Dynamic lymph flow scintigraphy in lymphoedema: Description of a new procedure and normal and abnormal patterns

A dynamic study of lymphatic flow was performed in 23 patients complaining of lymphoedema of the lower limbs. All were injected intradermally with 1 mCi (37 MBq) of 99Tcsup(m)-labelled human serum albumin (HSA) in the medial web on the dorsum of each foot. Image acquisition for the lower pelvis and both thighs was started within 5 min. A GE 500A gamma camera with an extra-large field of view and a low energy, all purpose collimator interfaced with a GE Star computer was used. Images were acquired in the dynamic mode with a 128x128 matrix every minute up to 40 min. Delayed images for the same region and for both legs were taken at 90 min. Time-activity curves for equal regions of interest over the inguinal regions on both sides were generated. Three patterns were recognized. (1) Normal flow (12 patients) with symmetrical or slightly increased or decreased flow on one side compared with the other, characterized by early appearance of medial bands and inguinal and pelvic lymph nodes in the early and delayed images. (2) An obstructed pattern (5 patients) characterized by subcutaneous pooling, absent medial bands in the dynamic part of the study, a flat curve on the affected side representing background activity, and absent inguinal and pelvic nodes in the delayed images. Occasionally the obstruction was incomplete and there was a delayed appearance of the nodes, which were less in number and smaller in size than on the normal side. (3) An enhanced pattern (6 patients) characterized by fast flow of lymph through the dilated lymphatics, occasionally subcutaneous pooling and an increase in the number and size of inguinal and pelvic lymph nodes on the affected side. The authors conclude that intradermal injection of 99Tcsup(m)-HSA can be used to study the pathophysiology of lymphatic flow in the most difficult group of patients suffering from chronic lymphoedema of the lower limbs