Chylothorax and chylous ascites. Clinical utility of planar scintigraphy and tomographic imaging with SPECT/CT.

Abstract

UNLABELLED:

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 lymphoscintigraphy 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 SPECT-technique (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.

• Authors: M Weiss, F Schwarz, J Wallmichrath, R Baumeister, A Frick, P Bartenstein, A Rominger
• Journal: Nuklearmedizin. Nuclear medicine (Nuklearmedizin) Vol. 54 Issue 5 Pg. 231-40 ( 2015) ISSN: 2567-6407 [Electronic] Germany
• PMID: 26183818 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Topics

• Adult
• Aged
• Chylothorax (diagnosis)
• Chylous Ascites (diagnosis)
• Female
• Humans
• Lymphoscintigraphy (methods)
• Male
• Middle Aged
• Multimodal Imaging (methods)
• Reproducibility of Results
• Sensitivity and Specificity
• Tomography, Emission-Computed, Single-Photon (methods)
• Tomography, X-Ray Computed (methods)