Reverse Lymphatic Flow in Lower Extremity Lymphedema Visualized on Single-Photon Emission Computed Tomography-A...

Area of Science:

• Oncology
• Radiology
• Lymphology

Background:

• Pelvic lymphadenectomy for gynecologic and genitourinary cancers increases lymphedema risk.
• Bilateral lower extremity lymphedema is uncommon despite total lymphadenectomy.
• Understanding lymph flow dynamics is crucial for managing post-surgical lymphedema.

Purpose of the Study:

• To investigate lymph flow physiology in patients with lower extremity lymphedema post-pelvic lymphadenectomy.
• To identify the presence and patterns of retrograde lymphatic flow using advanced imaging.
• To correlate radiologic findings with clinical presentation in lymphedema patients.

Main Methods:

• Retrospective analysis of patients treated for lower extremity lymphedema from January 2017 to December 2018.
• Evaluation of 10 patients with a history of pelvic lymphadenectomy using single-photon emission computed tomography (SPECT).
• Subdermal radioisotope injection into the healthy foot, followed by SPECT imaging after 4 hours to assess lymph transport and identify retrograde flow.

Main Results:

• The majority of patients had undergone surgery for gynecological malignancies.
• Pelvic and hip lymphatic retention was observed in 70% of patients.
• Retrograde lymphatic flow towards the affected limb was detected in 60% of the evaluated patients.

Conclusions:

• SPECT-CT imaging effectively visualizes lymphatic abnormalities after pelvic lymphadenectomy.
• Retrograde lymphatic flow is a significant finding in a substantial proportion of patients with unilateral lower extremity lymphedema.
• These findings enhance the understanding of lymphedema pathophysiology and may inform future treatment strategies.