Diagnostic Radiology Tests

How do you get diagnosed with lymphedema?

Is there a "test" for lymphedema?

There is a question that is asked continuously in the online groups I am a member of is, "Is there a test that can be done to accurately determine whether or not you have lymphedema?"

Yes, there is. It us called lymphoscintigraphy. In this procedure radioactive dye is injected into the swollen limb. The substance then travels and is tracked until it reaches the lymphatic obstruction.

It is safe because it is minimally invasive. It is accurate and from this test, the lymphedema can be classified by type, hyperplasia, hypoplasia, or absence of lymphatics.

There are only two downsides to the test. It has to be done separately for each limb that is affected and it won't pick up the deeper lymphatics. These deeper lymphatics are responsible for the transport of about 10% of the bodies fluid.

This page gives basic info on the more common radiology tests and provides additional links for further study.

Pat O'Connor

May 11, 2008

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TESTING FOR LYMPHEDEMA - LYMPHATIC OBSTRUCTIONS

LYMPHOSCINTIGRAPHY

DEFINITION: A method used to identify the sentinel node (the first draining lymph node near a tumor). A radioactive substance that can be taken up by lymph nodes is injected at the site of the tumor, and a doctor follows the movement of this substance on a computer screen. Once the lymph nodes that have taken up the substance are identified, they can the fluid movement and discern which lymphatics are viable, which have damaged and even if important lymph nodes are missing.

LYMPHOSCINTIGRAPHY - The Procedure

Lymphatic mapping is the first of this three-part investigation. No anesthetic is required for this component of the assessment. It is performed in the Department of Nuclear Medicine by the surgeon and a medical physicist. The procedure is carefully explained to the patient who then lies on the imaging table with the appropriate anatomical site exposed. The surgeon injects 0.4mll (20 megaBecquerels) of technetium (Tc 99) unfiltered sulfur colloid intradermally in to four quadrants (0.1ml each) around the melanoma scar.

The patient is then positioned under the scanner and dynamic images obtained . This early phase dynamic scanning shows the lymphatic channels and the sentinel node(s) as they appear in sequence. This is carried out for 20 minutes. The patient is then asked to walk about in the hospital for approximately one hour.

A late phase scanning of the basin is done ninety minutes after the injection

INTRADERMAL BLUE DYE INJECTION

This is done on the operating table in theatre while the patient is under anesthesia (if general anesthesia is used) or before the local anesthetic infiltration. Vital blue dye (0.1 ml) is injected in to each of four quadrants around the melanoma scar (Figure 4). The surgeon scrubs and gowns while the operation site is prepared, thus, allowing time for the dye to reach the sentinel lymph node via the afferent lymphatics. This process takes 10-20 minutes in the lower limb and up to 30 minutes in the upper limb.

Society of Nuclear Medicine

See also: Lymphoscintigraphy

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Procedure Guidelines for Lymphoscintigraphy

Society of Nuclear Medcicine

http://interactive.snm.org/docs/pg_ch24_0403.pdf

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Feasibility of preoperative lymphoscintigraphy for identification of sentinel lymph nodes in patients with conjunctival and periocular skin malignancies.

Amato M, Esmaeli B, Ahmadi MA, Tehrani MH, Gershenwald J, Ross M, Holds J, Delpassand E.

Abstract

http://www.ncbi.nlm.nih.gov/pubmed/12644754

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LYMPHANGIOGRAM

This test is a specialized X-ray of the lymph nodes. It is not done so often now that CT scans and MRI scans can be used to check lymph nodes. But it may sometimes be necessary. You are most likely to have this test if you are being investigated for non-Hodgkin's lymphoma or Hodgkin's disease.

You can have a lymphangiogram of the lymph nodes in any part of the body. The test is done in the hospital X-ray department. It takes about 2-3 hours. It is not painful, but can be uncomfortable and tiring.

To show up the lymph nodes on the X-ray, a dye must be injected into the lymph vessels. This is usually done in the skin of the feet. A local anesthetic is injected first and then the dye. The dye travels through the lymphatic system and into the lymph nodes. Once the dye is in the lymph nodes, X-rays are taken. Any lymph nodes that contain cancer will show up as enlarged on the X-ray.

You may be asked to stay lying down for an hour or two after the test. You will probably be able to go home the same day.

You may have one or two side effects from the lymphangiogram. Your

Skin may look a slightly blue or green color
Urine may look slightly blue or green
These side effects are nothing to worry about and will disappear within 48 hours.

The results
It can take time for test results to come through. How long will depend on why you are having the scan. Usually, the scan is examined by a specialist in radiography and a report typed up. The report is then sent to your specialist, who will then give the results to you.

*Editor's Note: This test has been replaced by Lymphoscinitgraphy

The contrast agent used in a lymphangiogram caused secondary complications for patients with lymphedema and under no circumstance should a physician be using it today.

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Lymphangiogram

Medical Encyclopedia

A lymphangiogram is used to evaluate the possible spread of cancers and the effectiveness of cancer therapy. The X-rays may also help determine the cause of swelling in an arm or leg and check for parasitic diseases. The test is performed by injecting blue dye into an area to be tested. The blue dye helps to locate the lymphatic vessels where the catheter will be placed. Once the lymph vessels are found, contrast medium is injected through the catheter and X-rays are taken to monitor its progress as it spreads through the lymph system up the legs, into the groin, and along the back of the abdominal cavity. The next day, another set of X-rays is taken

http://www.nlm.nih.gov/medlineplus/ency/imagepages/9605.htm

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Lymphangiogram, Lymphangiography, Lymphography

http://www.1uphealth.com/health/lymphangiogram_info.html

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The Diagnosis and Treatment of Peripheral Lymphedema

http://www.u.arizona.edu/~witte/2003consensus.pdf

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Diagnosis of an early (latent) stage of secondary lymphedema of the arm - a necessary condition for its successful treatment

http://www.mucos.cz/eng/onko/dessla_e.html

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Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients

Abstract

H Weissleder and R Weissleder
Department of Radiology, Kreiskrankenhaus Emmendingen, Federal Republic of Germany

http://radiology.rsnajnls.org/cgi/content/abstract/167/3/729

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Radiology Diagnostic Aids in Lymphedema

Lymphedema can be diagnosed by physical examination, but diagnostic methods may be used to verify the diagnosis.

• Computed tomography (CT) can establish the diagnosis of lymphedema quickly by showing cross-sections of tissue. It is noninvasive.

• Duplex imaging can be used to rule out chronic venous insufficiency. A duplex study is a noninvasive ultrasound technique that uses sound waves (1) to obtain a picture of the veins (a B-mode image) and (2) to determine the velocity and direction of flow within the vein. It is the least expensive and most noninvasive technique.

• Lymphoscintigraphy can show the obstructed or deficient lymphatic vessels by injection of a radioactive agent into skin near the digits

• Lymphangiography shows abnormalities of the lymph nodes by means of x-rays of lymphatic vessels. Neither lymphoscintigraphy nor lymphangiography can detect cancer

Lymphatic abnormalities have been found in nearly all patients with severe chronic venous insufficiency. This is not necessarily lymphedema, but it is lymphatic damage resulting from increased vascular pressure.

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Sonography

http://www.sonography.net/

============= http://www.lymphedemapeople.com/thesite/lymphedema_diagnostic_radiology_tests.htm

Fluoroscopy Sonography

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Fluoroscopy Procerure

http://healthlibrary.brighamandwomens.org/Library/Encyclopedia/92,P07662

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Fluoroscopy - Eadiation-Emitting Products

FDA
http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115354.htm

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Ultrasound

One potentially fatal complication of lymphedema, particularly late stage lymphedema is thrombosis (blood clot). Ultrasounds provide a quick, safe and noninvasive reading of the overall blood flow in the affected lymphedema limb.

If an ultrasound show circulatory problems, then your doctor may initiate further testing to find specifically where the problem is and how serious it might be.

This procedure uses high frequency sound waves to assess tissues and organs. This test is used frequently to diagnose lymph node disorders secondary to its availability and is considered risk-free. It is primarily used for non-invasive depiction of enlarged lymph nodes.

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Focused Ultrasound (FUS)

http://www.healthsystem.virginia.edu/pub/fus/moreinfo.html

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Ultrasound - General

Mayo Clinic

http://www.mayoclinic.com/health/ultrasound/MY00308

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Venogram

What is a venogram?
* A venogram is a procedure that looks at your blood vessels (veins) by injecting x-ray dye and taking x-rays.

Why do I need a venogram?
* Your doctor has found a problem with the blood flow, through your veins, back to your heart.

Where is the venogram performed?
* It is performed in the Interventional Radiology Department.

Who will perform the venogram?
* A specially trained interventional radiologists.

What can I expect before the venogram?
* You will be seen in our clinic by one of our doctors and/ or nurse clinicians, who will obtain a health history, perform a brief physical exam, explain the procedure, and answer your questions.
* You will have blood drawn.
* You may to have a CT (computed tomography) scan and/ or ultrasound exam.
* You will have an IV (intravenous catheter) started on the day of your test.
* You will sign a consent form.

What can I expect during the venogram?
* You will be attached to a monitor so that IV medicine can be given to relax you.
* The doctor will numb the skin with a special medicine through a needle. He will insert a small tube into the vein he needs to view.
* The doctor will inject x-ray dye and take x-rays.
* You will feel a warm sensation from the dye.
* The doctor will view your x-rays on a TV monitor. This will help the doctor decide what is causing the problem.

What can I expect after the venogram?
* You will return to our recovery area.
* After your venogram , your IV will be taken out and you can go home.
* If the vein was fixed, you will be admitted to the hospital overnight. You will be observed closely for bleeding and proper blood flow through the vein.

What are the risks of having a venogram?
* Bleeding at the puncture site.
* Infection at the puncture site.

What are the benefits of having a venogram?
* So your doctor knows the exact reason why the blood is not flowing properly back to your heart.

What are the alternatives to having a venogram?
* The venogram is the best test.

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Venogram

http://www.webmd.com/a-to-z-guides/venogram

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Venogram - leg

by Todd A. Gould, RT-(R)(MR)(ARRT)

http://www.nlm.nih.gov/medlineplus/ency/article/003773.htm

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Magnetic Resonance Imaging (MRI)

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Introduction to MRI - How MRI Works

http://www.mritutor.org/mritutor/

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Magnetic Resonance Imaging (MRI)

MRI GLOSSARY

http://fonar.com/glossary.htm

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Computerized Axial Tomography

CT Scans

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CT Scans

http://www.colorado.edu/physics/2000/tomography/

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How CAT Scans Work

by Tom Harris

http://science.howstuffworks.com/cat-scan.htm

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Computerized Axial Tomography
(CAT Scan/CT Scan)

http://www.medicinenet.com/CAT_Scan/article.htm

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PET - Positron Emission Tomography

http://www.nationalpetscan.com/petref.htm

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PET Scanning

Bodyscan.md

http://www.nationalpetscan.com/patients/

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Angiogram

http://www.webmd.com/heart-disease/angiogram

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Angiogram

http://www.vascularweb.org/vascularhealth/Pages/angiogram.aspx

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Diagnostic Nuclear Medicine Examinations: Radioisotope Scintillation Scanning (Scintiscan)

In nuclear medicine, radioactive substances known as radioisotopes are administered to the patient in order to diagnose disease. A radioactive isotope disintegrates spontaneously (ultimately losing its radioactivity) and emits gamma rays from within the body which enable the physician to visualize internal abnormalities. This differs from x-ray procedures where the x-rays are passed through the body from an external source.

Examples of radioactive isotopes, commonly used for isotope-imaging studies, are gallium, iodine, and technetium. Sometimes non-radioactive compounds are simply labeled or tagged with a radioactive isotope and sometimes radioactive tracers (radioactive pharmaceuticals) are given by mouth or by vein. Some of the isotopes are selectively absorbed by tumors or by specific organs in the body. The concentrated radioisotopes outline the tumor or organ making it visible

on the photoscanner by the emission of the radioactive energy. Much research in nuclear medicine is concerned with attempts to find new radioisotopes and to develop radioisotope-labeled compounds that will be selectively absorbed in specific parts of the body.

A device called a photoscanner is used to measure the radioactivity from the nuclear substance absorbed by various parts of the body. A two dimensional representation or map can be made of the rays emitted from the radioisotope which shows where it is concentrated in the body tissue. Findings of such an examination are photographically recorded and are referred to as scans. The more common scans are illustrated in the diagram on the next page (Diagnostic Imaging -- Nuclear Medicine), -- bone, kidney, thyroid, brain, salivary glands, heart/lung, liver/spleen, and total body. Bone scanning with various bone-seeking isotopes is advocated for earlier diagnosis of bone metastasis. Other names for these types of scans are scintiscan, gallium scan, and lymphoscintography.

NCI

http://training.seer.cancer.gov/abstracting/procedures/clinical/nuclear/

======External Links===========

Near-infrared fluorescence imaging of lymphatics in head and neck lymphedema.

Mar 2012

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Internal Lymphedema People Links and articles on radiology:

Lymphoscintigraphy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy

Ultrasound

http://www.lymphedemapeople.com/wiki/doku.php?id=ultrasound

Magnetic Resonance Imaging

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging

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See also:

Edema

http://www.lymphedemapeople.com/wiki/doku.php?id=edema

Edema and Chronic Venous Insufficiency

http://www.lymphedemapeople.com/thesite/edema_chronic_venous_insufficiency.htm

Edema and Deep Venous Thrombosis

http://www.lymphedemapeople.com/thesite/lymphedema_deep_venous_thrombosis.htm

Edema and Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

http://www.lymphedemapeople.com/thesite/edema_and_reflex_sympathetic_dystrophy.htm

Edema and Venous Pooling

http://www.lymphedemapeople.com/thesite/edema_and_venous_pooling.htm

Angioedema

http://www.lymphedemapeople.com/wiki/doku.php?id=angioedema

Edema of the Neck

http://www.lymphedemapeople.com/thesite/lymphedema_of_the_neck.htm

Edema and Nephrotic Syndrome

http://www.lymphedemapeople.com/thesite/edema_nephrotic_syndrome.htm

Edema of the Face

http://www.lymphedemapeople.com/thesite/edema_of_the_face.htm

Thrombophlebitis

http://www.lymphedemapeople.com/wiki/doku.php?id=thrombophlebitis

Edema and Diabetes

http://www.lymphedemapeople.com/thesite/lymphedema_and_diabetes.htm

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Join us as we work for lymphedema patients everywehere:

Advocates for Lymphedema

Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.

http://health.groups.yahoo.com/group/AdvocatesforLymphedema/

Subscribe:

AdvocatesforLymphedema-subscribe@yahoogroups.com

Pat O'Connor

Lymphedema People / Advocates for Lymphedema

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For information about Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\

For Information about Lymphedema Complications

http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema

For Lymphedema Personal Stories

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3

For information about How to Treat a Lymphedema Wound

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound

For information about Lymphedema Treatment

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment

For information about Exercises for Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema

For information on Infections Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema

For information on Lymphedema in Children

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

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Lymphedema People - Support Groups

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Children with Lymphedema

The time has come for families, parents, caregivers to have a support group of their own. Support group for parents, families and caregivers of chilren with lymphedema. Sharing information on coping, diagnosis, treatment and prognosis. Sponsored by Lymphedema People.

http://health.groups.yahoo.com/group/childrenwithlymphedema/

Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com

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Lipedema Lipodema Lipoedema

No matter how you spell it, this is another very little understood and totally frustrating conditions out there. This will be a support group for those suffering with lipedema/lipodema. A place for information, sharing experiences, exploring treatment options and coping.

Come join, be a part of the family!

http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515

Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com

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MEN WITH LYMPHEDEMA

If you are a man with lymphedema; a man with a loved one with lymphedema who you are trying to help and understand come join us and discover what it is to be the master instead of the sufferer of lymphedema.

http://health.groups.yahoo.com/group/menwithlymphedema/

Subscribe: menwithlymphedema-subscribe@yahoogroups.com

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All About Lymphangiectasia

Support group for parents, patients, children who suffer from all forms of lymphangiectasia. This condition is caused by dilation of the lymphatics. It can affect the intestinal tract, lungs and other critical body areas.

http://health.groups.yahoo.com/group/allaboutlymphangiectasia/

Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com

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Lymphatic Disorders Support Group @ Yahoo Groups

While we have a number of support groups for lymphedema... there is nothing out there for other lymphatic disorders. Because we have one of the most comprehensive information sites on all lymphatic disorders, I thought perhaps, it is time that one be offered.

DISCRIPTION

Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of information available through sister site Lymphedema People.

http://health.groups.yahoo.com/group/lymphaticdisorders/

Subscribe: lymphaticdisorders-subscribe@yahoogroups.com

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Lymphedema People New Wiki Pages

Have you seen our new “Wiki” pages yet? Listed below are just a sample of the more than 140 pages now listed in our Wiki section. We are also working on hundred more. Come and take a stroll!

Lymphedema Glossary

http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing

Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema

Arm Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema

Leg Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema

Acute Lymphedema

http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema

The Lymphedema Diet

http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet