Insufficient hepatic uptake in pediatric patients on lymphoscintigraphy.
lymph flow disorder
lymphatic system
lymphoscintigraphy
nuclear medicine
prognosis
Journal
Pediatrics international : official journal of the Japan Pediatric Society
ISSN: 1442-200X
Titre abrégé: Pediatr Int
Pays: Australia
ID NLM: 100886002
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
03
01
2022
received:
10
11
2021
accepted:
03
02
2022
pubmed:
6
5
2022
medline:
7
5
2022
entrez:
5
5
2022
Statut:
ppublish
Résumé
To demonstrate the association between pediatric outcomes and tracer hepatic uptake as a marker of systemic circulation in lymphoscintigraphy. We included 31 initial lymphoscintigraphic studies. We compared the presence or absence of hepatic uptake between deceased and survived patients in both early and delayed images using Fisher's exact test. Kaplan-Meier survival analysis was performed based on imaging results, and these curves were compared using the log-rank test. The primary endpoint was death and the survival period was defined from the day of examination to the day of the last visit or death. Of 31 patients, six died. Hepatic uptake was significantly different in both early and delayed images (early images, died [with/without visualization] vs. survived [with/without visualization], 0/6 vs. 13/12, P = 0.028; delayed images, died [with/without visualization] vs. survived [with/without visualization], 2/4 vs. 22/3, P = 0.014) between deceased and survived patients. Survival periods were significantly different between the two groups with and without hepatic uptake in early and delayed images (with/without visualization in early imags = 1,177.1 ± 773.8 days/426.7 ± 419.8 days, P = 0.008 and with/without visualization in delayed images = 821.3 ± 738.0 days/467.4 ± 452.4 days, P = 0.003). Visualization of hepatic uptake in both early and delayed lymphoscintigraphy is associated with patient outcomes. Hepatic uptake could represent tracer inflow into the systemic circulation, indicating preservation of the connection between the lymphatic system and the systemic circulation. Physicians should evaluate these findings carefully on lymphoscintigraphy.
Sections du résumé
BACKGROUND
BACKGROUND
To demonstrate the association between pediatric outcomes and tracer hepatic uptake as a marker of systemic circulation in lymphoscintigraphy.
METHODS
METHODS
We included 31 initial lymphoscintigraphic studies. We compared the presence or absence of hepatic uptake between deceased and survived patients in both early and delayed images using Fisher's exact test. Kaplan-Meier survival analysis was performed based on imaging results, and these curves were compared using the log-rank test. The primary endpoint was death and the survival period was defined from the day of examination to the day of the last visit or death.
RESULTS
RESULTS
Of 31 patients, six died. Hepatic uptake was significantly different in both early and delayed images (early images, died [with/without visualization] vs. survived [with/without visualization], 0/6 vs. 13/12, P = 0.028; delayed images, died [with/without visualization] vs. survived [with/without visualization], 2/4 vs. 22/3, P = 0.014) between deceased and survived patients. Survival periods were significantly different between the two groups with and without hepatic uptake in early and delayed images (with/without visualization in early imags = 1,177.1 ± 773.8 days/426.7 ± 419.8 days, P = 0.008 and with/without visualization in delayed images = 821.3 ± 738.0 days/467.4 ± 452.4 days, P = 0.003).
CONCLUSIONS
CONCLUSIONS
Visualization of hepatic uptake in both early and delayed lymphoscintigraphy is associated with patient outcomes. Hepatic uptake could represent tracer inflow into the systemic circulation, indicating preservation of the connection between the lymphatic system and the systemic circulation. Physicians should evaluate these findings carefully on lymphoscintigraphy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15156Informations de copyright
© 2022 Japan Pediatric Society.
Références
Scalzetti EM, Heitzman ER, Groskin SA, Randall PA, Katzenstein AL. Developmental lymphatic disorders of the thorax. Radiographics 1991; 11(6): 1069-85.
Witte CL, Witte MH, Unger EC et al. Advances in imaging of lymph flow disorders. Radiographics 2000; 20(6): 1697-719.
Inoue M, Nakatsuka S, Yashiro H et al. Lymphatic intervention for various types of lymphorrhea: Access and treatment. Radiographics 2016; 36: 2199-211.
Chiewvit S, Kumnerdnakta S. Lymphoscintigraphic findings that predict favorable outcome after lymphaticovenous anastomosis. Lymphology 2017; 50(1): 1-8.
Milsom JW, Kron IL, Rheuban KS, Rodgers BM. Chylothorax: An assessment of current surgical management. J. Thorac. Cardiovasc. Surg. 1985; 89: 221-7.
Lopez-Gutierrez JC, Tovar JA. Chylothorax and chylous ascites: Management and pitfalls. Semin. Pediatr. Surg. 2014; 23: 298-302.
Majdalany BS, Saad WA, Chick JFB, Khaja MS, Cooper KJ, Srinivasa RN. Pediatric lymphangiography, thoracic duct embolization and thoracic duct disruption: A single-institution experience in 11 children with chylothorax. Pediatr. Radiol. 2018; 48: 235-40.
Weissler JM, Cho EH, Koltz PF et al. Lymphovenous anastomosis for the treatment of chylothorax in infants: A novel microsurgical approach to a devastating problem. Plast. Reconstr. Surg. 2018; 141(6): 1502-7.
Itkin M, Pizarro C, Radtke W, Spurrier E, Rabinowitz DA. Lymphatic management in single-ventricle patients. Semin. Thorac. Cardiovasc. Surg. Pediatr. Card. Surg. Annu. 2020; 23: 41-7.
Biko DM, Dori Y, Savoca M et al. Pediatric pulmonary lymphatic flow disorders: Diagnosis and management. Paediatr. Respir. Rev. 2020; 36: 2-7.
Sakai H, Kageyama T, Tsukuura R, Yamamoto T. Anatomical location of lymphatic pathway in the posterior thigh. Ann. Plast. Surg. 2021; 88(3): 330-4.
De Angelis LC, Bellini T, Witte MH et al. Congenital chylothorax: Current evidence-based prenatal and post-natal diagnosis and management. Lymphology 2019; 52(3): 108-25.
Cholet C, Delalandre C, Monnier-Cholley L, Le Pimpec-Barthes F, El Mouhadi S, Arrivé L. Nontraumatic chylothorax: Nonenhanced MR lymphography. Radiographics 2020; 40(6): 1554-73.
Narayanan P, Iyngkaran T, Sohaib SA, Reznek RH, Rockall AG. Pearls and pitfalls of MR lymphography in gynecologic malignancy. Radiographics 2009; 29(4): 1057-69. discussion 69-71.
Tomczak H, Nyka W, Lass P. Lymphoedema: Lymphoscintigraphy versus other diagnostic techniques-a clinician's point of view. Nucl. Med. Rev. Cent. East. Eur. 2005; 8: 37-43.
Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: Evaluation of extremity lymphoedema. Br. J. Radiol. 2007; 80: 219-26.
Yuan Z, Chen L, Luo Q, Zhu J, Lu H, Zhu R. The role of radionuclide lymphoscintigraphy in extremity lymphedema. Ann. Nucl. Med. 2006; 20: 341-4.
Hosokawa T, Shibuki S, Tanami Y et al. Extracardiac complications in intensive care units after surgical repair for congenital heart disease: Imaging review with a focus on ultrasound and radiography. J. Pediatr. Intensive Care 2021; 10: 85-105.
Yang J, Codreanu I, Zhuang H. Minimal lymphatic leakage in an infant with chylothorax detected by lymphoscintigraphy SPECT/CT. Pediatrics 2014; 134: e606-10.
Turpin S, Lambert R. Lymphoscintigraphy of Chylous anomalies: Chylothorax, Chyloperitoneum, Chyluria, and lymphangiomatosis-15-year experience in a pediatric setting and review of the literature. J. Nucl. Med. Technol. 2018; 46(2): 123-8.
Pui MH, Yueh TC. Lymphoscintigraphy in chyluria, chyloperitoneum and chylothorax. J. Nucl. Med. 1998; 39(7): 1292-6.
Sty JR, Starshak RJ. Atlas of pediatric radionuclide lymphography. Clin. Nucl. Med. 1982; 7: 428-33.
Bellini C, Boccardo F, Campisi C et al. Lymphatic dysplasias in newborns and children: The role of lymphoscintigraphy. J. Pediatr. 2008; 152: 587-9, 9.e1-3.
Bellini C, Villa G, Sambuceti G et al. Lymphoscintigraphy patterns in newborns and children with congenital lymphatic dysplasia. Lymphology 2014; 47: 28-39.
Bellini C, Boccardo F, Taddei G et al. Diagnostic protocol for lymphoscintigraphy in newborns. Lymphology 2005; 38: 9-15.
Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: Radionuclide lymphoscintigraphy in the evaluation of lymphedema. J. Nucl. Med. 2003; 44: 43-57.
Kargl S, Maier-Hiebl B. Pediatric chylothorax-lymphatic imaging enables targeted surgical treatment. Indian J. Thorac. Cardiovasc. Surg. 2019; 35: 233-6.
Shah AR, Dinwiddie R, Woolf D, Ramani R, Higgins JN, Matthew DJ. Generalized lymphangiomatosis and chylothorax in the pediatric age group. Pediatr. Pulmonol. 1992; 14(2): 126-30.
Chang EI, Skoracki RJ, Chang DW. Lymphovenous anastomosis bypass surgery. Semin. Plast. Surg. 2018; 32: 22-7.