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Inicio Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) Lymphoscintigraphy for differential diagnosis of peripheral edema: Diagnostic yi...
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Vol. 31. Issue 5.
Pages 237-242 (September - October 2012)
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Vol. 31. Issue 5.
Pages 237-242 (September - October 2012)
Original article
Lymphoscintigraphy for differential diagnosis of peripheral edema: Diagnostic yield of different scintigraphic patterns
Linfogammagrafía en el diagnostico diferencial del edema. Rendimiento diagnóstico de diferentes patrones gammagráficos
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J.R. Infantea,
Corresponding author
infantetorre@yahoo.com

Corresponding author.
, L. Garcíaa, P. Lagunab, C. Durána, J.I. Rayoa, J. Serranoa, M.L. Domíngueza, R. Sáncheza
a Servicio de Medicina Nuclear, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
b Servicio de Cirugía Vascular, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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Tables (4)
Table 1. Characteristics of the study group.
Table 2. Definitive diagnoses.
Table 3. Presence of the different scintigraphic patterns in the two study groups.
Table 4. Diagnostic performance of the four scintigraphic patterns considered.
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Abstract

Edema of the limbs is a common reason for medical consultation, for which the lymphoscintigraphy is considered to be a reliable method for its differential diagnosis.

Objective

To evaluate the usefulness of radionuclide studies in the differential diagnosis of edema, and the diagnostic yield of different scintigraphic patterns.

Material and methods

A total of 61 patients, mean age 43 years, referred to our department in the last 3 years for suspected lymphoedema, were considered. One patient was discarded due to lack of diagnosis, 56 had lower limb edema and 4 upper limb edema. After intradermal injection of two doses of 99mTc-nanocolloid, scintigraphic scans were made at 30 and 120min. The final diagnosis was based on imaging tests, clinical course, and response to treatment. We calculated the parameters of the diagnostic yield of four different scintigraphic patterns (presence of dermal backflow, asymmetry-alteration in inguinal/axillary nodes, presence of collateral pathways, and visualization of intermediate lymph nodes), considering them individually and jointly.

Results

The best diagnostic yield was achieved by considering dermal backflow and asymmetry in inguinal/axillary nodes (accuracy 88.9%, specificity 96.4%, PPV 95.5%). Evaluation of intermediate lymph nodes and presence of collateral pathways contributed little to the diagnostic yield, showing poor sensitivity and high false positive rates.

Conclusion

The lymphoscintigraphy had high diagnostic yield, allowing early treatment of lymphoedema. The dermal backflow and asymmetry in inguinal/axillary nodes had the greatest diagnostic accuracy. Evaluation of intermediate lymph nodes and visualization of collateral pathways contributed little to improving the diagnosis.

Keywords:
Edema
Lymphoedema
Lymphoscintigraphy
Scintigraphy patterns
Resumen

El edema de extremidades constituye un motivo frecuente de consulta médica, considerándose la linfogammagrafía un método fiable para su diagnóstico diferencial.

Objetivo

valorar la utilidad del estudio isotópico en el diagnóstico diferencial del edema y el rendimiento diagnóstico de diferentes patrones gammagráficos encontrados.

Material y Métodos

se consideraron 61 pacientes remitidos a nuestro Servicio en los últimos tres años por sospecha de linfedema, descartándose uno por falta de diagnóstico. La media de edad fue de 43 años. 56 de los pacientes presentaban edema en miembros inferiores y 4 en superiores. Tras inyección intradérmica de dos dosis de 99mTc-nanocoloide, se realizaron rastreos gammagráficos de extremidades a los 30 y 120 minutos de su administración. El diagnóstico definitivo se basó en pruebas de imagen, evolución clínica y respuesta a tratamiento. Se calculó el rendimiento diagnóstico de cuatro diferentes patrones gammagráficos (presencia de flujo dérmico, asimetría-alteración en ganglios inguinales/axilares, presencia de vías colaterales y visualización de ganglios intermedios) considerándose de manera individual y conjunta.

Resultados

el mayor rendimiento diagnóstico se alcanzó considerando el flujo dérmico y la asimetría en ganglios inguinales/axilares (exactitud 88,9%, especificidad 96,4%, VPP 95,5%). La valoración de ganglios intermedios y presencia de vías colaterales aportó escaso rendimiento diagnóstico, con baja sensibilidad y elevada tasa de falsos positivos.

Conclusión

la linfogammagrafía presentó un alto rendimiento diagnóstico, permitiendo un tratamiento precoz del linfedema. El flujo dérmico y asimetría en ganglios inguinales/axilares mostraron la mayor exactitud diagnóstica. La valoración de ganglios intermedios y visualización de vías colaterales no aportaron mejoría al diagnóstico.

Palabras clave:
Edema
linfedema
linfogammagrafía
patrones gammagráficos

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