Abstract
Secondary upper limb lymphoedema is usually caused by lymphatic system dysfunction. Diagnosis is primarily based on clinical features. However, there are no distinct diagnostic criteria for lymphoedema. Although conventional lymphoscintigraphy is a useful technique to diagnose the severity of lymphoedema, the resultant data are two-dimensional. In this study, we examined the pathology of lymphoedema using single photon emission computed tomography-computed tomography lymphoscintigraphy (SPECT-CT LSG), a new technique that provides 3-dimensional information on lymph flow. We observed lymph flow pathways in the subcutaneous and muscle layers of the upper limbs. A significant positive correlation was found between the dermal back flow (DBF) type and the visualization of lymph nodes around the clavicle (p = 0.000266), the type of lymph flow pathways and the visualization of lymph nodes around the clavicle (p = 0.00963), and the DBF type and the lymph flow pathway (p = 0.00766). As the severity of lymphoedema increased, the DBF appeared more distally in the upper limb and the flow into the lymph nodes around the clavicle decreased, whereas the lymph flow pathways in the muscle layer became dominant. These findings demonstrate the features of lymphoedema pathology and the functional anatomy and physiology of the lymphatic system without the need for cadaver dissection.
Highlights
Lymphoedema is caused by dysfunction of the lymphatic system that leads to pathological retention of fluid and solutes[1,2]
A correlation was suspected between the location of Dermal back flow (DBF), severity of lymphoedema, and the positive rate of the lymph nodes around the clavicle in an LSG study in 2011, the underlying mechanism has not been investigated in previous research[10]
The aim of this study was to investigate the association between DBF patterns, the lymph nodes around the clavicle and the lymph flow of the patients with secondary upper limb lymphoedema using the images from SPECT-CT LSG
Summary
Lymphoedema is caused by dysfunction of the lymphatic system that leads to pathological retention of fluid and solutes[1,2] Patients suffer both physically and mentally during the clinical course of the disease, and the economic burden is not negligible[1,3,4]. A correlation has previously been reported between the clinical stage and the types of images acquired by LSG in patients with secondary upper limb lymphoedema[10]. We have used single photon emission computed tomography-computed tomography (SPECT-CT) LSG for the diagnosis of lymphoedema. This modality provides three-dimensional live images of lymph flow, unlike cadaveric studies that provide only anatomical information on the lymphatic system[14]. It is possible to assemble data from SPECT-CT LSG in the form of images, similar to images obtained via plain LSG
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