Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema*
CONTINUING EDUCATION The Third Circulation: Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema* Andrzej Szuba, MD, PhD1; William S. Shin1; H. William Strauss, MD2; and Stanley Rockson, MD1 1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California; and 2Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, California all. Lymphedema results from impaired lymphatic transport Lymphedema—edema that results from chronic lymphatic in- caused by injury to the lymphatics, infection, or congenital sufficiency—is a chronic debilitating disease that is frequently abnormality. Patients often suffer in silence when their misdiagnosed, treated too late, or not treated at all. There are, primary physician or surgeon suggests that the problem is however, effective therapies for lymphedema that can be im- plemented, particularly after the disorder is properly diagnosed mild and that little can be done. Fortunately, there are and characterized with lymphoscintigraphy. On the basis of the effective therapies for lymphedema that can be imple- lymphoscintigraphic image pattern, it is often possible to deter- mented, particularly after the disorder is characterized with mine whether the limb swelling is due to lymphedema and, if so, lymphoscintigraphy. whether compression garments, massage, or surgery is indi- At the Stanford Lymphedema Center, about 200 new cated. Effective use of lymphoscintigraphy to plan therapy re- cases of lymphedema are diagnosed each year (from a quires an understanding of the pathophysiology of lymphedema and the influence of technical factors such as selection of the catchment area of about 500,000 patients). Evidence that the radiopharmaceutical, imaging times after injection, and patient disease is often overlooked by physicians caring for the activity after injection on the images.
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