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1. Clin Physiol Funct Imaging. 2012 Mar;32(2):126-32. doi:
10.1111/j.1475-097X.2011.01066.x. Epub 2011 Nov 10.

The washout rate of a subcutaneous (99m) Tc-HSA depot in lower extremity
lymphoedema.

Jensen MR, Simonsen L, Karlsmark T, Bülow J.

Department of Clinical Physiology and Nuclear and Medicine Department of
Dermatology and Venereology, Bispebjerg Hospital, University Hospital of
Copenhagen, Copenhagen, Denmark.

Purpose:  Lymphoscintigraphy is currently the leading diagnostic modality of
lower extremity lymphoedema but has been criticized for being unreliable. Washout
rate constants have been investigated and proven to be of diagnostic value in
several studies of breast-cancer-related lymphoedema; however, the applicability
in lower extremity lymphoedema needs further evaluation. The aim of the study was
to verify if washout of (99m) Tc-Human Serum Albumin ((99m) Tc-HSA) is a reliable
diagnostic tool in lower extremity lymphoedema. Methods:  Twenty healthy
volunteers and eight patients (11 legs) with lymphoscintigraphy verified lower
extremity lymphoedema participated in the study. A depot consisting of 0·1 ml
10 MBq/ml (99m) Tc-HSA was injected subcutaneously into the dorsum of each foot.
The depot washout rate was measured using a portable scintillation detector
system and time-activity curves were generated. After 30 min of supine rest and
10 min of standardized ergometric exercise, measurements were recorded for
20 min. Following correction for physical decay of (99m) Tc, the depot washout
rate constant was calculated using linear regression analysis. Finally depot
half-life was calculated from the washout rate constant. Results:  Median
half-life for healthy volunteers was 9·4 h (range 2·5-28·3 h). Median half-life
for lymphoedema patients was 10·7 h (range 1·5-35·1 h). No statistical
significant difference could be detected between healthy volunteers and
lymphoedema patients (P = 0·78). Conclusions:  The washout rate of a subcutaneous
(99m) Tc-HSA depot is not a reliable diagnostic tool in examination of lower
extremity lymphoedema. Additional examinations revealed in vivo instability of
the utilized (99m) Tc-HSA as the likely reason.

© 2011 The Authors. Clinical Physiology and Functional Imaging © 2011
Scandinavian Society of Clinical Physiology and Nuclear Medicine.

PMID: 22296633 [PubMed - in process]