Quantitative lymphoscintigraphy

Carena, Mauro; Campini, Riccardo; Zelaschi, G.; Rossi, Giovanna; Aprile, C.; Paroni, Giulia

doi:10.1007/bf00253447

Cited by 49 publications

(55 citation statements)

References 5 publications

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“…In this field, few authors rely purely on morphologic data (9,10). The sensitivity of morphologic criteria (7,9,10,12) often appears to be inferior (70%-80%) to that of isolated functional parameters (90% or more) (5,8). In practice, most protocols for examining edemas of the limbs take into account both morphologic data and different functional parameters (6)(7)(8)11,12).…”

Section: Discussionmentioning

confidence: 99%

“…The sensitivity of morphologic criteria (7,9,10,12) often appears to be inferior (70%-80%) to that of isolated functional parameters (90% or more) (5,8). In practice, most protocols for examining edemas of the limbs take into account both morphologic data and different functional parameters (6)(7)(8)11,12). In fact, our study showed that lymphatic extraction of tracer from the injection site (8,12), or its subsequent nodal accumulation (8), can vary significantly from one examination to the next according to variations in the quantity of tracer injected.…”

Section: Discussionmentioning

confidence: 99%

“…In practice, most protocols for examining edemas of the limbs take into account both morphologic data and different functional parameters (6)(7)(8)11,12). In fact, our study showed that lymphatic extraction of tracer from the injection site (8,12), or its subsequent nodal accumulation (8), can vary significantly from one examination to the next according to variations in the quantity of tracer injected. All lymphatic system studies that use any of those functional parameters as diagnostic criteria must clearly specify and standardize the injected volumes, colloid radioactivity levels, and quantities of labeled tracer.…”

Section: Discussionmentioning

confidence: 99%

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Scintigraphic Investigations of the Lymphatic System: The Influence of Injected Volume and Quantity of Labeled Colloidal Tracer

Bourgeois

2007

Journal of Nuclear Medicine

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Volumes injected for lymphoscintigraphic investigations are highly variable, and the quantity of labeled colloids injected is usually not reported. The aim of the present study was to evaluate whether and how volume and quantity quantitatively affect lymphoscintigraphic results. Methods: Each of 9 healthy volunteers (4 men and 5 women; mean age, 21 y; range, 19-26 y) participated in 4 lymphoscintigraphic investigations using the same protocol, in which the volume injected was 0.2 or 1.0 mL and the quantity injected was 0.02 or 0.2 mg. Subcutaneous injections of 99m Tclabeled human serum albumin nanosized colloids were placed in the first interdigital space of each foot. Activity at the injection sites and in the inguinoiliac nodes after a standardized sequence of rest, exercise, and normal-activity periods was measured and analyzed as a function of volume and quantity. Results: The highest extraction rate was observed for a quantity of 0.2 mg and a volume of 0.2 mL. This extraction rate was significantly higher than the rates obtained for a quantity of 0.2 mg and a volume of 1.0 mL or for a quantity of 0.02 mg and a volume of 0.2 mL, neither of which differed from the extraction rate for a quantity of 0.02 mg and a volume of 1.0 mL. Activity in inguinoiliac nodes was significantly higher for a quantity of 0.2 mg than for a quantity of 0.02 mg, irrespective of volume. With quantity remaining constant, volume did not influence the activity in inguinoiliac nodes. Conclusion: Both volume and quantity influence the results of lymphoscintigraphic investigations with regard to the quantities extracted from injection sites and the accumulations in nodal regions. Therefore, volume and quantity should be standardized when quantitative parameters are used for diagnostic purposes. Lymphosci ntigraphy using 99m Tc-labeled colloids is a simple and nontraumatic method for studying diseases of the lymphatic system. The technique has been used to evaluate lymph nodes in various types of cancer (1,2). It is now used merely to demonstrate so-called sentinel lymph nodes (3,4) and is also applied in assessing limb edemas (5-12). In publications devoted to these oncologic and nononcologic lymphoscintigraphic investigations, highly variable volumes have been injected, and the quantity of injected colloids has rarely been mentioned. Nonetheless, each of these parameters can influence the results of investigations, both qualitatively (nodal visibility) and quantitatively (nodal activity levels or extraction of tracer from injected sites). The present study was undertaken to determine the influence of volume and quantity on quantitative parameters of lymphoscintigraphy. MATERIALS AND METHODSNine healthy volunteers (4 men and 5 women; mean age, 21 y; range, 19-26 y) participated. The subjects had no history of upperlimb osteoarticular or lymphatic lesions. Subjects who were likely to have lesions of the lymphatic system (with diseases such as psoriasis or diabetes or who regularly played sports such as soccer, basketball, or volleyball) w...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Scintigraphic Investigations of the Lymphatic System: The Influence of Injected Volume and Quantity of Labeled Colloidal Tracer

Bourgeois

2007

Journal of Nuclear Medicine

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“…Em nosso estudo, a análise da curva não possibilitou a distinção entre o membro com e sem linfedema, mesmo após correção pela atividade administrada, o que possivelmente indique a interferência de outros fatores, como a variação na retenção do material em trânsito por cada linfonodo ou por toda a cadeia inguinal. Diversos autores propõem que, ao invés da chegada do radiofármaco na cadeia inguinal, o clareamento do ponto de injeção seria um melhor parâmetro de quantificação [19][20][21][22] .…”

Section: Resultsunclassified

Critérios semiquantitativos de análise da linfocintilografia em linfedema dos membros inferiores

Sapienza¹,

Endo²,

Ferraro³

et al. 2006

J. vasc. bras.

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288 ResumoObjetivo: Avaliar se diferentes parâmetros de análise da linfocintilografia permitem a distinção entre membros com e sem linfedema em pacientes com quadro clínico de edema unilateral.Métodos: Levantamento retrospectivo dos exames de 20 pacientes submetidos a linfocintilografia para investigação de edema unilateral de membros inferiores, divididos em pacientes com linfedema primário (grupo 1, n = 7) ou secundário pós-traumático (grupo 2, n = 13). Foi realizada linfocintilografia após injeção subdérmica de soroalbumina humana marcada com tecnécio-99m nos pés, com imagens da região inguinal durante 15 min e imagens dos membros inferiores após 15 min e 1 h. Os parâmetros analisados foram: tempo de aparecimento da cadeia inguinal, índice semiquantitativo (fluxo linfático, difusão intersticial, aspecto dos vasos, tempo de aparecimento e aspecto dos linfonodos inguinais) e inclinação da curva de atividade em função do tempo da região inguinal. As medidas nos membros clinicamente acometidos foram comparadas aos membros sem linfedema em ambos os grupos.Resultado: O tempo médio de aparecimento da cadeia inguinal e o índice semiquantitativo foram significativamente maiores nos membros com linfedema que nos membros sem linfedema quando considerados todos os pacientes, com maior retardo e índice semiquantitativo nos membros com linfedema do grupo 1 em relação aos do grupo 2.Conclusão: A análise do tempo de aparecimento da cadeia inguinal e o índice semiquantitativo fornecem parâmetros objetivos de avaliação do linfedema que podem auxiliar na detecção e seguimento dos pacientes com linfedema.Palavras-chave: Cintilografia, linfedema. AbstractObjective: To evaluate whether different parameters could be used in the analysis of lymphoscintigraphy to distinguish affected from unaffected limbs in patients with unilateral edema.Methods: Twenty patients who underwent lymphoscintigraphy for screening of unilateral lower limb edema were retrospectively assessed and divided into patients with primary lymphedema (group 1, n = 7) or secondary post-traumatic edema (group 2, n = 13). Technetium 99m-labeled human serum albumin was subdermally administered in the feet, followed by a dynamic lymphoscintigraphy of the pelvis during 15 min and static images of the lower limbs after 15 min and 1 h. Analyzed parameters were detection time of groin activity, semi-quantitative index (lymph flow, interstitial diffusion, aspect of vessels, detection time and aspect of inguinal lymph nodes) and slope of groin time-activity curve. The parameters of clinically affected limbs were compared to those of the contralateral limbs in both groups.Results: Detection time of groin activity and semi-quantitative index were significantly higher in affected limbs considering all patients, with a more severe delay and a higher semi-quantitative index in group 1 compared to group 2.Conclusion: Analysis of detection time of groin activity and semiquantitative index can add objective parameters that can be used in the diagnosis and follow-up of patients with ly...

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“…In an attempt to gain insight into patterns of regional lymph flow, previous studies have been based on lymphoscintigraphy, using the rate of clearance of a suspension of radiolabelled particles from a subcutaneous depot as a quantitative measure of local lymph flow [4, 5, 6, 7, 8, 9, 10, 11, 12]. The most readily available material for such studies is Tc-99m-nanocolloid.…”

Section: Introductionmentioning

confidence: 99%

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

Pain

Barber²,

Ballinger³

et al. 2004

J Vasc Res

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Aim: The ability to return interstitial protein to central blood is key to the defence against oedema. The aim of this study was to quantify this ability by measuring the rate at which radiolabelled human immunoglobulin (HIgG) accumulated in blood following injection into the subcutis of the hand in normal volunteers and in patients with breast cancer-related lymphoedema (BCRL). Methods: A total of 37 control subjects (healthy normal volunteers or breast cancer patients prior to treatment) and 18 women with BCRL were studied with dual-isotope lymphoscintigraphy. Each received bilateral subcutaneous depot injection in the dorsal web space of HIgG labelled with Tc-99m on one side and In-111 on the other. Activities remaining at the depot and accumulating in blood were measured at regular intervals for 3 h. Clearance from the depot was exponential and expressed as the rate constant k_depot (min^–1). Accumulation in blood was essentially linear and, using an estimate of blood volume based on height and weight, was expressed as the linear constant b_blood (% administered activity·min^–1). The time axis intercept of this linear fit was recorded as an index of the minimum time to arrival of radioprotein in blood. The efficiency with which radioprotein that has left the depot (extra-depot activity) is transported into blood [tissue-to-blood (T-B) transport] was quantified (1) as the quotient b_blood/k_depot, and (2) as a function of time after injection by comparing the total amount of radioprotein in blood at any time with the total amount of radioprotein that was no longer in the depot at the same time. Results: Tc-99m-HIgG and In-111-HIgG behaved similarly and are interchangeable. At all times between 60 and 180 min in controls, about 50% of protein that had left the depot was present in blood. T-B transport was reduced to about 20% in BCRL arms in which the hand was involved in swelling (p < 0.001 versus controls), but remained unchanged in patients in whom the hand was spared. The minimum time to arrival of radioprotein in blood was not reduced in BCRL; on the contrary, there appeared to be a small proportion of injected activity that arrived rapidly in blood in BCRL patients but not in controls. Conclusion: We conclude that T-B transport is only impaired in BCRL when radioprotein is injected into swollen tissue. Significant quantities of radioprotein may escape from the arm via local access to blood. Individual variation in this capacity may explain the regional sparing observed in BCRL.

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Quantitative lymphoscintigraphy

Cited by 49 publications

References 5 publications

Scintigraphic Investigations of the Lymphatic System: The Influence of Injected Volume and Quantity of Labeled Colloidal Tracer

Scintigraphic Investigations of the Lymphatic System: The Influence of Injected Volume and Quantity of Labeled Colloidal Tracer

Critérios semiquantitativos de análise da linfocintilografia em linfedema dos membros inferiores

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

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