ASSESSMENT OF LYMPHEDEMA WITH LYMPHOSCINTIGRAPHY: CAN NODAL QUANTIFICATION HELP?

Lymphoscintigraphy with combined qualitative and quantitative analysis is reported to be a more sensitive approach to diagnose lymphedema in comparison with the conventional clinical analysis. Our study seeks to evaluate the diagnostic performance of lower limb lymphoscintigraphy with amalgamation of qualitative and quantitative analysis by measuring the ilio-inguinal nodal uptake. This prospective observational study was comprised of 86 patients (172 limbs) diagnosed with lower limb lymphedema. After a thorough clinical grading of edema, radionuclide lymphoscintigraphy was performed as per a dedicated institutional protocol. Ilio-inguinal nodal quantification of tracer uptake was computed along with the visual study of the scans. Additionally, the corresponding mean nodal uptake percentage for each grade of lymphedema was assessed and a cut off nodal uptake percentage to differentiate between normal and abnormal limbs was defined. Although quantitative analysis with nodal uptake percentage provides objective criteria to diagnose lymphedema, it can only act as an adjunct to qualitative method without replacing it. Finally, standardization of procedure for quantitative lymphoscintigraphy is needed including the potential for combining both rate of clearance of tracer from injection site and nodal uptake for quantification.

Radionuclide Lymphoscintigraphy in the Diagnosis of Idiopathic Congenital Lymphedema– a Case Report

Congenital lymphedema is the rarest form of primary lymphedema, accounting for approximately 1: 60,000 live births. Congenital lymphedema can be classified into familial (hereditary) and idiopathic (non hereditary) subgroups. When congenital lymphedema is of the hereditary form the eponym Milroy disease is applied. Lymphedema without any dysmorphic features and no family history of lymphedema the eponym idiopathic congenital lymphedema is utilized. Etiology of idiopathic primary congenital lymphedema is unknown and a de novo genetic event of genes involved in lymphangiogenesis is a possibility. Radionuclide lymphoscintigraphy is considered as a gold standard for the diagnosis of lymphedema. This reported interesting case was an eleven months old girl having swelling of right lower limb since birth. There was no family history of lymphedema and no any dysmorphic features consistent with Milroy disease. The primary diagnosis was congenital lymphedema of idiopathic (non hereditary) subtype. Lymphoscintigraphic with Technetium-99m (Tc- 99m nanocolloid) revealed no lymphatic channels or inguinal lymph nodes on right side in early or delayed images up to 2 hours views and the diagnosis of primary idiopathic congenital lymphedema was confirmed.Bangladesh J. Nuclear Med. 18(2): 183-185, July 2015

Radionuclide Lymphoscintigraphy in the Evaluation of Lower Extremity Lymphedema – Single Hospital Experience

Objective: To find out the type of pattern of obstruction in patient with lymphedema of lower extremities by Lymphoscintigraphy to evaluate.Method: This retrospective study was carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS) from January 2014 to June 2014. The study included 51 patients. Lymphoscintigraphy performed by Tc-99m nano-colloid and were interpreted by expert of Nuclear Medicine Physician.Result: Lymphoscintigraphy was done total 51patients with clinically diagnosed lymphedema (29 males and 22 females; age range 10–80 years). Seventeen patients (33.3%) revealed normal flow in both limbs, whereas only one patients (1.9%) consistent with primary lymphedema.Thirty-three patients (64.7%) consistent with secondary lymphedema, where thirty patients (58.8%) revealed unilateral partial obstruction and three patient (5.9%) had bilateral partial obstruction.Conclusion: Lymphoscintigraphy is safe and effectiveBangladesh J. Nuclear Med. 18(1): 43-46, January 2015