par Bourgeois, Pierre ;Munck, Denis ;Becker, Corinne;Leduc, Olivier ;Leduc, Albert
Référence The European journal of lymphology and related problems, 6, 21, page (10-21)
Publication Publié, 1997
Article révisé par les pairs
Résumé : A three-phase lymphoscintigraphic investigation protocol of the lower limb edemas had been developped and its normalcy established on normal young healthy volunteers. The repective contributions of the three phases had however not been analyzed and the specificity and sensitivity of the protocol not evaluated in patients. The specificity of the protocol was analyzed in 97 limbs (of 77 patients) with no edema and without any suspected lymphatic abnormality. No Morphological Abnormality (MA) of the lymphatic system was observed in that group and extraction (at the level of the injection sites : E) was normal in all. In a single case, the tracer did not reach the first inguinal node at the end of phase 1 (30 min after the subcutaneous injection of the 99mTc labeled HSA nanocolloids in the first interdigital space of the feet and the limbs being at rest and recumbent). On the other hand, sensitivity of the protocol was evaluated in 47 patients with unilateral edema. At the end of phase 3 (one hour of walking after phase 2), MA were noted in 37 of the 47 edematous limbs (sensitivity = 78%) and in 4 of the contralateral non edematous ones. Specificity based on the absence of MA thus was at least equal to 91%. On the other hand, E was abnormal in 50% of the edematous limbs but in one third of the contralateral non oedematous one too. When the results of phases 1 and 2 (5 min of tiptoeing after phase 1) were taken into account, sensitivity was at least 94%. The proposed 3 phases lymphoscintigraphic investigation protocol that includes morphological as well as functional data obtained in various conditions was thus confirmed to be specific and sensitive for the evaluation of limbedemas.

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