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  • [BMC Med Imaging.] Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study

    [BMC Med Imaging.] Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study

    성균관의대 / 권혜령, 최준영*

  • 출처
    BMC Med Imaging.
  • 등재일
    2021 Dec 8
  • 저널이슈번호
    21(1):188. doi: 10.1186/s12880-021-00713-1.
  • 내용

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    Abstract
    Background: We investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema.

    Materials and methods: A total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and four types of dermal backflow patterns (absent; distal only; proximal only; whole lower limb) were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole lower limb at 3 months (early response) and 1 year (late response) was measured. Volume difference ratios (continuous variable and binary variable with a cut-off value of zero) were compared according to the lymphoscintigraphic variables.

    Results: The group with whole lower limb dermal backflow had a greater volume change than the other groups (p = 0.047). The group with dermal backflow in the whole lower limb OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p = 0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p = 0.016, p = 0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p = 0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p = 0.040).

    Conclusions: Preoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

     

     

    Affiliations

    Hye Ryeong Kwon  1 , Ji Hye Hwang  2 , Goo-Hyun Mun  3 , Seung Hyup Hyun  1 , Seung Hwan Moon  1 , Kyung-Han Lee  1 , Joon Young Choi  4
    1 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
    2 Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    3 Department of Plastic and Reconstructive Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    4 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea. jynm.choi@samsung.com.

  • 키워드
    Lymphedema; Lymphoscintigraphy; Lymphovenous anastomosis; Treatment response.
  • 연구소개
    본 연구는 하지 림프부종 환자에서 림프혈관문합술 (lymphovascular anastomosis) 전 시행한 림프신티그라피가 수술 후 치료효과를 예측할 수 있는지 보고자 하였습니다. 림프신티그라피의 정성적 및 정량적 지표들이 예측인자로서 평가되었고 조기 및 후기 치료반응은 수술 후 3개월째 및 1년째 부종의 부피 감소를 통해 평가되었습니다. 그 결과 피부역류(dermal backflow)의 유무 및 위치와 이와 연관된 2시간째 하지섭취계수비율(2-h extremity uptake ratio)이 유의미한 예후인자임을 알게 되었습니다. 피부역류가 말단부 또는 전체 하지에 있는 환자들이 수술 후 부종의 부피 감소가 더 컸고, 피부역류의 범위가 넓을수록 수술 후 치료 효과는 더 컸습니다. 또한, 2-h extremity uptake ratio와 치료 반응 사이에는 양의 상관관계를 보였습니다. 이전 연구들은 주로 complex decongestive therapy를 시행 받은 부종환자들에서 림프신티그라피를 통한 예후평가를 하였다면, 본 연구는 림프혈관문합술 시행 환자들에서 림프신티그라피의 효용성을 밝혔기에 의미가 있습니다. 이를 통해 수술 전 시행한 림프신티그라피가 림프혈관문합술 후 좋은 예후가 기대되는 적합한 대상자를 찾아내는 것에 도움이 될 것으로 기대하고 있습니다.
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