AJR Get Involved! Join ARRS Today
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by O'Mahony, S.
Right arrow Articles by Peters, A. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by O'Mahony, S.
Right arrow Articles by Peters, A. M.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
DOI:10.2214/AJR.04.1341
AJR 2006; 186:1349-1355
© American Roentgen Ray Society

Original Research

Imaging of Lymphatic Vessels in Breast Cancer–Related Lymphedema: Intradermal Versus Subcutaneous Injection of 99mTc-Immunoglobulin

Susan O'Mahony1,2, Chandra K. Solanki2, Robert W. Barber2, Peter S. Mortimer3, Arnie D. Purushotham1 and A. Michael Peters2,4

1 Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK.
2 Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge, UK.
3 Department of Medicine, St. George's Hospital, London, UK.
4 Department of Nuclear Medicine, Royal Sussex County Hospital, Eastern Rd., Brighton BN2 5BE, UK.

OBJECTIVE. The disordered physiology that results from axillary lymph node clearance surgery for breast cancer and that leads to breast cancer–related lymphedema is poorly understood. Rerouting of lymph around the axilla or through new pathways in the axilla may protect women from breast cancer–related lymphedema. The aim of the study was to compare intradermal with subcutaneous injection of technetium-99m (99mTc)–labeled human polyclonal IgG (HIG) with respect to lymphatic vessel imaging.

MATERIALS AND METHODS. Six women with breast cancer–related lymphedema underwent unilateral upper limb lymphoscintigraphy, using a web space injection of 99mTc-labeled HIG, after intradermal and subcutaneous injections on separate occasions. Multiple sequential images were obtained of the affected upper limb and torso over 3 hr on each occasion. Accumulation of activity in blood was quantified from venous blood samples taken from the opposite arm.

RESULTS. Imaging after intradermal injection clearly showed discrete lymphatic vessels in five of six patients, in contrast to imaging after subcutaneous injection, which did not show any discrete vessels in any patient. Intradermal injection resulted in more rapid visualization of cutaneous lymph rerouting than subcutaneous injection in six of six patients. Recovery of injected 99mTc-labeled HIG in venous blood was greater after intradermal injection in six of six patients.

CONCLUSION. In patients with breast cancer–related lymphedema, lymphatic vessels are more clearly depicted after intradermal than subcutaneous injection as a result of direct access of radiotracer to dermal lymphatics. This finding has implications for imaging lymphatic vessel regeneration and lymph rerouting.

Keywords: breast cancer–related lymphedema • intradermal injection • lymphangiography • lymphoscintigraphy • lymph nodes • oncologic imaging • subcutaneous injection • 99mTc-HIG


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by the American Roentgen Ray Society.