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Jaleel J, Nasurudeen S, Babu AS, Gupta P, Khangembam BC, Patel C, Kumar R. Utility of 99mTc-Sulfur Colloid Lymphoscintigraphy and SPECT/CT in Chylothorax and Chylous Ascites. Nucl Med Mol Imaging 2023; 57:265-274. [PMID: 37982099 PMCID: PMC10654269 DOI: 10.1007/s13139-023-00813-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 11/21/2023] Open
Abstract
Purpose To assess the diagnostic efficacy of 99mTc-sulfur colloid lymphoscintigraphy in chylothorax and chylous ascites, and the utility of single-photon emission computed tomography-computed tomography (SPECT/CT) in localizing the sites of leaks. Methods Data from patients who underwent lymphoscintigraphy for clinical suspicion of chylothorax or chylous ascites were retrospectively analyzed. Biochemical fluid analysis was taken as the reference standard. Pleural fluid triglyceride level > 110 mg/dL (with pleural fluid/serum ratio > 1) and a cholesterol level < 200 mg/dL (with pleural fluid/serum ratio < 1) were considered confirmatory for chylothorax. Ascitic fluid triglyceride level > 200 mg/dL with a low cholesterol level (ascites fluid/serum ratio < 1) was considered confirmatory for chylous ascites. Results 26 patients (15 males, 57.7%) aged 9 months to 68 years were enrolled in the study. Based on the reference standard, 17 had chylothorax or chylous ascites (9 with surgical history). Lymphoscintigraphy was positive in 16 (with 1 false positive) and negative in 10 (with 2 false negatives). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of lymphoscintigraphy were 88.2% (63.6-98.5%), 88.9% (51.8-99.7%), 80.0% (51.6-93.8%), 93.8% (70.1-99.0%), and 88.5% (69.9-97.6%), respectively. SPECT/CT could localize sites of leaks in 61.5% (8/13) with a localization rate of 77.8% (7/9) and 25.0% (1/4) in patients with surgical and nonsurgical causes, respectively. Conclusion 99mTc-sulfur colloid lymphoscintigraphy is a highly efficacious noninvasive modality to diagnose chylothorax or chylous ascites with a high positive predictive value. SPECT/CT could localize the sites of leaks more frequently in patients with surgical causes.
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Affiliation(s)
- Jasim Jaleel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anushna Sunila Babu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Gupta
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Chetan Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Tsuchiya M, Ito T, Tamada S, Hamamoto K, Takano M, Azuma R. Lymphoscintigraphy with single-photon emission computerized tomography/computed tomography for evaluating lymphatic leakage following pelvic and para-aortic lymphadenectomy. Radiol Case Rep 2023; 18:3041-3045. [PMID: 37434621 PMCID: PMC10331132 DOI: 10.1016/j.radcr.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Lymphatic ascites following pelvic and para-aortic lymphadenectomy is a well-known complication. Surgical treatment and interventional radiology are required in a few cases. To determine the appropriate treatment strategy, it is important to preoperatively detect the presence and location of lymphatic leakage. However, the methods have yet to be established. We report a case in which lymphoscintigraphy with single-photon emission computerized tomography/computed tomography (SPECT/CT) was performed to evaluate pelvic lymphorrhea that occurred following total hysterectomy with pelvic and para-aortic lymphadenectomy for stage IIIA uterine sarcoma. Lymphoscintigraphy with SPECT/CT showed leakage of radioisotopes into the pelvic space, and intranodal lymphangiography was performed based on these findings. Following the procedure, the pelvic lymphorrhea improved, and no radioisotope leakage was confirmed by re-evaluation with lymphoscintigraphy with SPECT/CT. Our case indicates that lymphoscintigraphy with SPECT/CT may be useful for detecting the precise site of lymphatic leakage before interventional radiology or surgery.
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Affiliation(s)
- Masato Tsuchiya
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 3570025 Japan
| | - Tsubasa Ito
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Soichiro Tamada
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kohei Hamamoto
- Department of Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masashi Takano
- Department of Obstetrics and Gynecology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 3570025 Japan
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Minamitani Y, Inomata K, Inoue T, Kawase A, Takashima S, Nishihara T. Clinical utility of SPECT/CT in a neonate with postoperative chylothorax. Pediatr Int 2023; 65:e15567. [PMID: 37368498 DOI: 10.1111/ped.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 04/07/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Yohei Minamitani
- Department of Neonatology, Perinatal Center, Kumamoto City Hospital, Kumamoto, Japan
| | - Kei Inomata
- Department of Neonatology, Perinatal Center, Kumamoto City Hospital, Kumamoto, Japan
| | - Takeshi Inoue
- Department of Neonatology, Perinatal Center, Kumamoto City Hospital, Kumamoto, Japan
| | - Akihiko Kawase
- Department of Neonatology, Perinatal Center, Kumamoto City Hospital, Kumamoto, Japan
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Yang Q, Bai X, Bao H, Li Y, Men W, Lv L, Liu Z, Han X, Li W. Invasive treatment of persistent postoperative chylothorax secondary to thoracic duct variation injury: Two case reports and literature review. Medicine (Baltimore) 2022; 101:e31383. [PMID: 36316910 PMCID: PMC9622594 DOI: 10.1097/md.0000000000031383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
RATIONALE Postoperative chylothorax is a rare complication after pulmonary resection. Thoracic duct variations may play a key role in postoperative chylothorax occurrence and make treatment difficult. No studies in the literature have reported the successful treatment of chylothorax second to thoracic duct variation by lipiodol-based lymphangiography. PATIENT CONCERNS A 63-year-old male and a 28-year-old female with primary lung adenocarcinoma were treated by video-assisted thoracoscopic cancer resection, and suffered postoperative chylothorax. Conservative treatment was ineffective, including nil per os, persistent thoracic drainage, fatty food restriction, and somatostatin administration. DIAGNOSIS Postoperative chylothorax. INTERVENTIONS Patients received lipiodol-based lymphangiography under fluoroscopic guidance. Iatrogenic injuries were identified at thoracic duct variations, including an additional channel in case 1 and the lymphatic plexus instead of the thoracic duct in case 2. OUTCOMES Thoracic duct variations were identified by lipiodol-based lymphangiography, and postoperative chylothorax was successfully treated by lipiodol embolizing effect. LESSONS Thoracic duct variations should be considered after the failure of conservative treatment for postoperative chylothorax secondary to pulmonary resection. Lipiodol-based lymphangiography is valuable for identifying the thoracic duct variations and embolizing chylous leakage.
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Affiliation(s)
- Qiwei Yang
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xu Bai
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Han Bao
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yukang Li
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Wanfu Men
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ling Lv
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Zhenghua Liu
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiangjun Han
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
- *Correspondence: Xiangjun Han, Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang 110001, Liaoning, China (e-mail: )
| | - Wenya Li
- Department of Thorax, The First Hospital of China Medical University, Shenyang, Liaoning, China
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Nuclear cardiology for a cardiothoracic surgeon. Indian J Thorac Cardiovasc Surg 2022; 38:268-282. [PMID: 35529010 PMCID: PMC9023643 DOI: 10.1007/s12055-021-01311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
Abstract
Cardiac surgeons are commonly faced with issues regarding the balance between the potential risk and the potential benefit of a surgical procedure. Nuclear cardiology procedures such as single-photon emission computed tomography and positron emission tomography provide the surgeon with objective information that augments standard clinical and angiographic assessments related to the diagnosis, prognosis, and potential benefit from any intervention. Myocardial perfusion is imaged with the use of radiopharmaceuticals that accumulate rapidly in the myocardium in proportion to the myocardial blood flow. Radionuclide lung imaging most commonly involves the demonstration of pulmonary perfusion using technetium-99 m macro aggregate albumin (Tc-99 m MAA), as well as the assessment of ventilation using inspired inert gas, usually xenon, or Tc-99 m-labelled aerosols. Nuclear cardiology is extensively used as a part of the work-up of ischemic heart disease and cardiac failure in deciding the optimal therapeutic strategy with its ability to predict the severity of the disease. It has also proved extremely useful in the management of congenital heart disease and the diagnosis of pulmonary embolism, among many other applications. Myocardial perfusion imaging is a basic adjunct to the noninvasive assessment of patients with stable angina, baseline electrocardiogram (ECG) abnormalities, post-revascularisation assessment, and heart failure. This review article covers a summary of basic concepts of nuclear cardiology about what a cardiac surgeon should be aware of. To many, it is just a perfusion test, but the versatility, reliability, and future of the technology are without a doubt.
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Hosokawa T, Uchiyama M, Tanami Y, Sato Y, Wakabayashi Y, Oguma E. Insufficient hepatic uptake in pediatric patients on lymphoscintigraphy. Pediatr Int 2022; 64:e15156. [PMID: 35510682 DOI: 10.1111/ped.15156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To demonstrate the association between pediatric outcomes and tracer hepatic uptake as a marker of systemic circulation in lymphoscintigraphy. METHODS We included 31 initial lymphoscintigraphic studies. We compared the presence or absence of hepatic uptake between deceased and survived patients in both early and delayed images using Fisher's exact test. Kaplan-Meier survival analysis was performed based on imaging results, and these curves were compared using the log-rank test. The primary endpoint was death and the survival period was defined from the day of examination to the day of the last visit or death. RESULTS Of 31 patients, six died. Hepatic uptake was significantly different in both early and delayed images (early images, died [with/without visualization] vs. survived [with/without visualization], 0/6 vs. 13/12, P = 0.028; delayed images, died [with/without visualization] vs. survived [with/without visualization], 2/4 vs. 22/3, P = 0.014) between deceased and survived patients. Survival periods were significantly different between the two groups with and without hepatic uptake in early and delayed images (with/without visualization in early imags = 1,177.1 ± 773.8 days/426.7 ± 419.8 days, P = 0.008 and with/without visualization in delayed images = 821.3 ± 738.0 days/467.4 ± 452.4 days, P = 0.003). CONCLUSIONS Visualization of hepatic uptake in both early and delayed lymphoscintigraphy is associated with patient outcomes. Hepatic uptake could represent tracer inflow into the systemic circulation, indicating preservation of the connection between the lymphatic system and the systemic circulation. Physicians should evaluate these findings carefully on lymphoscintigraphy.
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Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Mayuki Uchiyama
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yasuharu Wakabayashi
- Division of Radiological Technology, Saitama Prefectural Children's Medical Center, Saitama, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
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Liu Y, Tong G, Wen Z, Zhuang H. Hyperthyroidism Incidentally Noted on Lymphoscintigraphy. Clin Nucl Med 2021; 46:761-763. [PMID: 34028408 DOI: 10.1097/rlu.0000000000003688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 43-year-old woman with edema in both left upper limb and lower limb underwent lymphoscintigraphy to evaluate possible lymphedema. Two separate lymphoscintigraphies, one for the lower and the other for the upper limbs, were performed with interval of 3 days. Incidentally, an activity in the region of the thyroid glands was noted in the delayed images of both studies. Subsequently, Graves disease was diagnosed based on the patient's symptoms and the results of laboratory examinations.
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Affiliation(s)
- Yong Liu
- From the Departments of Ultrasonography
| | - Guansheng Tong
- Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhe Wen
- Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hongming Zhuang
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Ngeow AJH, Chan MY, Teoh OH, Sanamandra SK, Chan DKL. Non-immune hydrops fetalis secondary to congenital chylothorax with diffuse interstitial lung disease: a diagnostic conundrum. BMJ Case Rep 2021; 14:14/4/e240688. [PMID: 33863770 PMCID: PMC8055142 DOI: 10.1136/bcr-2020-240688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A Chinese male infant was born at 35 weeks weighing 2935 g to a mother with polyhydramnios and prenatal hydrops fetalis. He developed marked respiratory distress secondary to bilateral congenital chylothorax and required pleural drainage, high frequency oscillation and inhaled nitric oxide therapy. He was extubated to non-invasive ventilation by day 14. There was no bacterial or intrauterine infection, haematologic, chromosomal or cardiac disorder. He was exclusively fed medium-chain triglyceride formula. High-resolution CT showed diffuse interstitial lung disease. He received a dexamethasone course for chronic lung disease to facilitate supplemental oxygen weaning. A multidisciplinary team comprising neonatology, pulmonology, haematology, interventional radiology and thoracic surgery considered congenital pulmonary lymphangiectasia as the most likely diagnosis and advised open lung biopsy, lymphangiography or scintigraphy for diagnostic confirmation should symptoms of chylothorax recur. Fortunately, he was weaned off oxygen at 5 months of life, and tolerated human milk challenge at 6 months of life and grew well.
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Affiliation(s)
- Alvin Jia Hao Ngeow
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Mei Yoke Chan
- Haematology/Oncology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Oon Hoe Teoh
- Respiratory Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | - Daisy Kwai Lin Chan
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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Wen Z, Tong G, Liu Y. Potential Utilization of Lymphoscintigraphy in Patients With Klippel-Trenaunay Syndrome. Clin Nucl Med 2021; 46:25-30. [PMID: 33156055 DOI: 10.1097/rlu.0000000000003361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Klippel-Trenaunay syndrome (KTS) is a rare disease that was characterized by vascular malformation. Lymphatic malformation was also commonly associated with KTS. However, the application of lymphoscintigraphy in the management of patients with KTS was rarely described. The purpose of this study is to assess whether the findings of lymphoscintigraphy can aid the management of the patients with KTS. METHODS A total of 28 patients with known KTS who underwent Tc-dextran lymphoscintigraphy with lower extremity tracer injection were included in this retrospective analysis. The images from lymphoscintigraphy were reviewed for any abnormalities in the body with the attention on the region of left subclavian-jugular venous angle. RESULTS In addition to abnormal activity in the other regions, abnormal activity in the left subclavian-jugular venous angle was visualized in over half of the patients (53.6%, 15/28). Based on the findings of the lymphoscintigraphy, 7 patients with left subclavian-jugular venous angle activity underwent thoracic duct decompression. In 4 patients with postsurgery follow-up, 3 achieved significant, measurable symptomatic relief. CONCLUSIONS Lymphoscintigraphy can be used to assess potential candidates for thoracic duct decompression to alleviate the symptoms in patients with KTS.
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Affiliation(s)
- Zhe Wen
- From the Departments of Nuclear Medicine
| | | | - Yong Liu
- Ultrasonography, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
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Pan HP, Lao Q, Fei ZH, Yang L, Zhou HC, Lai C. MR Lymphangiography for Focal Disruption of the Thoracic Duct in Chylothorax of an Infant: a Case Report and Literature Review. ACTA ACUST UNITED AC 2019; 32:265-268. [PMID: 29301603 DOI: 10.24920/j1001-9294.2017.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chylothorax is a rare cause of pleural effusion in children, and it is usually difficult to identify the location of chyle leakage due to the small size of the thoracic duct in children. Herein we report an infant case with chylothorax whose leakage of the thoracic duct was successfully located by magnetic resonance lymphangiography (MRL) using pre-contrast MR cholangiopancreatography (MRCP) and gadodiamide-enhanced spectral presaturation inversion recovery (SPIR) T1-weighted imaging, which demonstrate the imaging method is easy and effective for detecting the focal disruption of the thoracic duct in children with chylothorax and younger than 8 months old.
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Affiliation(s)
- Hai-Peng Pan
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China; Department of Radiology, Hangzhou Children's Hospital, Hangzhou 310014, China
| | - Qun Lao
- Department of Radiology, Hangzhou Children's Hospital, Hangzhou 310014, China
| | - Zheng-Hua Fei
- Department of Radiology, Huzhou Maternity & Child Care Hospital, Huzhou, Zhejiang 313000, China
| | - Li Yang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052
| | - Hai-Chun Zhou
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052
| | - Can Lai
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052
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Iio K, Soneda K, Shimotakahara A, Hataya H, Kono T. Effective method of evaluating infantile chylothorax. Pediatr Int 2019; 61:203-205. [PMID: 30767369 DOI: 10.1111/ped.13762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/19/2018] [Accepted: 12/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuki Iio
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Keiko Soneda
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Increased 99mTc Pertechnetate Uptake But Unimpressive 131I Activity in the Metastatic Mediastinal Lymph Nodes in a Thyroid Cancer Patient. Clin Nucl Med 2019; 44:176-178. [DOI: 10.1097/rlu.0000000000002405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Turpin S, Lambert R. Lymphoscintigraphy of Chylous Anomalies: Chylothorax, Chyloperitoneum, Chyluria, and Lymphangiomatosis-15-Year Experience in a Pediatric Setting and Review of the Literature. J Nucl Med Technol 2018; 46:123-128. [PMID: 29438003 DOI: 10.2967/jnmt.117.203281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022] Open
Abstract
In the pediatric setting, lymphoscintigraphy is used mostly for the evaluation of lymphedema. Only a few cases of chylous anomalies and lymphatic malformations imaged with lymphoscintigraphy have been reported in the literature. The aim of this study was to review the use of lymphoscintigraphy in those pathologies. Methods: All lymphoscintigraphy studies performed for chylous anomalies between 2001 and 2017 in our hospital were retrospectively reviewed. The results were correlated to clinical and radiologic findings. Lymphoscintigraphy consisted of sequential imaging after injection of 3.7-9.25 MBq (100-250 μCi) of 99mTc-filtered sulfur colloid at the level of the feet or hands. Results: Twenty-five studies were performed on 21 patients. Fourteen studies were obtained for the evaluation of chylothorax. Eleven were performed for chyloperitoneum, chyluria, chylopericardium, exudative enteropathy, or lymphangiomatosis. Ten studies were positive for lymphatic leakage, and 1 had uncertain results. After correlation with radiologic findings and follow-up, there were 7 true-negative and 5 false-negative results (previous 67Ga-interfering activity in 1, injection in only the hands in 3, and a low-fat diet in 1). One study became positive after injection in the feet, and another became positive after a switch to a high-fat diet. Conclusion: Lymphoscintigraphy is a useful tool for imaging lymphatic anomalies in children. Suggestions to optimize results include placing the patient on a high-fat diet, withholding octreotide, injecting the 4 extremities, and imaging with SPECT/CT.
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Affiliation(s)
- Sophie Turpin
- Nuclear Medicine, Medical Imaging, CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Raymond Lambert
- Nuclear Medicine, Medical Imaging, CHU Sainte-Justine, Montréal, Quebec, Canada
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Crean AM, Ahmed F, Motwani M. The Role of Radionuclide Imaging in Congenital Heart Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Up-to-date review of nuclear medicine applications in pediatric thoracic imaging. Eur J Radiol 2017; 95:418-427. [DOI: 10.1016/j.ejrad.2016.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/02/2016] [Accepted: 04/13/2016] [Indexed: 12/13/2022]
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Majdalany BS, Murrey DA, Kapoor BS, Cain TR, Ganguli S, Kent MS, Maldonado F, McBride JJ, Minocha J, Reis SP, Lorenz JM, Kalva SP. ACR Appropriateness Criteria ® Chylothorax Treatment Planning. J Am Coll Radiol 2017; 14:S118-S126. [DOI: 10.1016/j.jacr.2017.02.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/30/2023]
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17
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Lin Y, Li Z, Li G, Zhang X, Deng H, Yang X, Liu L. Selective En Masse Ligation of the Thoracic Duct to Prevent Chyle Leak After Esophagectomy. Ann Thorac Surg 2017; 103:1802-1807. [PMID: 28385376 DOI: 10.1016/j.athoracsur.2017.01.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postoperative chylothorax remains an important cause of reoperation and prolonged hospital stay after esophagectomy for the treatment of esophageal carcinoma. Chylothorax is potentially life threatening and difficult to manage. The benefit of routine thoracic duct ligation is controversial. A promising alternative is to identify chyle leaks at the time of esophagectomy and perform the ligation selectively. We developed a novel technique to identify chyle leak at the time of esophagectomy and compared it with routine ligation of thoracic duct. METHODS This cohort study involved all of the qualified patients with resectable esophageal carcinoma treated between March 1, 2011, and December 31, 2015, by a single surgical team at West China Hospital. Patients receiving routine en masse ligation of the thoracic duct were assigned to group A, and patients receiving selective en masse ligation of the thoracic duct were assigned to group B. All patients in the selective ligation group received 120 mL olive oil orally before the operation. The end point included frequencies of chyle leak detected at the time of esophagectomy, postoperative chylothorax, and need for chylothorax-related reoperation. RESULTS The study enrolled 296 patients who fulfilled the study requirement: 55 in group A and 241 in group B. Patients in group A experienced significantly higher incidences of postoperative chylothorax and chylothorax-related reoperation than group B (9.1% vs 0% [p < 0.01] and 3.6% vs 0% [p < 0.01]). Incidence of detection of intraoperative chyle leak (chylothorax plus chylous ascites) was significantly higher in group B than in group A (9.5% vs 0%, p < 0.01). No intraoperative or postoperative complications related to preoperative oral olive oil administration or selective en masse ligation of the thoracic duct were observed. CONCLUSIONS Our method of selective en masse ligation of the thoracic duct during esophagectomy was feasible and safe and was associated with reduced rates of postoperative chylothorax.
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Affiliation(s)
- Yidan Lin
- Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China.
| | - Zhihui Li
- Thyroid and Breast Surgery Department, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Li
- Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaolong Zhang
- Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China
| | - Hanyu Deng
- Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyan Yang
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- Thoracic Surgery Department, West China Hospital, Sichuan University, Chengdu, China
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Zhang W, Wu P, Li F, Tong G, Chen X, Zhu Z. Potential Applications of Using 68Ga-Evans Blue PET/CT in the Evaluation of Lymphatic Disorder: Preliminary Observations. Clin Nucl Med 2016; 41:302-308. [PMID: 26859218 PMCID: PMC4851227 DOI: 10.1097/rlu.0000000000001171] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/03/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Potentials of 68Ga-NEB as a PET tracer in the evaluation of a variety of lymphatic drainage disorders were analyzed. METHODS 68Ga-NEB was injected subcutaneously, and the PET/CT images were acquired in 13 patients with different suspected lymphatic drainage abnormality. The 68Ga-NEB PET/CT findings were compared with Tc-SC lymphoscintigraphy. RESULTS 68Ga-NEB activity could be clearly observed in the lymphatic route on the PET/CT images from all the patients. In 5 (38.5%) of 13 patients tested, 68Ga-NEB PET/CT provided more information than the Tc-SC lymphoscintigraphy. CONCLUSIONS 68Ga-NEB PET/CT can be used as an alternative of Tc-SC lymphoscintigraphy in the evaluation of lymphatic disorders, which enables fast results and might be more accurate than the conventional Tc-SC lymphoscintigraphy.
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Affiliation(s)
- Wei Zhang
- From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
| | - Peilin Wu
- From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
| | - Fang Li
- From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
| | - Guansheng Tong
- From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
| | - Xiaoyuan Chen
- From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
| | - Zhaohui Zhu
- From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD
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Weiss M, Schwarz F, Wallmichrath J, Baumeister R, Frick A, Bartenstein P, Rominger A. Chylothorax and chylous ascites. Clinical utility of planar scintigraphy and tomographic imaging with SPECT/CT. Nuklearmedizin 2015; 54:231-40. [PMID: 26183818 DOI: 10.3413/nukmed-0723-15-02] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/09/2015] [Indexed: 11/20/2022]
Abstract
UNLABELLED The aim was to analyze conventional planar scintigraphy and SPECT/CT in patients clinically suspicious for chylothorax or chylous ascites. Lymphoscintigraphy was performed for two reasons: first, to help diagnose chylothorax or -abdomen, by demonstrating diffuse uptake in fluid accumulations, and then secondly, to detect the site of leakage to test the prediction that additional use of SPECT/CT-technique improves upon the diagnostic value of planar lymphoscintigraphy in the baseline detection of thoraco-abdominal lymphatic disorders. PATIENTS, MATERIAL, METHODS From 7/2008-7/2014 a total of 24 consecutive patients (8 woman, 16 men; age, range 31-79 years) presenting with clinical symptoms suspicious for chylothorax and/or chylous ascites were examined by planar lymphoscintigraphy (n = 26) and additional tomographic SPECT/CT- (n = 22) or SPECT-technique (n = 2). RESULTS Chylothorax could be scintigraphically confirmed in n = 9, chylous ascites in n = 5 scintigraphies, and excluded in n = 10 patients. In all planar scintigraphy findings of pathological lymph drainage regions (n = 14), SPECT/CT delivered additional relevant information, notably the anatomic localization of the lymphatic leakage. For the baseline detection of thoraco-abdominal lymphatic transport disorders, lymphoscintigraphy showed sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%. CONCLUSIONS Our findings show that due to the particular advantages presented by tomographic separation of overlapping sources, SPECT/CT specifies better the anatomical sites, improving the localization of lymphatic leakage in aid of planning surgical re-interventions.
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Affiliation(s)
- M Weiss
- Mayo Weiss MD, Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistr.15, 81377 Muenchen, Germany, Tel. +49/(0)89/440 07 76 38, E-mail:
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