Quantitative imaging in medicine and surgery · 2026
Diagnostic value of combined computed tomography lymphangiography and technetium-99m dextran lymphoscintigraphy in systemic lupus erythematosus complicated with chylous effusion and/or lymphedema.
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Guo Lifang, Zhang Chunyan, Sun Ying, Sun Yuguang, Wen Zhe, Guo Jia, Yan Xuan, Wang Mengjun, Yang Lei, Wang Rengui, Yue Yunlong
Аннотация
BACKGROUND: When systemic lupus erythematosus (SLE) affects the lymphatic system, it disrupts the normal physiological function of the lymphatic circulation, leading to clinical chylous effusion and lymphedema. Currently, the computed tomography lymphangiography (CTL) or technetium-99m dextran (99Tcm-DX) lymphoscintigraphy features of patients with SLE complicated by chylous effusion and lymphedema have not been published, and studies on the imaging features of different subtypes are lacking. This study aimed to analyze the imaging characteristics of CTL and 99Tcm-DX lymphoscintigraphy in 23 patients with SLE complicated with chylous effusion and/or lymphedema, and describe the differences in imaging findings among different subtypes, so as to provide a reference for the clinical understanding of this disease.
METHODS: A retrospective analysis was conducted on the clinical and imaging data of 23 patients with SLE complicated by chylous effusion and/or lymphedema. All patients underwent CTL and 99Tcm-DX lymphoscintigraphy. The patients were divided into three subgroups: chylous effusion (n=19), chylous effusion and lymphedema (n=3), and lymphedema (n=3). The signs of lymphatic abnormalities detected by the two examinations were compared using the McNemar test (with the exact probability method), and diagnostic consistency was evaluated using the kappa test (P<0.05 was considered statistically significant), and the differences in imaging features among the subgroups were described.
RESULTS: No significant differences were found between CTL and 99TCm-DX lymphoscintigraphy in depicting thoracic duct outlet obstruction, thoracic segment tortuosity or dilation of the thoracic duct, left subclavian trunk visualization, abnormal perineal distribution, chylothorax, or chylous ascites (P>0.05), with kappa values of 0.623, 0.862, 0.511, 0.646, 0.425, and 0.777, indicating diagnostic agreement levels of good, almost perfect, good, good, moderate, and good, respectively. However, the two methods differed significantly in showing combined chylothorax and chylous ascites (P<0.05), with minor diagnostic agreement (kappa =0.157). CTL additionally identified contrast extravasation in the left cervical trunk, mediastinum, lung, perirenal, and peritoneal areas, as well as iliac and lumbar trunk dilation, which were not detected by lymphoscintigraphy. Subgroup analysis showed that the chylous effusion group mainly exhibited lesions of the thoracic duct, iliac lymphatic vessels, and lumbar trunks; the chylous effusion and lymphedema group displayed multi-region involvement with abnormal lower-extremity lymphatic reflux; and the lymphedema group had thoracic duct outlet obstruction and distal lymphatic occlusion in the affected limb.
CONCLUSIONS: CTL demonstrates subtle morphological abnormalities of lymphatic vessels and provides precise anatomical localization. 99TCm-DX lymphoscintigraphy is useful for dynamically evaluating lymphatic drainage and detecting chylous effusion. The two modalities are complementary and provide comprehensive information for SLE complicated by chylous effusion and/or lymphedema. Distinct imaging patterns among the three subgroups may support clinical subtyping of this condition.
METHODS: A retrospective analysis was conducted on the clinical and imaging data of 23 patients with SLE complicated by chylous effusion and/or lymphedema. All patients underwent CTL and 99Tcm-DX lymphoscintigraphy. The patients were divided into three subgroups: chylous effusion (n=19), chylous effusion and lymphedema (n=3), and lymphedema (n=3). The signs of lymphatic abnormalities detected by the two examinations were compared using the McNemar test (with the exact probability method), and diagnostic consistency was evaluated using the kappa test (P<0.05 was considered statistically significant), and the differences in imaging features among the subgroups were described.
RESULTS: No significant differences were found between CTL and 99TCm-DX lymphoscintigraphy in depicting thoracic duct outlet obstruction, thoracic segment tortuosity or dilation of the thoracic duct, left subclavian trunk visualization, abnormal perineal distribution, chylothorax, or chylous ascites (P>0.05), with kappa values of 0.623, 0.862, 0.511, 0.646, 0.425, and 0.777, indicating diagnostic agreement levels of good, almost perfect, good, good, moderate, and good, respectively. However, the two methods differed significantly in showing combined chylothorax and chylous ascites (P<0.05), with minor diagnostic agreement (kappa =0.157). CTL additionally identified contrast extravasation in the left cervical trunk, mediastinum, lung, perirenal, and peritoneal areas, as well as iliac and lumbar trunk dilation, which were not detected by lymphoscintigraphy. Subgroup analysis showed that the chylous effusion group mainly exhibited lesions of the thoracic duct, iliac lymphatic vessels, and lumbar trunks; the chylous effusion and lymphedema group displayed multi-region involvement with abnormal lower-extremity lymphatic reflux; and the lymphedema group had thoracic duct outlet obstruction and distal lymphatic occlusion in the affected limb.
CONCLUSIONS: CTL demonstrates subtle morphological abnormalities of lymphatic vessels and provides precise anatomical localization. 99TCm-DX lymphoscintigraphy is useful for dynamically evaluating lymphatic drainage and detecting chylous effusion. The two modalities are complementary and provide comprehensive information for SLE complicated by chylous effusion and/or lymphedema. Distinct imaging patterns among the three subgroups may support clinical subtyping of this condition.