Observation of the lymph flow in the lower extremities of edematous patients with noninvasive methods

An RI-lymphography with a computer onlined gamma camera was used for observing the lymph flow of edematous patients without any invasive procedures and for estimating the active movement of lymph vessels. Subjects were composed of 8 normal volunteers (group 1), 41 non-edematous patients (group 2) and 26 edematous patients (group 3). Four mCi of Tc-99m-HSA in a volume of 0.1 ml was injected subcutaneously in the pretibial region of the lower extremity, and immediately after the injection scintigram was recorded on the thigh every 5 sec. for 30 min. Results: 1) Normal volunteers; Time-activity curves showed a gradual increase in RI activity in relation to time without remarkable spike-like fluctuations. The maximum count attained was less than 200 cps in all experiments. 2) Non-edematous patients; In 46 out of 57 experiments (80.8%), the similar time-activity curves were observed as those of the normal volunteers. On the other hand, time-activity curves in 11 out of 57 (19.2%) showed a much steeper stepwise-increase simultaneously with remarkable spike-waves. The maximum count was over 200 cps in these cases. 3) Edematous patients; In 12 out of 35 experiments (34.3%), the maximum count was over 200 cps. In these edematous diseases other than lymphedema and hyperthyroidism, time-activity curves showed a rapid stepwise increase with a lot of spikes, and the maximum count was over 500 cps in 6 experiments. In 23 out of 35 (65.7%), the maximum count was less than 200 cps. In these cases, edema was attributable to secondary lymphedema, hypothyroidism, aging and so on. 4) Relationship between edema and lymph flow: When subjects were divided into 3 groups (non-edema, mild and severe edema), the maximum count 200 cps was observed in 16.7% in non-edema group, 45.8% in mild and 9.1% in severe edema group