Abstract
The lymphoscintigraphic investigation (LySc) of the superficial lymphatic system (SLS) remains the gold standard for the diagnosis of lower limb lymphoedema. However, LySc of the deep lymphatic system (DLS) may be useful for diagnosing deep lymphatic system insufficiency in patients with lower limb oedema (LLE) but normal and/or paradoxical LySc of the SLS. The purpose of this study was therefore to evaluate a new LySc of the deep lymphatic system in patients presenting with a normal and/or paradoxical SLS exam showing LLE. In all, 15 patients with unilateral and 17 with bilateral LLE underwent 3-phased deep LySc of the lower limb via the injection of 99 mTc-labelled human serum albumin (HSA) nanocolloids in the Kager’s triangle. The absence of popliteal lymphatic node visualization after phase 2 of DLS LySc to diagnose a deep lymphatic insufficiency has a specificity and a sensitivity of 89% in patients with unilateral LLE and without associated venous symptoms. An insufficiency of the DLS was observed in 67% of cases with unilateral LLE and 59% of patients with bilateral LLE of venous and/or lymphatic origin. In conclusion, the lymphoscintigraphic visualization of the popliteal lymphatic nodes after the injection of 99 mTc-labelled HSA nanocolloids in the Kager’s triangle seems to be an effective way to diagnose DLS insufficiency in patients with LLE but normal findings in the SLS.
Highlights
N Women Men Age Venous Oedema Origin Saphenectomy Deep venous thrombosis/Phlebitis Lymphatic Oedema Origin Primary lymphoedema Secondary lymphoedema Lymphangitis Mycosis
popliteal lymphatic nodes (PLNs) were observed in 93% (14/15) of healthy lower limbs versus 33% (5/15) of oedematous lower limbs after the 2nd phase and in 93% (14/15) of healthy lower limbs versus 47% (7/15) of oedematous lower limbs after the 3rd phase
When using near-infrared fluorescence imaging techniques that allow only the visualization of the SLS18, imaging investigations of lower limb oedema (LLE) suspected to be of lymphatic origin are solely based on lymphoscintigraphic examinations (LySc) of the SLS19
Summary
Group 2 16 15 1 23.6 ± 14.5 4 3 1 12 10 0 1 1 in young women with unilateral symptoms and a family history of lower limb oedema)[14]. In 1993, Bräutigam et al proposed a protocol for two-compartment lymphoscintigraphy[11] and confirmed in 1998 that an investigation of the DLS might be necessary to understand the physiopathology of certain types of complex oedema[14]. The purpose of this study was to evaluate a methodological approach of evaluating lower limb DLS in patients presenting with unilateral or bilateral lower limb oedema (LLE) with no sign of morphological or functional abnormalities in the SLS
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