Nucl Med Mol Imaging.  2019 Feb;53(1):47-56. 10.1007/s13139-018-0565-2.

Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol

• Villa G
• Campisi CC
• Ryan M
• Boccardo F
• Di Summa P
• Frascio M
• Sambuceti
• Campisi C

• KMID: 2446885
• DOI: http://doi.org/10.1007/s13139-018-0565-2

Abstract

INTRODUCTION
Lymphoscintigraphy is the gold standard for imaging in the diagnosis of peripheral lymphedema. However, there are no clear guidelines to standardize usage across centers, and as such, large variability exists. The aim of this perspectives paper is to draw upon the knowledge and extensive experience of lymphoscintigraphy here in Genoa, Italy, from our center of excellence in the assessment and treatment of lymphatic disorders for over 30 years to provide general guidelines for nuclear medicine specialists. METHOD: The authors describe the technical characteristics of lymphoscintigraphy in patients with limb swelling. Radioactive tracers, dosage, administration sites, and the rationale for a two-compartment protocol with the inclusion of subfascial lymphatic vessels are all given in detail.
RESULTS
Examples of lymphoscintigraphic investigations with various subgroups of patients are discussed. The concept of a transport index (TI) for semi-quantitative analysis of normal/pathological lymphatic flow is introduced. Different concepts of injection techniques are outlined. DISCUSSION: It is past time that lymphoscintigraphy in the diagnosis of lymphatic disorders becomes standardized. This represents our first attempt to outline a clear protocol and delineate the relevant points for lymphoscintigraphy in this patient population.

Keyword

Lymphoscintigraphy; Epifascial and subfascial lymphatic vessels; Semi-quantitative transport index; Limb swelling

MeSH Terms

Diagnosis*
Extremities
Humans
Italy
Lymphatic Vessels
Lymphedema*
Lymphoscintigraphy*
Methods
Nuclear Medicine
Radioactive Tracers
Specialization
Radioactive Tracers