Indian Journal of Nuclear Medicine
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Year : 2013  |  Volume : 28  |  Issue : 3  |  Page : 134-137

Significance of popliteal lymph nodes visualization during radionuclide lymphoscintigraphy for lower limb lymphedema

1 Department of Nuclear Medicine, Kasr Al-Ainy Hospital (NEMROCK), Cairo, Egypt
2 Department of Nuclear Medicine, National Cancer Institute, Cairo University, Cairo, Egypt

Correspondence Address:
Ahmed Abdel-Samie Kandeel
No. 1424, 7th Neighborhood, 4th District, 6 October City, Postal Code 12573, Giza
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-3919.119540

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Purpose : To examine the frequency and significance of visualization of popliteal nodes during lymphoscintigraphy for the investigation of lower extremity swelling. Materials and Methods: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 90 patients (24 males, 66 females; age range, 4-70 years) who had clinical evidence of lower limb lymphedema and were referred for routine lymphoscintigraphy; imaging was performed 5, and 90 minutes after injection without any vigorous exercise between the injection and imaging. Results: According to the scan findings, patients were divided into two groups; group I included 63 patients without popliteal nodes visualization on scanning, and group II included 27 patients with positive popliteal nodes uptake. None of patients with primary lymphedema (N = 22) due to agenesis or hypoplasia showed popliteal node uptake, whereas, patients with secondary lymphedema (N = 68) had either severe (N = 23) or partial (N = 45) lymphatic obstruction. A high positive association of popliteal node uptake with the severity of lymphatic obstruction was noted. Popliteal nodes were visualized in 26 of 57 patients with dermal back flow (46%), and in only 1 of 33 patients without dermal back flow (3%). There was a strong association between skin rerouting and popliteal node visualization (P < 0.01). Skin changes were detected in 24 patients (38%) with positive popliteal node uptake. Conclusion: Popliteal lymph nodes uptake during lymphoscintigraphy for clinical lymphedema of the lower limb indicates lymph rerouting through the deep system and raises a diagnosis of higher severity and longer duration of lymphatic dysfunction.

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