Clinical and Translational Imaging

, Volume 6, Issue 2, pp 135–143 | Cite as

Lower limb lymphoscintigraphy patterns among patients with lower limb lymphedema: a pictorial essay

  • Edward C. Nganga
  • Samuel Gitau
  • Khalid Makhdomi
Pictorial Essay
Part of the following topical collections:
  1. Lymphatic and hematological system



Lymphoscintigraphy is the imaging of choice in diagnosis of lymphedema. Diagnosis is made on the basis of qualitative assessment of tracer distribution at specified time points. A sound knowledge of the anatomy and function of the lymphatic system combined with understanding of tracer propagation and distribution through the lymphatic system is necessary for accurate diagnosis of lymphedema.

Technique and image findings

Lymphoscintigraphy at Aga Khan University Hospital (AKUH) is performed by intradermal injection of Tc 99m nanocolloid with planar imaging performed at 5, 15 min and 1½ h for reproducibility. Images are analyzed mainly by qualitative parameters that relate to tracer kinetics within the lymphatic system. We describe different image appearances which represent the various patterns of tracer distribution in normal lymphatics and with lymphedema.


Lymphoscintigraphy is a highly accurate and reproducible technique for the evaluation of the lymphedema. A thorough knowledge of the various imaging appearances on lymphoscintigraphy is necessary for proper interpretation of images. Addition of quantitative parameters would increase the accuracy.


Lymphedema Lymphoscintigraphy Qualitative analysis Quantitative analysis Nuclear medicine 


Compliance with ethical standards

Informed consent

Verbal and written informed consent was obtained from the patients or next of kin. The standard protocol including dosage, route of radiotracer injection and time to imaging were not altered. Potential patient identifiers were not used.

Conflict of interest

The authors have no conflict of interest to declare.


  1. 1.
    Moshiri M, Katz DS, Boris M, Yung E (2002) Using lymphoscintigraphy to evaluate suspected lymphedema of the extremities. Am J Roentgenol 178(2):405–412CrossRefGoogle Scholar
  2. 2.
    Keeley V (2006) The use of lymphoscintigraphy in the management of chronic oedema. J Lymphoed 1(1):42–57Google Scholar
  3. 3.
    Moffatt C, Franks P, Doherty D, Williams A, Badger C, Jeffs E et al (2003) Lymphoedema: an underestimated health problem. QJM 96(10):731–738CrossRefPubMedGoogle Scholar
  4. 4.
    Weissleder H, Weissleder R (1988) Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology 167(3):729–735CrossRefPubMedGoogle Scholar
  5. 5.
    Scarsbrook A, Ganeshan A, Bradley K (2007) Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphoedema. Br J Radiol 80(951):219–226CrossRefPubMedGoogle Scholar
  6. 6.
    Mohler ER, Mondry TE (2011) Lymphedema: prevention and treatment. UpToDate. Accessed 10 Sept 2016
  7. 7.
    Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C et al (2010) Intradermal lymphoscintigraphy at rest and after exercise: a new technique for the functional assessment of the lymphatic system in patients with lymphoedema. Nucl Med Commun 31(6):547–551PubMedGoogle Scholar
  8. 8.
    Williams WH, Witte CL, Witte MH, McNEILL GC (2000) Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema. Clin Nucl Med 25(6):451–464CrossRefPubMedGoogle Scholar
  9. 9.
    Szuba A, Rockson SG (1998) Lymphedema: classification, diagnosis and therapy. Vasc Med 3(2):145–156CrossRefPubMedGoogle Scholar
  10. 10.
    Ter S-E, Alavi A, Kim CK, Merli G (1993) Lymphoscintigraphy A reliable test for the diagnosis of lymphedema. Clin Nucl Med 18(8):646–654CrossRefPubMedGoogle Scholar
  11. 11.
    Andersson HC, Parry DM, Mulvihill JJ (1995) Lymphangiosarcoma in late-onset hereditary lymphedema: case report and nosological implications. Am J Med Genet 56(1):72–75CrossRefPubMedGoogle Scholar
  12. 12.
    Szczesny G, Olszewski WL, Gorecki A (2005) Lymphoscintigraphic monitoring of the lower limb lymphatic system response to bone fracture and healing. Lymph Res Biol 3(3):137–145CrossRefGoogle Scholar
  13. 13.
    Shenoy R (2008) Clinical and pathological aspects of filarial lymphedema and its management. Korean J Parasitol 46(3):119–125CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mohler ER et al (2013) Clinical manifestations and diagnosis of lymphedema. Accessed 12 Dec 2016
  15. 15.
    Warren AG, Brorson H, Borud LJ, Slavin SA (2007) Lymphedema: a comprehensive review. Ann Plast Surg 59(4):464–472CrossRefPubMedGoogle Scholar
  16. 16.
    Rijke AM, Croft BY, Johnson RA, de Jongste AB, Camps J (1990) Lymphoscintigraphy and lymphedema of the lower extremities. J Nucl Med Off Publ Soc Nucl Med 31(6):990Google Scholar
  17. 17.
    Sapienza MT, Endo IS, Ferraro GC, Tavares MG, Neto C, de Carvalho G, Guedes Neto HJ, Lewin S, Marone MM (2006) Criteria for semi-quantitative analysis of lymphoscintigraphy in lower limb lymphedema. J Vasc Bras 5(4):288–294CrossRefGoogle Scholar
  18. 18.
    Kramer EL (2004) Lymphoscintigraphy: defining a clinical role. Lymph Res Biol 2(1):32–37CrossRefGoogle Scholar

Copyright information

© Italian Association of Nuclear Medicine and Molecular Imaging 2018

Authors and Affiliations

  • Edward C. Nganga
    • 1
  • Samuel Gitau
    • 1
  • Khalid Makhdomi
    • 1
  1. 1.Agakhan University Hospital, NairobiNairobiKenya

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