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Peripheral lymphovenous communication in lymphoedema.
MedLine Citation:
PMID:  22495080     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: To investigate whether in lower extremity lymphoedema, lymph proteins enter blood before they do the thoracic duct. METHODS: Retrospective analysis of routine lymphoscintigraphy in 69 adults imaged at 5, 45 and 150 min following bilateral subcutaneous web space injection of Tc-nanocolloid was carried out. Regions of interest were placed over the liver and ilioinguinal lymph nodes bilaterally on the anterior images at 45 and 150 min. Individual minor (0.5 point for each) and major (1 point for each) criteria of abnormal scintigraphy were applied to each limb and summed to give a lymphoscintigraphic abnormality score. An abnormal limb had a score ≥1. RESULTS: The ratio of hepatic counts per pixel to total bilateral ilioinguinal counts (L/N ratio) was higher in patients with abnormal results on lymphoscintigraphy (median 6.2; interquartile range 4.0-15.6 pixels×10; n=48) compared with that in patients with normal lymphoscintigraphic results (2.5 [1.5-5.0] pixels×10; n=21; P<0.0002). In the abnormal group, the lymphoscintigraphic score (two limbs summed) correlated with the 150-min L/N ratio (rs=0.42; P<0.005). L/N ratios at 45 and 150 min correlated in the abnormal group (rs=0.44; P<0.005) but not in the normal group (rs=0.3; P>0.05). The 45-min activity, as a percentage of the 150-min activity, was higher in lymph nodes than in the liver in both the abnormal (35.0 [8.2-50.0] vs. 10.6 [5.8-30.0]%; P<0.0001]) and normal groups (38.3 [18.4-63.5] vs. 23.3 [12.4-33.1]%; P<0.05), and, with respect to the liver, was higher in the normal group (P<0.01). CONCLUSION: In lymphoedema, more lymph proteins enter blood proximal to the thoracic duct. The time courses of nodal and hepatic activities suggest that access may occur within nodes themselves.
Authors:
Gregory Francis William Stamp; Adrien Michael Peters
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-8
Journal Detail:
Title:  Nuclear medicine communications     Volume:  -     ISSN:  1473-5628     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8201017     Medline TA:  Nucl Med Commun     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aBrighton and Sussex Medical School bDepartment of Nuclear Medicine, Royal Sussex County Hospital, Brighton, UK.
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