Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492006000400008
Jornal Vascular Brasileiro
Original Article

Critérios semiquantitativos de análise da linfocintilografia em linfedema dos membros inferiores

Criteria for semi-quantitative analysis of lymphoscintigraphy in lower limb lymphedema

Marcelo Tatit Sapienza; Irene Shimura Endo; Giselle Christina Ferraro; Márcia Garrido Modesto Tavares; Guilherme de Carvalho Campos Neto; Henrique Jorge Guedes Neto; Shlomo Lewin; Marília Martins Silveira Marone

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Resumo

OBJETIVO: Avaliar se diferentes parâmetros de análise da linfocintilografia permitem a distinção entre membros com e sem linfedema em pacientes com quadro clínico de edema unilateral. MÉTODOS: Levantamento retrospectivo dos exames de 20 pacientes submetidos a linfocintilografia para investigação de edema unilateral de membros inferiores, divididos em pacientes com linfedema primário (grupo 1, n = 7) ou secundário pós-traumático (grupo 2, n = 13). Foi realizada linfocintilografia após injeção subdérmica de soroalbumina humana marcada com tecnécio-99m nos pés, com imagens da região inguinal durante 15 min e imagens dos membros inferiores após 15 min e 1 h. Os parâmetros analisados foram: tempo de aparecimento da cadeia inguinal, índice semiquantitativo (fluxo linfático, difusão intersticial, aspecto dos vasos, tempo de aparecimento e aspecto dos linfonodos inguinais) e inclinação da curva de atividade em função do tempo da região inguinal. As medidas nos membros clinicamente acometidos foram comparadas aos membros sem linfedema em ambos os grupos. RESULTADO: O tempo médio de aparecimento da cadeia inguinal e o índice semiquantitativo foram significativamente maiores nos membros com linfedema que nos membros sem linfedema quando considerados todos os pacientes, com maior retardo e índice semiquantitativo nos membros com linfedema do grupo 1 em relação aos do grupo 2. CONCLUSÃO: A análise do tempo de aparecimento da cadeia inguinal e o índice semiquantitativo fornecem parâmetros objetivos de avaliação do linfedema que podem auxiliar na detecção e seguimento dos pacientes com linfedema.

Palavras-chave

Cintilografia, linfedema

Abstract

OBJECTIVE: To evaluate whether different parameters could be used in the analysis of lymphoscintigraphy to distinguish affected from unaffected limbs in patients with unilateral edema. METHODS: Twenty patients who underwent lymphoscintigraphy for screening of unilateral lower limb edema were retrospectively assessed and divided into patients with primary lymphedema (group 1, n = 7) or secondary post-traumatic edema (group 2, n = 13). Technetium 99m-labeled human serum albumin was subdermally administered in the feet, followed by a dynamic lymphoscintigraphy of the pelvis during 15 min and static images of the lower limbs after 15 min and 1 h. Analyzed parameters were detection time of groin activity, semi-quantitative index (lymph flow, interstitial diffusion, aspect of vessels, detection time and aspect of inguinal lymph nodes) and slope of groin time-activity curve. The parameters of clinically affected limbs were compared to those of the contralateral limbs in both groups. RESULTS: Detection time of groin activity and semi-quantitative index were significantly higher in affected limbs considering all patients, with a more severe delay and a higher semi-quantitative index in group 1 compared to group 2. CONCLUSION: Analysis of detection time of groin activity and semi-quantitative index can add objective parameters that can be used in the diagnosis and follow-up of patients with lymphedema.

Keywords

Scintigraphy, lymphedema

References

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