due to the metastases of a malignant tumor and/or the dissection of lymph nodes. The others were control patients without lymphedema. With the assistance of a computer, sequential images and time-activity curves of tracer activity in the lymph nodes and the soft tissue were obtained at 30 minutes after injection. An image of the axillary or inguinal lymph nodes was identified 2-6 minutes after injection in control cases. Four main abnormal findings, the delayed appearance of radioactivity and interruption of the lymphatic system, the collateral pathways, and the retrograde lymphatic flow were observed clearly, as was the nonvisualization of the lymph nodes. These abnormalities were observed in a high percentage of patients with moderate lymphedema, as compared with a low percentage of patients with slight lymphedema. The collateral pathways could not be observed in patients with severe lymphedema. Imaging with Tc-99m HSA was considered to be more useful than other techniques, including radiocolloid lymphoscintigraphy, for examining patients with lymphedema.     

Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema

PURPOSE: The primary difficulty in evaluating and treating peripheral lymphedema is visualization of the lymphatics. Functional lymphatic studies have been performed on patients with peripheral edema to diagnose lymphedema, to determine its severity, and to understand the varied drainage patterns. METHODS: After intradermal injection in the hands or feet, initial flow and whole-body images were taken using Tc-99m human serum albumin in more than 700 patients with possible lymphedema. RESULTS: Clear images of truncal lymph transport and draining lymph nodes were obtained, and pattern differences between primary and secondary lymphedema were seen. Follow-up studies showed any functional change in lymphatic dynamics. CONCLUSION: Peripheral lymphatics can now be easily visualized. Because lymphangioscintigraphy can be performed before and after medical treatment, follow-up evaluation of patients with lymphedema is possible. The procedure is noninvasive, repeatable, easy to perform, and harmless to the lymphatic endothelium.     

Lymphoscintigraphy in the diagnosis of lymphatic leak after surgical repair of femoral artery injury

PURPOSE: Technetium-99m-labeled sulfur colloid lymphoscintigraphy is useful to evaluate lower extremity lymphatic circulation in cases of possible lymphedema and to reveal abnormal lymphatic collections. Groin lymphatic fistulas and lymphoceles are known complications of peripheral vascular surgical procedures. The authors describe a patient with ascites that developed into right lower extremity swelling after surgical repair of a femoral artery injury. Even after surgical ligation of multiple lymphatic channels, the patient continued to have lymphorrhea. It was unclear whether this was attributable to a persistent lymphatic leak or an ascitic leak from a postsurgical defect resulting in an abnormal connection with the peritoneal cavity. METHODS: Lymphoscintigraphy of the lower extremities was performed using Tc-99m sulfur colloid. Images were obtained at several intervals after injection of the radiotracer. Images were also acquired after the wound packing was removed. RESULTS: The images revealed an accumulation of radiotracer in the right groin, confirming the lower extremity lymphatic origin of the collection. CONCLUSIONS: Lymphoscintigraphy is useful to evaluate the origin of serous collections in the groin, a region in which lymphatic complications of vascular surgery are not uncommon.     

Interstitial lymphangiography: initial clinical experience with a dimeric nonionic contrast agent

Interstitial lymphangiography performed with intradermal injection of a new nonionic dimeric contrast agent was used to examine 34 normal lower extremities and 35 lower extremities with proved lymphedema. An infusion pump was used to inject 2 mL of the contrast agent into the intradermal interdigital space at a rate of 0.1 mL/min. In all normal extremities, the injection deposit appeared homogeneous, and one to five lymph vessels could be identified. Diffusion of contrast agent into perilymphatic tissue occurred 30-40 cm proximal to the injection site; inguinal lymph nodes were, therefore, not routinely visualized. The findings at interstitial lymphangiography were abnormal in all extremities with advanced lymphedema. The results indicate that interstitial lymphangiography with the use of a nonionic dimeric contrast agent allows morphologic assessment of lymphatic vessels and facilitates the diagnosis of lymphatic obstructive disease.     

Respiratory clearance of aerosolized radioactive solutes of varying molecular weight

To determine the influence of varying molecular weight (mol wt) on respiratory clearance of aerosolized solutes, we studied eight radiopharmaceuticals, each administered to four dogs: sodium 99mTc pertechnetate (TcO4), 99mTc glucoheptonate ([99mTc]GH), 51Cr-ethylenedinitrotetraacetate ([51Cr]EDTA), 99mTc diethylenetriaminepentaacetate ([99mTc] DTPA), 111In diethylenetriaminepentaacetate ([111In]DTPA), 67Ga desferoxaminemesylate ([67Ga]DFOM), 99mTc dextran ([99mTc]DX) and 111In transferrin ([111In]TF). After aerosolization (0.8 m MMD, 2.4 GSD), clearance was determined for 30 min and then corrected by intravenous injection for nonairspace radioactivity. In-TF clearance (0.11 +/- 0.10%/min) was lower than TcO4 (6.32 +/- 0.62%/min), [99mTc]GH (1.50 +/- 0.37%/min), [51Cr]EDTA (2.38 +/- 1.02%/min), [99mTc]DTPA (3.51 +/- 0.40%/min), [111In]DTPA (2.35 +/- 0.42%/min), [67Ga] DFOM (1.99 +/- 0.49%/min) and [99mTc]DX (1.81 +/- 0.75%/min) clearances (p less than 0.001). TcO4 clearance was higher than others (p less than 0.001). Technetium binding to DX was unsatisfactory; aerosolization caused unbinding from DTPA. We conclude that respiratory clearance of large mol wt solutes within 30 min is negligible and, that clearance of molecules between 347-5,099 daltons differs greatly, suggesting that binding and/or intrapulmonary retention affect transfer.     

Gadoteridol for MR imaging of lymphatic vessels in lymphoedematous patients: initial experience after intracutaneous injection

The aim of this study was to evaluate the feasibility of gadoteridol in visualizing lymphatic vessels of lymphoedematous patients after intracutaneous injection. 20 lower extremities in 10 lymphoedematous patients were examined. Gadoteridol (9 ml) was subdivided into five portions and injected intracutaneously into the dorsal aspect of each foot. For MRI, a three-dimensional spoiled gradient echo sequence was performed. No complications were observed during or after intracutaneous injection of gadoteridol. The lymphoedema was bilateral in seven and unilateral in three of the examined patients. Contrast enhancement of gadoteridol was detected in lymphatic vessels at the level of the lower leg in 17 lower extremities (85%). Enhancing lymphatic vessels of the upper leg were observed in 11 lower extremities (55%). Furthermore, gadoteridol enhanced 10 out of 20 inguinal lymph node groups (50%). No external iliac lymph nodes were observed in any of the patients. Regions of dermal backflow, indicating proximal lymphatic obstruction, were seen in 13 lower extremities (65%). As soon as 15 min after gadoteridol injection, accompanying venous enhancement was detected in all lower extremities (100%). MRI of lymphatic vessels in lymphoedematous patients is safe and feasible after intracutaneous injection of gadoteridol if the diagnosis of lymphoedema necessitates a better definition for optimal therapeutic planning or an objective, diagnostic baseline is required. The proposed technique represents a minimally invasive imaging method of identifying anatomical and physiological derangements in lymphatic vessels.     

Inguinoscrotal lymphatic reflux detected by lymphoscintigraphy

We performed lymphoscintigraphy with^99mTc-human serum albumin in a case of suspected lymphedema of the right leg after inguinal lymph node dissection. Dermal backflow of the leg and lymphocele at the inguinal chain were observed, and lymphatic reflux into the scrotum was also delineated. The scintigraphy could demonstrate a persistent lymphatic problem under conservative treatment, and could lead the physician to conduct surgical treatment. Scintigraphic demonstration of the inguinoscrotal lymphatic reflux has not been previously reported.     

淋巴显像评估妇科肿瘤治疗后下肢淋巴系统损伤

目的分析妇科肿瘤治疗后淋巴水肿患者淋巴显像的影像特点,建立评估下肢淋巴系统损伤的方法。方法166例连续陛病例（332个肢体）双足第1,2趾间皮下注射99Tcm-DX111—185MBq（0．1～0．15m1）后行淋巴显像。根据显像结果,以淋巴管完整程度和淋巴皮下返流状况为指标,将下肢淋巴系统损伤分为0,1,2和3级。根据国际淋巴学会淋巴水肿临床分期标准,将淋巴水肿分为0,I,Ⅱa,Ⅱb和Ⅲ期。列联表,检验比较2种分类方法间的相关关系。矿检验分析淋巴系统损伤分级的临床特征。结果妇科肿瘤治疗后患者淋巴显像表现包括：下肢、盆腔和腹腔区域的淋巴管中断、皮下淋巴返流、淋巴管和淋巴结不显影、淋巴囊肿和淋巴瘘等。332个肢体,水肿分期为0,I,Ⅱa,Ⅱb和Ⅲ期的分别为65（19．6％）,71（21．4％）,131（39．5％）,62（18．7％）和3（0．9％）个,淋巴显像损伤分级为0,1,2和3级的数量分别为36（10．8％）,79（23．8％）,116（34．9％）和101（30．4％）个。统计学分析表明,2者间有良好的相关性（x2=313．483,P〈0．001）。临床分析表明,2和3级损伤所占比例放疗组高于非放疗组,分别为70．5％（158／224）和54．6％（59／108）,x2=9．662,P=0．022;有丹毒病史者3级损伤比例也高于无丹毒者,分别为73．1％（38／52）和43．9％（50／144）,x2=12．238,P〈0．001。随着淋巴水肿病程进展,3级损伤肢体数所占百分比逐渐增高、病程〈1．5年者为36．6％（34／93）,病程1．5～5年者为72．3％（34／47）,病程〉5年者为76．9％（20／26）（x2=23．123,P〈0．001）。不同类型妇科肿瘤（x2=4．000,P=0．676）、是否化疗（x2=0．411,P=0．938）对淋巴系统损伤分级无明显影响。结论淋巴显像损伤分级方法有助于评估妇科肿瘤治疗后患者的淋巴系统损伤程度,可为治疗后淋巴水肿的临床诊断和预防提供客观依据。