原发性下肢淋巴功能不全的改良淋巴管造影术

Lymphology Pub Date : 2023-01-01
M Wald, J Svobodova, H Krizova
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引用次数: 0

摘要

淋巴管造影有时会将脚和脚趾的原发性淋巴水肿误诊为整个下肢淋巴功能不全(LLLI)。造成这种情况的原因是采用了标准的淋巴管造影方案,即在第一趾间间隙注射一次放射性示踪剂,然后对下肢淋巴管和淋巴结进行图像分析。在这里,我们展示了对淋巴管造影方案的修改,在内踝正上方的临床健康组织中注入第二剂量的放射性示踪剂,可以更准确地描述下肢浅表淋巴系统的形态异常,从而完善 LLLI 的诊断。我们采用标准淋巴管造影方案对 14 名足趾肿胀患者(16 名下肢患者)进行了检查。随后进行了改良淋巴管造影。标准淋巴管造影显示所有 14 名患者(16 个下肢)的浅表淋巴系统严重淋巴功能不全,包括腹股沟结节数量明显减少,而改良淋巴管造影显示 11 名患者(13 个下肢)整个下肢近端施术部位的浅表淋巴管形态基本正常。总之,在足趾原发性淋巴水肿患者中使用改良淋巴管造影方案可以完善诊断和后续医疗管理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Modified Lymphoscintigraphy in Primary Lymphatic Insufficiency of the Lower Limb.

Primary lymphedema of the foot and toes could be sometimes misdiagnosed by lymphoscintigraphy as a whole lower limb lymphatic insufficiency (LLLI). This is caused by using standard lymphoscintigraphic protocol based on one interstitial injection of radiotracer applied into the first interdigital space followed by image analysis of lower limb lymphatic vessels and lymph nodes. Here, we show that a modification of the lymphoscintigraphic protocol and introduction of a second dose of radiotracer right above the inner ankle to the clinically healthy tissue can more accurately describe morphological abnormalities of the superficial lymphatic system at the lower limb and thereby refine the diagnosis of the LLLI. Fourteen patients with swelling of the foot and toes (16 lower limbs) were examined using standard lymphoscintigraphic protocol. Subsequently, modified lymphoscintigraphy was performed. While standard lymphoscintigraphy showed severe lymphatic insufficiency of the superficial lymphatic system in all 14 patients (in 16 lower limbs), including significantly reduced number of inguinal nodes, modified lymphoscintigraphy revealed almost normal morphology of superficial lymphatic vessels in 11 patients (in 13 lower limbs) throughout the entire lower limb proximal to the application site. In conclusion, using the modified lymphoscintigraphy protocol in patients with foot and toes primary lymphedema can refine diagnosis and follow-up medical management.

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