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Der Nuklearmediziner 2009; 32(1): 67-75
DOI: 10.1055/s-0029-1192016
Spezielle nuklearmedizinische Verfahren

© Georg Thieme Verlag KG Stuttgart · New York

Lymphabflussszintigrafie

LymphoscintigraphyM. Weiss 1
  • 1Klinik und Poliklinik für Nuklearmedizin, Klinikum der Ludwig-Maximilians-Universität München
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Publication History

Publication Date:
13 March 2009 (online)

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Zusammenfassung

Erkrankungen des Lymphsystems werden häufig durch klinische Untersuchungen diagnostiziert. Bildgebende Verfahren erlauben darüber hinaus eine Objektivierung und Differenzialdiagnose der lymphatischen Fehlfunktion. Die Lymphszintigrafie basiert auf dem (physiologischen) Transport des Radiotracers und erlaubt eine Beurteilung der Veränderungen des Lymphabflusses oder Störungen der Lymphgefäße; sie bietet Informationen über den Lymphtransport, die Filtration und die retikulo-endotheliale Funktion. Klinische Ergebnisse haben gezeigt, dass die Lymphszintigrafie in Kombination mit der Auswertung mittels numerischen Transportindex oder mittels Region-of-Interest-Technik gut mit den klinischen Befunden korreliert und somit suffiziente Aussagen über die Lymphdrainage in der klinischen Routinediagnostik bietet.

Abstract

Lymphedema usually is diagnosed based on clinical findings, but imaging studies permit objective confirmation and differential diagnosis of the lymphatic dysfunction. Lymphoscintigraphy is based on the (physiological) transport of radiotracers and permits the assessment of changes in lymphatic flow or disturbances of lymphatic vessels; it provides information about lymph transport, filtration, and reticuloendothelial function. Clinical results prove that lymphoscintigraphy combined with an evaluation by the numeric transport index or by means of region-of-interest-technique is well correlated to clinical findings and therefore provides sufficient information about lymph drainage in routine clinical diagnostics.

Schlüsselwörter

Lymphszintigrafie - Lymphkinetik - Lymphödem - Lymphabfluss

Key words

lymphoscintigraphy - lymph kinetics - lymph edema - lymph drainage

Literatur

  • 1 Abernethy NJ, Hay JB. The recirculation of lymphocytes from blood to lymph: physiological considerations am molecular mechanisms.  Lymphology. 1992;  25 1-30
    PubMedSearch in Google Scholar
  • 2 Bates DO, Levick JR, Mortimer PS. Subcutaneous interstitial fluid pressure and arm volume in lymphoedema.  Int J Mircrocirc. 1992;  11 359-373
    PubMedSearch in Google Scholar
  • 3 Baumeister RGH, Seifert J, Wiebecke B. Homologous and autologous experimental lymph vessel transplantation: initial experience.  Int J Microsurg. 1981;  3 19-22
    PubMedSearch in Google Scholar
  • 4 Baumeister RGH, Seifert J, Wiebecke B. et al . Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphedema.  World J Surg. 1981;  5 401-407
    CrossrefPubMedSearch in Google Scholar
  • 5 Baumeister RGH. Mikrochirurgie des Lymphgefäßsystems.  Chirurg. 1983;  54 374-378
    PubMedSearch in Google Scholar
  • 6 Bergqvist L, Strand SE, Persson BR. Particle sizing and biokinetics of interstitial lymphoscintigraphic agents.  Semin Nucl Med. 1983;  13 9-19
    CrossrefPubMedSearch in Google Scholar
  • 7 Bollinger A. Microlymphatics of human skin.  Int J Microcirc. 1993;  12 1-15
    PubMedSearch in Google Scholar
  • 8 Cambria R A, Gloviczki P, Naessens J M. et al . Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386 extremities.  J Vasc Surg. 1993;  18 773-782
    PubMedSearch in Google Scholar
  • 9 Casley-Smith JR. Measuring and representing peripheral oedema and its alterations.  Lymphology.. 1995;  28 ((1)) 41-47
    PubMedSearch in Google Scholar
  • 10 Castenholz A. Rheology and immunbiological significance of the peripheral lymph.  Lymphology. 1994;  27 11-14
    PubMedSearch in Google Scholar
  • 11 Castenholz A. Partikel- und Zellbewegungen zwischen Interstitium und Lymphbahn.  LymphForsch. 1997;  1 7-13
    PubMedSearch in Google Scholar
  • 12 Castenholz A. Zur strukturellen Organisation und Permeabilität der Gewebe-Lymphschranke.  LymphForsch. 1998;  2 7-15
    PubMedSearch in Google Scholar
  • 13 Christensen J, Hamad M, Shawa N. Primary lymphedema of the leg: Relationship between subcutaneous tissue pressure, intramuscular pressure and venous function.  Lymphology. 1985;  18 86-89
    PubMedSearch in Google Scholar
  • 14 Földi M, Kubik S. Lehrbuch der Lymphologie für Mediziner, Masseure und Physiotherapeuten. , Urban und Fischer Verlag, 5. Aufl. 2002
    PubMed
  • 15 Fokin A, Robicsek F, Masters T. et al . Propagation of viral-size particles in lymph and blood after subcutaneous inoculation.  Microcirculation. 2000;  7 193-200
    CrossrefPubMedSearch in Google Scholar
  • 16 Golueke PJ, Montgomery RA, Petronis JD. et al . Lymphoscintigraphy to confirm the clincal diagnosis of lymphedema.  J Vasc Surg. 1989;  10 306-312
    CrossrefPubMedSearch in Google Scholar
  • 17 Guyton A, Granger H, Taylor A. Interstitial fluid pressure.  Physiol Rev. 1971;  51 527-563
    PubMedSearch in Google Scholar
  • 18 Higuchi M, Fokin A, Masters TN. et al . Transport of colloidal particles in lymphatics and vasculature after subcutaneous injection.  J Appl Physiol. 1999;  86 1381-1387
    PubMedSearch in Google Scholar
  • 19 Ikomi F, Hanna G, Schmid-Schonbein GW. Intracellular and extracellular transport of perfluoro carbon emulsion from subcutaneous tissue to regional lymphatics.  Artif Cells Blood Substit Immobil Biotechnol. 1994;  22 1441-1447
    PubMedSearch in Google Scholar
  • 20 Ikomi F, Hanna GK, Schmid-Schonbein GW. Mechanism of colloidal particle uptake into the lymphatic system: basic study with percutaneous lymphography.  Radiology. 1995;  196 107-113
    PubMedSearch in Google Scholar
  • 21 Ikomi F, Hunt J, Hanna G. et al . Interstitial fluid, plasma protein, colloid, and leukocyte uptake into initial lymphatics.  J Appl Physiol. 1996;  81 2060-2067
    PubMedSearch in Google Scholar
  • 22 Ikomi F, Hanna GK, Schmid-Schonbein GW. Size- and surface-dependent uptake of colloid particles into the lymphatic system.  Lymphology. 1999;  32 90-102
    PubMedSearch in Google Scholar
  • 23 Lamki LM, Logic JR. Defining lymphatic drainage patterns with cutaneous lymphoscintigraphy. In: Balch CM, Houghton AN, Milton GW, Sober AJ, Soong S-J Cutaneous Melanoma. Philadelphia: Lipincott 1992: 367-375
    Search in Google Scholar
  • 24 McNeill GC, Witte MH, Witte CL. et al . Wohle-body lymphoangioscintigraphy: preferred method for initial assessment of the peripheral lymphatic system.  Radiology. 1989;  172 495-502
    PubMedSearch in Google Scholar
  • 25 Moghimi S, Bonnemain B. Subcutaneous delivery of diagnostic agents to the lymphatic system: applications in lymphoscintigraphy and indirect lymphography.  Adv Drug Deliv Rev. 1999;  37 295-312
    CrossrefPubMedSearch in Google Scholar
  • 26 Mostbeck A, Partsch H. Isotope lymphography: possibilities and limits in evaluation of lymph transport.  Wien Med Wochenschr. 1999;  149 87-91
    PubMedSearch in Google Scholar
  • 27 Nawaz K, Hamad M, Sadek S. et al . Lymphscintigraphy in peripheral lymphedema using technetium-labelled human serum album: normal and abnormal patterns.  Lymphology. 1985;  18 181-186
    PubMedSearch in Google Scholar
  • 28 Olszewski WL. Lymphatics, lymph and lymphoid cells: an integrated immune system.  Eur Surg Res. 1986;  18 264-270
    CrossrefPubMedSearch in Google Scholar
  • 29 O`Morchoe CC, Jones WR, Jarosz HM. et al . Temperature dependence of protein transport across lymphatic endothelium in vitro.  J Cell Biol. 1984;  98 629-640
    CrossrefPubMedSearch in Google Scholar
  • 30 Partsch H. Assessment of abnormal lymph drainage for the diagnosis of lymphedema by isotopic lymphoangiography and by indirect lymphography.  Clin Dermatol. 1995;  13 445-450
    CrossrefPubMedSearch in Google Scholar
  • 31 Partsch H. Practical aspects of indirekt lymphography and lymphoscintigraphy.  Lymphatic Research and Biology. 2003;  1 71-73
    CrossrefPubMedSearch in Google Scholar
  • 32 Porter CJ, Charman SA. Lymphatic transport of proteins after subcutaneous administration.  J Pharm Sci. 2000;  89 297-310
    CrossrefPubMedSearch in Google Scholar
  • 33 Rada IO, Tufose N. Peripheral lymphedema and fibrosclerosis of the lymphatic wall.  Lymphology. 1986;  19 88-89
    PubMedSearch in Google Scholar
  • 34 Schmid-Schönbein GW. Microlymphatics and lymph flow.  Physiol Rev. 1990;  70 987-1028
    PubMedSearch in Google Scholar
  • 35 Sjöberg T, Norgren L, Stehen S. Contractility of human leg lymphatics during exercise before and after indomethacin.  Lymphology. 1989;  22 186-193
    PubMedSearch in Google Scholar
  • 36 Spiegel M, Vesti B, Shore A. et al . Pressure of lymphatic capillaries in human skin.  Am J Physiol. 1992;  262 1208-1210
    PubMedSearch in Google Scholar
  • 37 Stewart KC, Lyster DM. Interstitial lymphoscintigraphy for lymphatic mapping in surgical practice and research.  J Invest Surg. 1997;  10 249-262
    PubMedSearch in Google Scholar
  • 38 Strand SE, Bergqvist L. Radioloabeled colloids and macromolecules in the lymphatic system.  Crit Rev Ther drug Carrier Syst. 1989;  6 211-238
    PubMedSearch in Google Scholar
  • 39 Taylor A. The lymphatic edema safety factor: The role of edema dependent lymphatic factors.  Lymphology. 1990;  23 111-123
    PubMedSearch in Google Scholar
  • 40 Ter SE, Alavi A, Kim CK. et al . Lymphoscintigraphy: a reliable test for the diagnosis of lymphedema.  Clin Nucl Med. 1993;  18 646-654
    PubMedSearch in Google Scholar
  • 41 Watson PD, Bell DR, Renkin EM. Early kinetics of large molecule transport between plasma and lymph in dogs.  Am J Physiol.. 1980;  239 525-531
    PubMedSearch in Google Scholar
  • 42 Weiss M, Baumeister RGH, Hahn K. Post-therapeutic lymphedema: scintigraphy before and after autologous lymph vessel transplantation – 8 years long-term follow up.  Clin Nucl Med. 2002;  27 ((11)) 788-792
    CrossrefPubMedSearch in Google Scholar
  • 43 Weiss M, Baumeister RGH, Hahn K. Dynamic lymph flow imaging in patients with edema of the lower limb for evaluation of the functional outcome after autogenous lymph vessel transplantation – an 8 years follow up.  Eur J Nucl Med Mol Imaging. 2003;  30 ((2)) 202-206
    CrossrefPubMedSearch in Google Scholar
  • 44 Weiss M, Gildehaus FJ, Brinkbäumer K. et al . Lymph kinetics with technetium-99m labeled radiopharmaceuticals - Animal studies.  Nuklearmedizin. 2005;  44 156-165
    PubMedSearch in Google Scholar
  • 45 Weiss M, Santos R, Baumeister RGH. Aspekte der Auswertung bei der Lymphszintigrafie - Quantifizierung: Transportindex versus Region-of-interest-Technik.  LymphForsch. 2005;  9 ((2)) 78-84
    PubMedSearch in Google Scholar
  • 46 Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients.  Radiology. 1988;  167 729-735
    CrossrefPubMedSearch in Google Scholar
  • 47 Weissleder H, Schuchhardt C. Erkrankungen des Lymphgefäßsystems. Karger Kommunikation, Bonn 1994: 57–65 und 224–234
  • 48 Williams WH, Witte CL, Witte MH. et al . Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema.  Clin Nucl Med. 2000;  25 451-465
    CrossrefPubMedSearch in Google Scholar
  • 49 Witte CL, Witte MH, Unger EC. et al . Advances in imaging of lymph flow disorders.  Radiographics. 2000;  20 1697-1719
    CrossrefPubMedSearch in Google Scholar
  • 50 Zaugg-Vesti B, Dörffler-Melly J, Spiegel M. et al . Lymphatic capillary pressure in patients with primary lymphedema.  Microvasc Res. 1993;  46 128-132
    CrossrefPubMedSearch in Google Scholar

Korrespondenzadresse

PD Dr. M. Weiss

Klinik und Poliklinik für Nuklearmedizin

Ludwig-Maximilians-Universität München

Marchioninistr. 15

81377 München

Email: mayo.weiss@med.uni-muenchen.de