Potential Applications of Using 68Ga–Evans Blue PET/CT in the Evaluation of Lymphatic Disorder

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Abstract

Purpose

Potentials of ⁶⁸Ga-NEB as a PET tracer in the evaluation of a variety of lymphatic drainage disorders were analyzed.

Methods

⁶⁸Ga-NEB was injected subcutaneously, and the PET/CT images were acquired in 13 patients with different suspected lymphatic drainage abnormality. The ⁶⁸Ga-NEB PET/CT findings were compared with ^99mTc-SC lymphoscintigraphy.

Results

⁶⁸Ga-NEB activity could be clearly observed in the lymphatic route on the PET/CT images from all the patients. In 5 (38.5%) of 13 patients tested, ⁶⁸Ga-NEB PET/CT provided more information than the ^99mTc-SC lymphoscintigraphy.

Conclusions

⁶⁸Ga-NEB PET/CT can be used as an alternative of ^99mTc-SC lymphoscintigraphy in the evaluation of lymphatic disorders, which enables fast results and might be more accurate than the conventional ^99mTc-SC lymphoscintigraphy.

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Most cited references 27

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Lymphedema: a comprehensive review.

Anne Warren, Håkan Brorson, Loren Borud … (2007)

Lymphedema is a chronic, debilitating condition that has traditionally been seen as refractory or incurable. Recent years have brought new advances in the study of lymphedema pathophysiology, as well as diagnostic and therapeutic tools that are changing this perspective. To provide a systematic approach to evaluating and managing patients with lymphedema. We performed MEDLINE searches of the English-language literature (1966 to March 2006) using the terms lymphedema, breast cancer-associated lymphedema, lymphatic complications, lymphatic imaging, decongestive therapy, and surgical treatment of lymphedema. Relevant bibliographies and International Society of Lymphology guidelines were also reviewed. In the United States, the populations primarily affected by lymphedema are patients undergoing treatment of malignancy, particularly women treated for breast cancer. A thorough evaluation of patients presenting with extremity swelling should include identification of prior surgical or radiation therapy for malignancy, as well as documentation of other risk factors for lymphedema, such as prior trauma to or infection of the affected limb. Physical examination should focus on differentiating signs of lymphedema from other causes of systemic or localized swelling. Lymphatic dysfunction can be visualized through lymphoscintigraphy; the diagnosis of lymphedema can also be confirmed through other imaging modalities, including CT or MRI. The mainstay of therapy in diagnosed cases of lymphedema involves compression garment use, as well as intensive bandaging and lymphatic massage. For patients who are unresponsive to conservative therapy, several surgical options with varied proven efficacies have been used in appropriate candidates, including excisional approaches, microsurgical lymphatic anastomoses, and circumferential suction-assisted lipectomy, an approach that has shown promise for long-term relief of symptoms. The diagnosis of lymphedema requires careful attention to patient risk factors and specific findings on physical examination. Noninvasive diagnostic tools and lymphatic imaging can be helpful to confirm the diagnosis of lymphedema or to address a challenging clinical presentation. Initial treatment with decongestive lymphatic therapy can provide significant improvement in patient symptoms and volume reduction of edematous extremities. Selected patients who are unresponsive to conservative therapy can achieve similar outcomes with surgical intervention, most promisingly suction-assisted lipectomy.

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The changing management of chylothorax in the modern era.

Bradley Bender, Vijayashree Murthy, Ronald S Chamberlain (2016)

Initial conservative therapy is applied to all cases of chylothorax (CTx) with expected excellent outcomes. The indication for aggressive surgical treatment of early CTx remains uncertain and requires rigorous scientific scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize the leak and assess thoracic duct patency as well as to differentiate partial from complete thoracic duct transection. The aetiology of the CTx, flow rate and patient condition dictate the preferred management. Octreotide/somatostatin and etilefrine therapy is highly efficacious in the conservative management of CTx. For patients in whom conservative management fails, those who are good surgical candidates, and those in whom the site of the leak is well identified, surgical repair and/or ligation using minimally invasive techniques is highly successful with limited adverse outcomes. Similarly, if the site of the chylous effusion cannot be well visualized, a thoracic duct ligation via video-assisted thoracic surgery is the gold standard approach. A pleuroperitoneal or less often a pleurovenous shunt is a final option and may be curative in some patients.

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In Vivo Labeling of Serum Albumin for PET.

Gang Niu, Lixin Lang, Dale O. Kiesewetter … (2014)

The purpose of this study was to develop a novel in vivo albumin-labeling method to allow PET of cardiac function after myocardial infarction and vascular leakage and increased permeability in inflammatory diseases and malignant tumors.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Nucl Med

Journal ID (iso-abbrev): Clin Nucl Med

Journal ID (publisher-id): RLU

Title: Clinical Nuclear Medicine

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 0363-9762

ISSN (Electronic): 1536-0229

Publication date (Print): April 2016

Publication date (Electronic): 18 March 2016

Volume: 41

Issue: 4

Pages: 302-308

Affiliations

[1]From the *Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College; †Department of Nuclear Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China; and ‡Laboratory of Molecular Imaging and Nanomedicine, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD.

Author notes

Correspondence to: Zhaohui Zhu, MD, PhD, Department of Nuclear Medicine, Peking Union Medical College Hospital, No. 1 Shuaifuyuan, Wangfujing St, Dongcheng District, Beijing 100730, People’s Republic of China. E-mail: zhuzhh@ 123456pumch.cn ; Xiaoyuan Chen, PhD, National Institutes of Health, 35A Convent Dr, GD937, Bethesda, MD 20892. E-mail: shawn.chen@ 123456nih.gov .

Article

Publisher ID: RLU50386 Accession ID: 00008

DOI: 10.1097/RLU.0000000000001171

PMC ID: 4851227

PubMed ID: 26859218

SO-VID: 67899be7-38f3-4b90-ab81-5e4efcdde5b3

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

History

Date received : 29 December 2015

Date accepted : 3 January 2016

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Keywords: 68ga,chyloperitoneum,chylothorax,evans blue,lymphangioleiomyomatosis,lymphedema, chylothorax, chyloperitoneum,lymphoscintigraphy,pet/ct

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Keywords: 68ga, chyloperitoneum, chylothorax, evans blue, lymphangioleiomyomatosis, lymphedema, chylothorax, chyloperitoneum, lymphoscintigraphy, pet/ct

Potential Applications of Using 68Ga–Evans Blue PET/CT in the Evaluation of Lymphatic Disorder : Preliminary Observations

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Abstract

Purpose

Methods

Results

Conclusions

Related collections

NeuroImaging Methods

Most cited references 27

Lymphedema: a comprehensive review.

The changing management of chylothorax in the modern era.

In Vivo Labeling of Serum Albumin for PET.

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