Seyhan KARAÇAVUŞ, Ahmet TUTUŞ, Mustafa KULA

LENFÖDEMİN DEĞERLENDİRİLMESİNDE RADYONÜKLİD LENFOSİNTİGRAFİ

ÖZET Lenfödem, lenf sıvısını taşıyan lenf kanalları ile lenf düğümlerinin doğuştan ya da sonradan hasa- ra uğramasına bağlı olarak lenfatik transportta meydana gelen yetmezlik sonucu gelişen ödemle karakterize, kronik, ilerleyici, sıklıkla geç tanı alan bir hastalıktır. Lenfatik yetmezlik sonucu cilt ve ciltaltı dokuda proteinden zengin sıvının aşırı birikimi mevcuttur. Klinik tanı dışında lenfatik akım ve drenaj yerleri lenfosintigrafi ile değerlendirilebilir. Lenfatik görüntüleme, ekstremitede meydana gelen şişliğin etyolojisinin belirlenmesinde ve tedavi başarısını öngörmede önemli rol oynayabilir. Lenfosintigrafi, lenfatik sistemin temel fonksiyonlarından biri olan, büyük moleküllerin interstisyel mesafeden vasküler kompartmana geri taşınması esasına dayanır. Tc-99m ile bağlı protein veya kolloid gibi radyoaktif bir madde interstisyel mesafeye enjekte edildiğinde, bu madde ilk olarak lenfatik kanallara, sonra bölgesel lenf nodlarına geçer ve gama kamera ile görüntüleme yapılarak lenfatik yollar ve fonksiyonun değerlendirmesi sağlanabilir. Bu nedenle lenfosintigrafinin, lenföde- min tanısında ve lenfatik sistemin görüntülenmesinde temel yöntem olduğu düşünülmektedir.

Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema

ABSTRACT Lymphedema is a chronic debilitating progressive disease characterized with edema, that results from impaired lymphatic transport caused by injury to the lymphatics, seconder or congenital ab- normality and is frequently misdiagnosed. It consists of excess protein-rich interstitial fluid within the skin and subcutaneous tissue resulting from lymphatic dysfunction. Besides clinical diagnosis, lymphatic flow and sites of lymph drainage can readily be evaluated with lymphoscintigraphy. Lymphatic imaging can play a pivotal role in defining the etiology of extremity swelling and in predicting the success of common therapies. Lymphoscintigraphy relies on one of the essential functions of the lymphatic system that is to transport large molecules from the interstitial space back to the vascular compartment. If a large molecule such as a protein or colloid with a radioactive label e.g., Tc-99m is injected into the in- terstitial space, its transport through the initial lymphatics, the collectors and region lymph nodes, can be followed using the gamma camera to detect the radioactivity which provides a picture of lymphatic function and pathways. So, lymphoscintigraphy is widely considered to be the main investigation to establish the diagnosis of lymphedema and visualize peripheral lymphatics.

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