DIAGNOSTIC VALUE OF VISUALIZATION OF THE LYMPHATIC SYSTEM WITH CHRONIC LYMPHATIC EDEMA OF THE LOWER EXTREMITIES
. The imaging technique of lymphoscintigraphy is currently the "gold standard" for the diagnosis of lymphatic edema, however, the lack of a standard protocol for conducting the study and interpreting the results makes it difficult to widely apply this method in Russian practice. The aim of the study was to develop clinical diagnostic criteria for chronic lymphatic edema of the lower extremities based on morphofunctional disorders of lymphatic transport detected by lymphoscintigraphy. Materials and methods of research. To visualize the lymphatic outflow from the lower extremities, isotopic lymphoscintigraphy was used according to the research protocol developed by us using a labeled colloidal isotope of technetium (Tc - 99m) at a dose of 600 MBq and obtaining a sequential series of images of both limbs: early - 20 minutes after injection of the radiopharmaceutical and delayed - 2 hours after injection using hybrid SPECT-CT scanner (Simens Symbia T16, Germany). A qualitative and semi - quantitative assessment of lymphatic transport and morphofunctional changes in lymphatic vessels and lymph nodes of the lower extremities was carried out with the calculation of the transport index using the Kleinhans method (1985) for each limb. Results and their discussion. Lymphoscintigraphy was performed in 160 patients with chronic lymphatic edema of the lower extremities (320 limbs). The indicators of visualization of the intact lymphatic system according to lymphoscintigraphy were determined - this is symmetrical timely evacuation and movement of radiopharmaceutical in the extremities, visualization of lymphatic vessels throughout the limb, early visualization of regional lymph nodes: within 15 - 20 minutes. Qualitative lymphoscintigraphy revealed the following morphofunctional disorders of the lymphatic system of the lower extremities: asymmetric visualization of regional lymph nodes and collectors; lack of visualization of regional lymph nodes and collectors, cutaneous backflow; intermittent, dilated lymphatic collectors; collateral lymphatic collectors; reduction in the number of regional lymph nodes; radiopharmaceutical depot in the soft tissues of the lower extremities. With a semiquantitative assessment of lymphatic transport, the average indicators of the transport index were calculated for various clinical forms of chronic lymphatic edema of the lower extremities: with classical lymphedema, the transport index was 31.08±1.56 points, with phlebolymphedema - 18.69± 1.31 points, with lipolymphedema - 8.68± 0.60 points, with lymphedema associated with cancer treatment - 42.0± 0.64 points. The sensitivity of qualitative lymphoscintigraphy in the diagnosis of lymphedema is 78.0%, quantitative lymphoscintigraphy is 100%. Conclusion. The value of the methods of visualization of lymphatic transport is invaluable at the stage of stratification of the risks of edema progression, planning of patient management tactics, building correct rehabilitation programs and monitoring of lymphatic edema. A long - term personalized rehabilitation program based on the identified defects in the contrast of lymph nodes and lymph vessels will prevent the progression of the disease and the development of advanced stages, as well as increase the effectiveness of treatment.