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Nuklearmedizin 2015; 54(05): 231-240
DOI: 10.3413/Nukmed-0723-15-02
Original article
Schattauer GmbH

Chylothorax and chylous as

Clinical utility of planar scintigraphy and tomographic imaging with SPECT/CTChylothorax und chylöser AszitesDie klinische Bedeutung der planaren Szintigraphie und der tomographischen Bildgebung mit SPECT/CT
M. Weiss
1   Department of Nuclear Medicine, Ludwig Maximilian University of Munich, Germany
,
F. Schwarz
2   Institute for Clinical Radiology, Ludwig Maximilian University of Munich, Germany
,
J. Wallmichrath
3   Department of Micro-, Hand- and Reconstructive Surgery, Ludwig Maximilian University of Munich, Germany
,
R. Baumeister
3   Department of Micro-, Hand- and Reconstructive Surgery, Ludwig Maximilian University of Munich, Germany
,
A. Frick
3   Department of Micro-, Hand- and Reconstructive Surgery, Ludwig Maximilian University of Munich, Germany
,
P. Bartenstein
1   Department of Nuclear Medicine, Ludwig Maximilian University of Munich, Germany
,
A. Rominger
1   Department of Nuclear Medicine, Ludwig Maximilian University of Munich, Germany
› Author Affiliations
Further Information

Publication History

received: 06 February 2015

accepted in revised form: 09 July 2015

Publication Date:
28 December 2017 (online)

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Summary

The aim was to analyze conventional planar scintigraphy and SPECT/CT in patients clinically suspicious for chylothorax or chylous ascites. Lymphoscintigraphy was performed for two reasons: first, to help diagnose chylothorax or -abdomen, by demonstrating diffuse uptake in fluid accumulations, and then secondly, to detect the site of leakage to test the prediction that additional use of SPECT/ CT-technique improves upon the diagnostic value of planar lympho scintigraphy in the baseline detection of thoraco-abdominal lymphatic disorders. Patients, material, methods: From 7/2008-7/2014 a total of 24 consecutive patients (8 woman, 16 men; age, range 31-79 years) presenting with clinical symptoms suspicious for chylothorax and/or chylous ascites were examined by planar lymphoscintigraphy (n = 26) and additional tomographic SPECT/CT- (n = 22) or SPECTtechnique (n = 2). Results: Chylothorax could be scintigraphically confirmed in n = 9, chylous ascites in n = 5 scintigraphies, and excluded in n = 10 patients. In all planar scintigraphy findings of pathological lymph drainage regions (n = 14), SPECT/CT delivered additional relevant information, notably the anatomic localization of the lymphatic leakage. For the baseline detection of thoraco-abdominal lymphatic transport disorders, lymphoscintigraphy showed sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%. Conclusions: Our findings show that due to the particular advantages presented by tomographic separation of overlapping sources, SPECT/CT specifies better the anatomical sites, improving the localization of lymphatic leakage in aid of planning surgical re-interventions.

Zusammenfassung

Ziel war es, die konventionelle planare Szintigraphie und SPECT/CT bei Patienten mit klinischem Verdacht auf Chylothorax oder chylösem Aszites zu beurteilen. Die Lymphszintigraphie wurde aus zwei Gründen durchgeführt: Erstens, um die Diagnose Chylothorax oder -abdomen durch Nachweis einer diffusen Anreicherung in Flüssigkeitsansammlungen zu unterstützen, und zweitens, um durch Lokalisation der Lymphleckage die Annahme zu überprüfen, ob der zusätzliche Einsatz der SPECT/CT-Technik die diagnostische Aussagekraft der planaren Szintigraphie in der Ausgangsdiagnostik thorakaler oder abdominaler Lymphtransportstörungen erweitert. Patienten, Material, Methoden: Zwischen 7/2008 und 7/2014 wurden n = 24 konsekutive Patienten (8 weiblich, 16 männlich, Alter 31–79 Jahre) mit klinischem Verdacht auf Chylothorax und/oder chylösem Aszites mittels planarer Lymphszintigraphie (n = 26) und zusätzlicher tomographischer SPECT/CT- (n = 22) oder SPECT-Technik (n = 2) untersucht. Ergebnisse: Ein Chylothorax konnte szintigraphisch in n = 9 Fällen, ein chylöser Aszites in n = 5 bestätigt werden sowie in n = 10 Patienten ausgeschlossen werden. Bei allen pathologisch beurteilten planaren Szintigraphien (n = 14) lieferte die SPECT/CT zusätzliche relevante Informationen, insbesondere bezüglich der anatomischen Lokalisation der lymphatischen Leckage. Für die Ausgangsdetektion thorako-abdominaler Lymphtransportstörungen zeigte die Lymphszintigraphie eine Sensitivität von 88%, eine Spezifität von 100%, einen positiven prädiktiven Wert von 100% sowie einen negativen prädiktiven Wert von 80%. Schlussfolgerungen: Unsere Ergebnisse zeigen, dass die SPECT/CT aufgrund ihrer spezifischen tomographischen Auflösung sich überlappender Aktivitätsanreicherungen die anatomischen Verhältnisse besser spezifiziert und somit durch eine Verbesserung der Lokalisation lymphatischer Leckagen die Planung chirurgischer Interventionen verbessert.

Keywords

Chylothorax - chylous ascites - lymphoscintigraphy - SPECT/CT - hybrid imaging

Schlüsselwörter

Chylothorax - Chylöser Aszites - Lymphszintigraphie - SPECT/CT - Hybridbildgebung
 

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