Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema

Purpose: The primary difficulty in evaluating and treating peripheral lymphedema is visualization of the lymphatics. Functional lymphatic studies have been performed on patients with peripheral edema to diagnose lymphedema, to determine its severity, and to understand the varied drainage patterns. Methods: After intradermal injection in the hands or feet, initial flow and whole-body images were taken using Tc-99m human serum albumin in more than 700 patients with possible lymphedema. Results: Clear images of truncal lymph transport and draining lymph nodes were obtained, and pattern differences between primary and secondary lymphedema were seen. Follow-up studies showed any functional change in lymphatic dynamics. Conclusion: Peripheral lymphatics can now be easily visualized. Because lymphangioscintigraphy can be performed before and after medical treatment, follow-up evaluation of patients with lymphedema is possible. The procedure is noninvasive, repeatable, easy to perform, and harmless to the lymphatic endothelium.