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Vol 9, No 1 (2003)
Research paper
Published online: 2003-01-08

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Utility assessment of 99mTc labelled human polyclonal immunoglobulin G scintigraphy for the diagnosis of limb lymphoedema

Artur Stępień, Jolanta Pawlus, Mirosław Dziekiewicz, Janusz Sroga, Tomasz Grądalski, Jan Kulka, Elżbieta Nowak
Acta Angiologica 2003;9(1):25-30.

Abstract

Background. Lymphoscintigraphy is the "gold standard" examination in lymphoedema diagnosis. The assessment of lymphatic system function is done on the base of outflow efficiency of the radiotracer, time of its appearance in lymph nodes, degree of its uptake in regional lymph nodes and presence of pathological backflow ways (dermal backflow). Some authors suggest the possibility of application of 99mTc labelled immmunoglobulin G (IgG) in lymphoscintigraphy.
Material and methods. 17 patients suspected of lymphoedema have been examined (11 upper limbs, 6 lower limbs). Each patient received subcutaneous 99mTc-IgG complex in a volume 0.1 mL with activity 50 MBq. The site of injection was the second web space of the affected extremity and the contralateral normal limb. Dynamic data acquisition with the use of Nucline AP gamma camera has been started immediately post injection (p.i.) to both extremities. The patients made small movement of fingers during examination in order to speed up the tracer outflow. The static visualization of whole body has been performed after 1, 3 and 4 hours p.i.
Results. The radiotracer outflow from the site of injection has been noticed in all cases of dynamic phase of examination. Flow rate of the radiopharmaceutics was differentiated and did not to show any correlation with the reason of lymphoedema. Dermal backflow has been observed in four cases (23.5%) connected with the tracer retention in soft tissues during delayed visualization. Additionally, long-time retention of the tracer in lymphatic vessels has been observed. There was no case of any local or general undesirable symptoms.
Conclusions. Scintigraphy 99mTc-IgG is a useful method in limb lymphoedema diagnosis.

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