technetium-tc-99m-sulfur-colloid and Lymphedema

The authors introduce the technique of reverse lymphatic mapping for vascularized lymph node transfer. This physiologic technique allows one to identify which lymph nodes drain the trunk as opposed to the extremity, to minimize the risk of iatrogenic lymphedema.. A prospective study of patients undergoing vascularized lymph node transfer using the reverse lymphatic mapping technique was conducted. Patients received technetium injections in the first and second webspaces of the foot and intradermal indocyanine green injections in the lower abdomen. Lymphatic vessels were traced to the lymph nodes draining the lower abdomen that were harvested; a gamma probe was used to localize lymph nodes draining the lower extremity, which were avoided. In cases of vascularized axillary lymph node transfer, technetium was injected into the hand and indocyanine green was injected into the back and lateral chest. Ten-second counts were recorded of the lymph node flap and the sentinel node draining the extremity for comparison.. Thirty-five patients underwent vascularized lymph node transfer (19 groin and 16 axillary lymph node transfers) guided by reverse lymphatic mapping. Follow-up time was 1 to 30 months. Mean 10-second count using the gamma probe for all lymph node flaps was 88.6 (SD, 123; median, 39); mean 10-second count of extremity sentinel nodes was 2462 (SD, 2115; median, 2000). On average, 10-second signal strength of the lymph node flap was 6.0 percent that of the extremity sentinel node.. Reverse lymphatic mapping guides vascularized lymph node flap harvest based on physiologic drainage patterns of the trunk and limb that may minimize the risk of iatrogenic lymphedema.. Therapeutic, IV.

Topics: Axilla; Coloring Agents; Humans; Indocyanine Green; Inguinal Canal; Lymph Nodes; Lymphedema; Prospective Studies; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Sentinel lymph node (SLN) dissections have a high sensitivity and negative predictive value for the detection of metastatic disease. The objective of this study was to examine the inguinal recurrence rate along with complication rates for patients undergoing inguinal SLN dissection alone for vulvar carcinoma.. An IRB approved prospective study enrolled patients with biopsy proven squamous cell carcinoma of the vulva. Peritumoral injection of Tc-99 sulfur colloid and methylene blue dye was used to identify SLNs intraoperatively. Patients with SLNs negative for metastatic disease were followed clinically. Patients with metastasis detected in a SLN subsequently underwent a full groin node dissection followed by standard treatment protocols.. Thirty-six patients were enrolled onto study with 35 undergoing a SLN dissection. All SNL dissections were successful with a mean of 2 SLN obtained per groin. There were 24 patients with stage I disease, 8 stage II, 3 stage III and 1 stage IV. A total of 56 SLN dissections were performed with 4 patients found to have inguinal metastasis by SLN dissection. There were 31 patients with a total of 46 SLN dissections found to be negative for metastatic disease. The median follow-up has been 29 months (range 8 to 51) with 2 groin recurrences for a groin recurrence rate of 4.3% and a recurrence rate per patient of 6.4%. There have been no reports of groin breakdown, extremity cellulitis or lymphedema.. The recurrence rate for patients undergoing inguinal sentinel node dissection alone is low. These patients did not experience any complications as seen with complete groin node dissections. Sentinel lymph node dissection should be considered as an option for evaluation of inguinal nodes for metastatic disease.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell; Cellulitis; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Lymphedema; Methylene Blue; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Prospective Studies; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid; Vulvar Neoplasms

Secondary lymphedema is a localized, acquired lymphatic microcirculatory disturbance that affects large numbers of patients after breast cancer therapy. There is a paucity of objective methods to quantitate lymphatic function and to anticipate the response to therapeutic interventions. We applied radionuclide lymphoscintigraphy to evaluate lymphatic transport and axillary lymph node visualization in women following breast cancer therapy to determine the utility of these data in these patients. Lymphoscintigraphy was performed after subcutaneous injection of 0.25 mCi of Tc-filtered sulfur colloid. Subcutaneous accumulation of radiotracer ('dermal backflow') and the visualization of axillary lymph nodes were graded using our own scoring system. The ratio of radioactivity within the affected to normal axillae (ARR) was also quantified. Nineteen patients with lymphedema after breast cancer therapy were evaluated. The disease severity was documented by serial measurements of the limb volume using the truncated cone formula. Responses to therapy were quantified after completion of the therapy. There was a correlation between the ARR and the percentage reduction in edema volume. The lymphoscintigraphic score correlated with the initial arm volume excess and with the durationof lymphedema. It can be concluded that quantitative and semi-quantitative assessment by radionuclide lymphoscintigraphy represents a potentially useful tool for the clinical assessment of upper extremity lymphedema.

Topics: Aged; Breast Neoplasms; Female; Humans; Lymph Nodes; Lymphedema; Lymphoscintigraphy; Mastectomy; Middle Aged; Physical Therapy Modalities; Postoperative Complications; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Upper Extremity

Limb lymphedema in horses can be debilitating and painful. Pneumatic compression therapy has shown significant benefits for people suffering from lymphedema. The objective of this study was to determine the effect of a novel, equine-specific pneumatic compression device on the lymphatic flow of healthy horse forelimbs as determined by Tc-99m sulfur colloid lymphoscintigraphy.. 6 healthy Thoroughbreds.. In a randomized crossover design, horses underwent bilateral forelimb lymphoscintigraphy following subcutaneous injection of Tc-99m sulfur colloid at the coronary band as untreated control or with pneumatic compression therapy using the EQ Press. Lateral, static images were obtained of the distal limb (time 0 to 60 minutes) and proximal limb (time 30 to 60 minutes) using a standard gamma camera. Lymphatic flow was determined by assigning a score to the time point at which Tc-99m sulfur colloid was first visualized at the level of the accessory carpal bone (1 to 7) in the distal limb and the cubital lymph node (1 to 4) in the proximal limb.. EQ Press treatment led to a significantly faster lymphatic flow of Tc-99m sulfur colloid to the predetermined anatomic locations of the accessory carpal bone (P = .002) in the distal limb and the cubital lymph node (P = .001) in the proximal limb.. Pneumatic compression therapy as provided by an equine-specific device encouraged lymphatic flow in healthy, nonedematous equine forelimbs. These data support further study of the EQ Press for pneumatic compression therapy in horses clinically affected by lymphedema and lymphatic drainage disorders.

Topics: Animals; Forelimb; Horse Diseases; Horses; Lymph Nodes; Lymphedema; Lymphoscintigraphy; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids in patients with melanoma undergoing SLNB.. We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012 to 2016 with at least 1 y of follow-up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy and SLNB. Student's t-test and chi-square were used to analyze the data with a P value of <0.05 being considered significant.. Patients were equally matched in regard to age, sex, and primary characteristics of their melanoma. In comparison to sulfur colloid, Lymphoseek required lower radiation dosages (P < 0.001), shorter mapping times (P = 0.008), and decreased number of sentinel nodes removed (P = 0.03). There was no difference in the number of patients with positive nodes (P = 0.5). In addition, there were no statistical differences between the two radioactive tracers in regard to the number of patients with false-negative SLNB.. Lymphoseek has the potential to decrease radioactivity and mapping time in patients who need SLNB. With a decrease in the number of nodes removed without loss of sensitivity, there is a potential to avoid unnecessary node removal and thus complications such as lymphedema. Longer follow-up will help to determine if there is any increase in false-negative rates despite fewer nodes removed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Dextrans; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Lymphedema; Lymphoscintigraphy; Male; Mannans; Melanoma; Middle Aged; Neoplasm Staging; Radiopharmaceuticals; Retrospective Studies; Sentinel Lymph Node Biopsy; Skin Neoplasms; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid; Young Adult

Lymphedema is a common complication in breast carcinoma patients undergoing axillary lymph node dissection. Although there is a significant reduction in the lymphedema rate with sentinel lymph node biopsy compared to axillary lymph node dissection, there is some risk after sentinel lymph node biopsy. Axillary reverse mapping, an emerging concept aims at identifying and preserving the draining lymph node of the arm that is invariably devoid of malignancy. This concept if validated may prevent lymphedema in breast carcinoma patients. Axillary reverse mapping node can be identified using a radiotracer or blue dye. We describe the procedure using filtered Tc-SC.

Topics: Aged; Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphedema; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

We investigated the prognostic value of qualitative lymphoscintigraphy in gynecological cancer-related lymphedema, which is a common complication after treatment.. All 152 patients underwent (99m) Tc tin-colloid lymphoscintigraphy before complex decongestive therapy (CDT). We analyzed the uptake patterns of the inguinal lymph nodes, main lymphatic vessel and collateral lymphatic vessels, as well as dermal back flow. We compared these lymphoscintigraphic findings and other clinical variables between good and poor therapeutic responders using Pearson's Chi-squared test, Fisher's exact test and multiple logistic regression analysis.. Eighty-nine patients (58.6%) had a poor therapeutic response to CDT. In univariate analysis, there were significant differences between good and poor responders in clinical stage (P < 0.001), therapy compliance (P < 0.001), main lymphatic vessel uptake pattern (P < 0.01), collateral lymphatic vessel uptake pattern (P < 0.01) and severity of dermal back flow (P < 0.001). After multivariate analysis, only severity of dermal back flow (P < 0.005), clinical stage (P < 0.05) and therapy compliance (P < 0.001) were found to be independent predictors of therapeutic response.. Lymphoscintigraphy may be useful to predict the outcome of patients with gynecological cancer-related lymphedema undergoing CDT along with clinical stage and compliance.

Topics: Adult; Aged; Female; Follow-Up Studies; Genital Neoplasms, Female; Humans; Lymphatic Vessels; Lymphedema; Lymphoscintigraphy; Middle Aged; Neoplasm Staging; Prognosis; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

The aim of this study was to evaluate the axillary reverse lymphatic mapping (ARM) procedure for reducing the risk of arm lymphedema after breast cancer surgery.. The ARM procedure was carried out with a subareolar injection of technetium-99 sulfur colloid the morning of surgery, and a patent blue dye injection into the upper inner arm after anesthesia.. Fifty-two women made up our study population. Thirty-seven patients underwent sentinel lymph node biopsy (SLNB) and 15 patients underwent an axillary lymph node dissection (ALND) for known nodal metastasis. The sentinel lymph node was identified in 36 of the 37 cases who underwent SLNB alone and in 12 of 15 patients who underwent on ALND. In 13 patients, both blue and radioactive lymph nodes or lymphatics were clearly identified (25%) and 5 patients had a clear crossover with nodes being both blue and hot. Only a single patient with crossover lymphatics had metastases present in their sentinel node.. The ARM technique did not prevent identification of the SLN and we identified much greater crossover than reported. We had a single patient, who underwent a sentinel node biopsy, with mild arm lymphedema (1.9%) after 2 years of follow up.

Topics: Adult; Aged; Arm; Axilla; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymph Nodes; Lymphedema; Mastectomy; Middle Aged; Neoplasm Staging; Prognosis; Prospective Studies; Radionuclide Imaging; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

We hypothesize that mapping the lymphatic drainage of the arm with blue dye (axillary reverse mapping [ARM]) during axillary lymphadenectomy decreases the likelihood of disruption of lymphatics and subsequent lymphedema.. This institutional review board-approved study involved 360 patients undergoing sentinel lymph node biopsy (SLNB) and/or axillary lymph node dissection (ALND) from May 2006 to October 2011. Technetium sulfur colloid (4 mL) was injected subareolarly, and 5 mL of blue dye was injected subcutaneously in the volar surface ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage, successful identification and protection of arm lymphatics, crossover, and occurrence of lymphedema.. A group of 360 patients underwent SLNB and/or ALND, 348 of whom underwent a SLNB. Of those, 237 (68.1%) had a SLNB only, and 111 (31.9%) went on to an ALND owing to a positive axilla. An additional 12 of 360 (3.3%) axilla had ALND owing to a clinically positive axilla/preoperative core needle biopsy. In 96% of patients with SLNB (334/348), breast SLNs were hot but not blue; crossover (SLN hot and blue) was seen in 14 of 348 patients (4%). Blue lymphatics were identified in 80 of 237 SLN incisions (33.7%) and in 93 of 123 ALND (75.4%). Average follow-up was 12 months (range, 3-48) and resulted in a SLNB lymphedema rate of 1.7% (4/237) and ALND of 2.4% (3/123).. ARM identified substantial lymphatic variations draining the upper extremities and facilitated preservation. Metastases in ARM-identified lymph nodes were acceptably low, indicating that ARM is safe. ARM added to present-day ALND and SLNB may be useful to lesser rates of lymphedema.

Topics: Axilla; Breast Neoplasms; Coloring Agents; Female; Follow-Up Studies; Humans; Lymph Nodes; Lymphatic Vessels; Lymphedema; Middle Aged; Radiopharmaceuticals; Rosaniline Dyes; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Lymphatic vasculature is known to spontaneously reconnect after hand replantation. Nonetheless, lymphatic outflow has not been specifically studied in hand transplantation.Lymphedema was studied clinically and scintigraphically in 3 bilateral upper limb transplants performed in Valencia, Spain, since 2006. Case 1 was a radiocarpal level, case 2 midforearm and proximal forearm, and case 3 was a transhumeral transplantation. Follow-up was 5, 4, and 3 years, respectively. Clinically, in case 1, there was a left-sided moderate lymphedema, case 2 was normal, and a right-sided moderate lymphedema was present in case 3. Lymphoscintigraphy results were consistent with the clinical findings. It was normal in the 4 nonedematous limbs. In the 2 affected limbs, there were scintigraphic findings of lymphatic block and lymphangiectasia.The study demonstrates objectively that lymphatic circulation can reconnect spontaneously in hand transplantations, although not in a homogeneously efficient way.

Topics: Amputation, Traumatic; Forearm; Forearm Injuries; Hand Transplantation; Humans; Lymphangiectasis; Lymphatic Vessels; Lymphedema; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Upper Extremity; Vascularized Composite Allotransplantation

Lymphedema of the lower limb can occur as a result of lymphatic obstruction secondary to malignancy or to lymphatic filariasis in endemic countries. Resistant lymphedema can be treated with microsurgical lymphovenous anastomosis, thus creating a lymphovenous shunt. Patency of these anastomoses cannot be assessed with conventional imaging modalities (lymphangiogram). Lymphoscintigraphy is useful for this purpose. Early visualization of liver and blood pool activity indirectly confirms presence of a patent lymphovenous shunt. We demonstrate the patency of lymphovenous shunt in a 48-year-old woman who underwent microsurgical lymphovenous anastomosis for severe lymphedema of the left lower limb.

Topics: Anastomosis, Surgical; Female; Humans; Lymphatic System; Lymphedema; Lymphoscintigraphy; Middle Aged; Technetium Tc 99m Sulfur Colloid; Vascular Patency

The aim of this study was to evaluate gall bladder visualization in lymphoscintigraphy of extremities.. Thirteen patients who had prediagnoses of lymphedema and were referred for lower extremity lymphoscintigraphy to our department were retrospectively evaluated. Lower extremity lymphoscintigraphy with Tc-99m sulfur colloid was performed on the patients, and planar images of the lower extremity and abdominal region were taken in early phase and late phase (at the 24th hour) routinely. Lymphoscintigraphy results of eight patients were normal regarding lymphatic flow or lymph nodes; however, additional pathologic tracer accumulations in gall bladder were observed, which disappeared at 24th hour images in three patients. Five patients had various pathologies regarding lymph flow or lymph nodes. However, there were no patients with gall bladder activity except those three patients who had casual anamnesis of fasting prior to the exam.. The fasting state of the patients might be the cause of gall bladder visualization during the lymphoscintigraphy of the extremities with sulfur colloid.

Topics: Abdomen; Adult; Female; Gallbladder; Humans; Lower Extremity; Lymph Nodes; Lymphatic Vessels; Lymphedema; Lymphoscintigraphy; Male; Pelvis; Reproducibility of Results; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid

Variations in arm lymphatic drainage put the arm lymphatics at risk for disruption during axillary lymph node surgery. Mapping the drainage of the arm with blue dye (axillary reverse mapping, ARM) decreases the likelihood of disruption of lymphatics and subsequent lymphedema.. This institutional review board (IRB)-approved study from May to October 2006 involved patients undergoing SLNB and/or ALND. Technetium sulfur colloid (4 mL) was injected in the subareolar plexus and 2-5 mL of blue dye intradermally was injected in the ipsilateral upper extremity (ARM). Data were collected on variations in lymphatic drainage that impacted SLNB or ALND, successful identification and protection of the arm lymphatics, any crossover between a hot breast node and a blue arm node, and occurrence of lymphedema.. Of the 40 patients undergoing surgery for breast cancer, 18 required an ALND, with a median age of 49.7 years old. Fourteen patients had a SLNB + ALND, and four patients had ALND alone. In 100% of patients, all breast SLNs were hot but not blue, and the false negative rate was 0. In 11 of 18 ALNDs (61%) blue lymphatics or blue nodes were identified in the axilla. In the initial seven cases with positive lymph nodes in the axilla, the blue node draining from the arm was biopsied and all were negative.. ARM identified significant lymphatic variations draining the upper extremities and facilitated preservation in all but one case. ARM added to present-day ALND and SLNB further defines the axilla and may be useful to prevent lymphedema.

Topics: Adult; Aged; Axilla; Breast Neoplasms; Coloring Agents; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Lymphatic Vessels; Lymphedema; Middle Aged; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), venography, lymphoscinti-graphy (LS) and contrast lymphography are frequently utilized in the evaluation of lower limb oedema but no clinical data from the Caribbean have been published on the role of LS despite its well-recognized clinical application. The successful clinical application of CT, colour doppler sonography and MRI in differentiating the various causes of lower limb oedema is well understood. Lymphoscintigraphy has found less acceptability especially in the Caribbean where nuclear imaging techniques are only now currently being developed. This paper describes the initial experience with this technique in 15 patients over a five-year period and discusses its value when lower limb lymphoedema is suspected. Scintigrams were analyzed for visualization of lymph vessels and lymph nodes, dilatation of lymphatic vessels, collaterals and dermal back flow. Lymphoscintigrams were classified as normal (n = 5) or consistent with lymphoedema (n = 10). Failure to visualize lymphatic vessels occurred in two cases of suspected primary lymphoedema. In the remaining eight cases of secondary lymphoedema, a positive study based on altered lymphatic flow and anatomy was recorded. An alternative explanation was offered in three out of five cases in which a normal lymphoscintigram was obtained.

Topics: Adult; Aged; Caribbean Region; Cost Savings; Edema; Evaluation Studies as Topic; Female; Humans; Lower Extremity; Lymphedema; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sampling Studies; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid

Isotope lymphography has largely replaced contrast lymphography in the diagnosis of lymphoedema. Its accuracy has only been assessed in small studies and it is not known if it can identify patients with a proximal lymphatic obstruction who may be suitable for lymphatic bypass surgery.. Three hundred and ninety-five patients suspected to have lymphoedema were investigated by isotope lymphography between 1985 and 1995. Contrast lymphography was also carried out in 29 of these patients because the isotope results were thought to be misleading, or because lymphatic bypass surgery was being considered.. In the 29 patients who had both investigations isotope lymphography detected 20 of 24 abnormal lymphatic systems. Four legs with obstructed groin lymphatics were reported as normal. Two legs with normal contrast lymphograms were erroneously diagnosed as having lymphoedema in the isotope study. Detectable groin nodes on the scintigrams were indicative of either normal lymphatics or proximal lymphatic obstruction. An increase in isotope uptake over 30-60 min of less than 50 per cent, or a total absence of isotope within groin nodes, was a sensitive indicator that patients were unsuitable for lymphatic bypass surgery.. Isotope lymphography is a moderately sensitive test for lymphoedema, which will mistakenly classify some normal legs as lymphoedematous. It will usually correctly identify patients who are suitable for lymphatic bypass surgery.

Topics: Contrast Media; Humans; Inguinal Canal; Leg; Lymphedema; Lymphography; Radionuclide Imaging; Radiopharmaceuticals; Rhenium; Technetium Tc 99m Sulfur Colloid

Topics: Female; Femoral Artery; Humans; Lithiasis; Lymph Nodes; Lymphedema; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Thigh

Topics: Abnormalities, Multiple; Female; Humans; Infant, Newborn; Intellectual Disability; Lymphedema; Lymphoscintigraphy; Male; Obstetric Labor, Premature; Pregnancy; Preoperative Care; Radiopharmaceuticals; Syndrome; Technetium Tc 99m Sulfur Colloid

Erysipelas (cellulitis/lymphangitis) is a superficial cutaneous infection spread by the lymphatic system which may result in permanent injury to the lymphatic vessels. The study evaluated the lymphatic drainage in the lower limbs of 30 patients with at least two episodes of erysipelas by means of lymphoscintigraphy. Twenty-two (73%) were female and 8 (27%) were male with ages ranging from 26 to 77 years (mean 52 years). Lymphoscintigraphy was performed by intradermal administration of 500 microCi (20 Mbq) of 99mTc antimony sulfur-colloid in two interdigital spaces of the feet. Whole body scintigraphy was performed 45 minutes after the administration of the radiopharmaceutical using a computerized gamma camera. Significant lymphatic abnormalities were found in 23 (77%) of these patients. We conclude that most patients with repeated erysipelas have significant and even permanent abnormalities in regional lymphatic drainage. Recurrent erysipelas suggests underlying primary or secondary lymphedema.

Topics: Adult; Aged; Antimony; Erysipelas; Female; Humans; Lymphedema; Lymphoscintigraphy; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Recurrence; Technetium Tc 99m Sulfur Colloid

To analyze the clinical and scintigraphic features in four postoperative patients with lower limb edema.. Four case reports are presented, and causes of increased lymphatic flow are discussed.. Filtered 99mTc-sulfur colloid (0.1 mL; 20 MBq) was administered by subcutaneous injection into the second web space of each foot. Sequential local (inguinal) and whole-body imaging was performed periodically up to 24 hours after the injections. The patients were three women who were 40, 51, and 86 years of age and an 81-year-old man.. Each patient had unilateral lower extremity swelling and had recently undergone an ipsilateral lower limb operation. One female patient had previously undergone proximal femoral vein ligation, and another female patient had venous insufficiency demonstrated by Doppler ultrasonography. The male patient had a history of severe arterial insufficiency, and the remaining female patient had no venous or arterial abnormalities. On lymphoscintigraphy, all patients showed increased lymphatic flow in the edematous lower limb. Only the male patient also demonstrated abnormal dermal backflow pattern.. Increased lymphatic flow most likely is a normal response to lower limb edema in the presence of normal peripheral lymphatic structures. In the four described cases, a recent lower limb surgical procedure may have resulted in disturbance of normal proximal lymphatic channels. The role of sympathetic innervation of the peripheral lymphatic system is a potential factor determining lymphatic response to trauma or surgical intervention. Increased flow on lymphoscintigraphy may not necessarily represent normal flow, especially if other scintigraphic features of abnormal lymphatic function-such as dermal backflow pattern-are present.

Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Leg; Lymph; Lymphedema; Male; Middle Aged; Postoperative Complications; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Several 99mTc-labeled radiopharmaceuticals have been developed for lymphoscintigraphy of the extremities. In the United States, however, these agents are not widely used clinically. This study evaluates the use of smaller particle sizes ( < 0.1 micron) of 99mTc-sulfur colloid (99mTc-SC) for lymphoscintigraphy.. The 99mTc-SC was prepared by kit, and the final preparation was filtered through a sterile 0.1-micron filter. The radiochemical purity (RCP) of the filtered 99mTc-SC was determined before administration. Nineteen patients with suspected lymphedema were injected with 18.5 MBq (500 muCi) filtered 99mTc-SC intradermally in each foot, and whole-body images were obtained immediately and 1, 3, 6 and 24 hr later. Local views over the inguinal or axillary lymph nodes were also obtained every 5 min for the first hour.. The average RCP value was 93.4% +/- 4.2% (n = 19), and the RCP difference pre- and postfiltration of the 99mTc-SC preparation was -1.7% +/- 1.4% (n = 40). Evaluation of the particle size with the polycarbonate filter showed that 89.9% +/- 4.5% (n = 28) of particles were less than 50 nm, and the particle size was further determined by electron microscopy to be 38.0 +/- 3.3 nm (n = 202). The mean particle sizes of two peaks measured by laser light scattering techniques were 7.5 and 53.9 nm (major peak). Clinical studies with filtered 99mTc-SC demonstrated similar lymphoscintigrams compared with those obtained with 99mTc antimony sulfide colloid (99mTc-ATC). Filtered 99mTc-SC showed a faster transport rate to the inguinal lymph nodes and lower radiation dosimetry for liver, spleen and whole body compared with 99mTc-ATC.. Filtered 99mTc-SC can be easily prepared and is readily available for routine clinical use in lymphoscintigraphic studies.

Topics: Antimony; Colloids; Filtration; Humans; Image Processing, Computer-Assisted; Lymph Nodes; Lymphedema; Particle Size; Radionuclide Imaging; Reagent Kits, Diagnostic; Technetium Compounds; Technetium Tc 99m Sulfur Colloid

The purpose of this study was to measure the variations of lymphatic flow. A noninvasive isotopic method was used to achieve a functional exploration of lymphatic circulation. Fifteen subjects were used in the study: 10 healthy subjects and 5 patients with lower extremity lymphedema. A first subcutaneous injection of technetium 99m rhenium sulfate (99mTc) was performed in the first interdigital space of both feet. The radioactivity was recorded in two places: the first one on the inguinal site by a gamma camera; the second, below the first, on the precordial site by a multichannel analyzer. With the two types of recording procedures, it was possible to obtain a curve that showed the amount of radioactivity in relation to time. In order to obtain a muscular activity fifty-five minutes after the injection, each subject or patient spent ten minutes on an ergometric bike. A second subcutaneous injection was performed one week later, but prior to the injection, the subject or patient took orally 1800 mg of heptaminol adenosine phosphate (HAP) per day for three days. The radioactivity recording was made under the same conditions as with the muscular activity. The statistical results of the experiment without treatment on the two types of recording show that in the healthy subjects the amount of radioactivity increased during muscular activity. Moreover, the treatment indicated higher radioactivity values, which remained at a higher level. However, the muscular activity performed by a patient was unable to increase the radioactivity. On the other hand, the drug gave radioactivity values that were higher than the previous values of the first curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenosine Monophosphate; Heptaminol; Humans; Leg; Lymph; Lymphedema; Physical Exertion; Radionuclide Imaging; Rhenium; Technetium Tc 99m Sulfur Colloid

Lymphoscintigraphy has been very useful in determination of lymphatic abnormalities. However, the radioactive isotopes used have been investigational and difficult obtain. The purpose of this study was to examine patients with extremity edema by lymphoscintigraphy using a radioactive colloid readily available in our nuclear pharmacy, Technetium 99m sulfur minicolloid. Forty limbs in 20 patients were evaluated using Technetium 99m sulfur minicolloid lymphoscintigraphy. All patients had lower extremity edema initially attributed to a venous or lymphatic etiology. There were 12 patients with normal bilateral studies. Seven patients exhibited unilateral obstruction to lymphatic flow, and one had unilateral enhanced flow of lymph. Those with normal studies included five patients with nonspecific edema, four with varicosities, and one patient each with acute deep vein thrombosis, chylous ascites, and excision of the greater saphenous vein for arterial bypass grafting. Five patients with obstructed patterns had previous arterial bypass procedures, one had trauma to the extremity, and one had lymphedema tarda. The one enhanced lymphoscintigraphic pattern was seen in a patient with acute cellulitis. All patients had Doppler venous examinations and other studies included strain gauge phlethysmography, venograms, computed tomography, magnetic resonance imaging, and ultrasound. As with other scintigraphic imaging agents used to study lymphatic flow, Technetium 99m provides clinically useful information in evaluating the swollen extremity noninvasively.

Topics: Adult; Aged; Aged, 80 and over; Evaluation Studies as Topic; Female; Humans; Leg; Lymphatic System; Lymphedema; Male; Middle Aged; Radionuclide Imaging; Rheology; Technetium Tc 99m Sulfur Colloid

Lymphoscintigraphy, using technetium-99m-labeled sulphur microcolloid, was employed to study the flow and transport of lymph in the lower extremities of 39 consecutive patients in whom lymphedema of one or both legs was suspected clinically. Time-activity curves of four segments of each leg were evaluated for lymph capacity, flow and soft-tissue uptake, and compared with the results from film scintigraphy. Curve analysis provided quantitative evaluation of the extent of hypoplasia or aplasia in primary lymphedema and of lymphatic obstruction in secondary lymphedema, and is particularly suited to assess the involvement of lymphatics in chronic venous disease. Film scintigraphy, on the other hand, is preferable in cases in which the pattern of activity distribution in the affected extremity is diagnostic, such as in dermal back flow, traumatic lymphocele, or megalymphatics. Venography is most informative in cases of suspected underlying venous disease, but the role of lymphangiography, which shows only part of the lymphatic system and requires incision of the edematous tissues, is considered questionable.

Topics: Adult; Aged; Female; Humans; Leg; Lymphatic System; Lymphedema; Lymphoscintigraphy; Male; Middle Aged; Technetium Tc 99m Sulfur Colloid; Thrombophlebitis; Tin; Tin Compounds; Varicose Veins

Condensed image processing (CIP), a computerized technique of scintiscans that generates a vertical distribution of activity as a function of time in a single image, was applied to isotopic lymphoscintigrams of four patients with leg lymphedema. By "condensing" information gained from multiple images into a single image, CIP better evaluates ascending progression of radiolabeled colloid in peripheral lymph and better localizes stagnant areas. In "high lymph flow failure," CIP also depicts radioactive "bursts" suggestive of increased lymphatic truncal contractility. This data processing method improves interpretation of dynamic scintiscan recordings and seems ideally suited for evaluation of peripheral lymph kinetics.

Topics: Adolescent; Adult; Female; Humans; Image Processing, Computer-Assisted; Leg; Lymphedema; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A canine model of distal limb lymphedema was established in order to study the treatment of this condition by lymph node transfer. This model was more difficult to establish than whole-limb lymphedema. Significant edema was achieved by a combination of preoperative irradiation and circumferential removal of skin from the irradiated areas followed by removal of the contents of the popliteal fossa. Despite these measures, it was not possible to produce lymphedema in every case, possibly because of the presence of lymphaticovenous shunts and panvascular compensation mechanisms.

Topics: Animals; Disease Models, Animal; Dogs; Hindlimb; Lymphatic System; Lymphedema; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A radioisotopic method was used to evaluate the state and dynamics of the lymphatic system in 92 patients affected by chronic oedema of the limbs and in 12 control subjects. After interstitial injections of 99mTc-sulphur microcolloid, scans were obtained using a LFOV camera linked to a data processor. The quantitative indices of clearance and lymph node uptake obtained showed good correlation with lymphoedema etiology, controls and ostensibly healthy limbs of patients affected by monolateral disease. In conclusion, quantitative lymphoscintigraphy appears to be a feasible indicator of early changes in the lymph pathophysiology and supports the hypothesis that lymphoedema generally arises from a predisposing congenital pathology.

Topics: Adolescent; Adult; Aged; Child; Extremities; Female; Humans; Lymphedema; Lymphoscintigraphy; Male; Middle Aged; Technetium Tc 99m Sulfur Colloid

Lymphatic drainage was followed with Tc lymphoscintigraphy. Micrometastases in head and neck cancer cases cannot be detected. The drainage pattern is highly variable and does not allow prognostic conclusions in tumors as demonstrated for the parasternal pathways. The method helps to determine the side and extent of a neck dissection prior to surgery as well as follow-up postoperatively. The development of lymphedema can be detected early in order to start treatment by manual lymph drainage.

Topics: Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Lymphedema; Lymphoscintigraphy; Postoperative Complications; Technetium Tc 99m Sulfur Colloid

Imaging of the thoracic duct is usually performed by radiological lymphography. However, this procedure, which uses an oil based dye injected directly into the lymph channels, has some adverse effects. In this paper we note that lymphoscintigraphy, a physiological and non invasive method, may visualize thoracic duct abnormalities, and might be particularly useful when radiological lymphography is contraindicated.

Topics: Chylothorax; Chylous Ascites; Humans; Hypertension, Portal; Lymphedema; Postoperative Complications; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

Although the clinical features of lymphedema are often distinctive, it is essential to confirm the diagnosis with an objective test. Isotope lymphography is simple and 95% accurate for defining deficient lymph clearance. It is particularly useful for separating venous from lymphatic edema. Definition of the precise abnormality--peripheral lymphatic obliteration, proximal lymph node obstruction, or valvular incompetence--can only be made with lymphangiography. The mainstay of treatment is the reduction of edema by regular elevation and massage and external compression with elastic stockings. Pneumatic leggings are also helpful. Gross edema caused by peripheral obliteration may be reduced surgically by simple excision (Homans' operation) or complete excision and skin grafting (Charles' operation). Reflux through incompetent vessels may be prevented by vessel ligation. Obstruction by the iliac lymph nodes may be bypassed with an enteromesenteric pedicle.

Topics: Clothing; Colloids; Female; Humans; Leg; Lymphedema; Lymphography; Male; Massage; Radionuclide Imaging; Rhenium; Skin Transplantation; Technetium Tc 99m Sulfur Colloid

A patient with lower extremity lymphedema studied with lymphoscintigraphy is described. Radionuclide lymphography demonstrated several thoracic duct malformations that were confirmed by contrast lymphography.

Topics: Adult; Female; Humans; Lymphedema; Lymphography; Lymphoscintigraphy; Technetium Tc 99m Sulfur Colloid; Thoracic Duct

Post-traumatic oedema after fractures of the tibia results from several causes which are often associated together. In addition to venous thrombosis, the lymphatic origin of oedema is not inconsiderable. Lymphatic scintigraphy was performed in 32 patients with tibial fractures, either open or closed. All were fixed internally. All had preventive treatment of venous thrombosis by calciparin. The intact leg was also investigated by scintigraphy which was done two to ten days after the trauma. The possible anomalies of scintigraphy are described and discussed. The patients were divided into two groups. Group one developed oedema at three months and group two did not. The anomalies of scintigraphy were significantly higher in group one. It is concluded that early scintigraphy is a safe test for the prediction of residual oedema after tibial fractures. The possible early prevention of oedema of a lymphatic origin is discussed.

Topics: Adult; Fractures, Closed; Fractures, Open; Humans; Lymphedema; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tibial Fractures

Topics: Edema; Humans; Leg Injuries; Lymph; Lymphedema; Lymphography; Lymphoscintigraphy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Microlymphaticovenous anastomoses provide a potential for reducing lymphedema of the upper extremity complicating radical mastectomy or irradiation. Lymphoscintigraphy is a valuable investigative modality in the perioperative evaluation of patients undergoing this surgical procedure. The radionuclide studies provide information regarding structural change and physiologic derangement with a low radiation dose to the patient. It is a simple, painless procedure requiring minimal skill and no surgical intervention. In addition, a reproducible method for preparing a radiocolloid suitable for lymphatic imaging using an approved drug as a precursor has been developed.

Topics: Arm; Humans; Intraoperative Period; Lymph Nodes; Lymphatic Metastasis; Lymphatic System; Lymphedema; Microsurgery; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Extremities; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Lymphedema; Pelvic Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Fibrosarcoma; Gold Colloid, Radioactive; Hodgkin Disease; Humans; Lymph Nodes; Lymphatic Metastasis; Lymphedema; Lymphoma, Follicular; Radionuclide Imaging; Retroperitoneal Space; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Teratoma

Topics: Adolescent; Child; Child, Preschool; Chylothorax; Hodgkin Disease; Humans; Lymph Node Excision; Lymphedema; Lymphoscintigraphy; Neuroblastoma; Pelvic Neoplasms; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The following effects of a massage by the Lymphapress apparatus could be demonstrated by girth measurements and nuclear medical investigations on the treated extremity: 1. Volume reduction (in lymphedema in average 4,6% of the basic extremity volume after 3 h). 2. Improvement of the lymph kinetics in cases with intact or decreased lymph transport. If isotopic lymphography failed to show any lymphatic transport as in cases with severe, indurated lymphedemas no effect on the lymph kinetics could be demonstrated. 3. Decrease of albumin content in the tissues. However there is an increase of local albumin concentration in lymphedema by overproportional water reduction. Therefore compression bandages should be applied between the Lymphapress massages for maintenance of the effect.

Topics: Arm; Diuresis; Female; Humans; Leg; Lymphedema; Massage; Mastectomy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid