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KMID : 1148920230570060265
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Nuclear Medicine and Molecular Imaging
2023 Volume.57 No. 6 p.265 ~ p.274
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Utility of 99mTc-Sulfur Colloid Lymphoscintigraphy and SPECT/CT in Chylothorax and Chylous Ascites
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Jasim Jaleel
Syeddharvesh Nasurudeen
Anushna Sunila Babu
Priyanka Gupta
Bangkim Chandra Khangembam
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Abstract
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Purpose : To assess the diagnostic efficacy of 99mTc-sulfur colloid lymphoscintigraphy in chylothorax and chylous ascites, and the utility of single-photon emission computed tomography-computed tomography (SPECT/CT) in localizing the sites of leaks.
Methods : Data from patients who underwent lymphoscintigraphy for clinical suspicion of chylothorax or chylous ascites were retrospectively analyzed. Biochemical fluid analysis was taken as the reference standard. Pleural fluid triglyceride level?>?110 mg/dL (with pleural fluid/serum ratio?>?1) and a cholesterol level??200 mg/dL with a low cholesterol level (ascites fluid/serum ratio?
Results : 26 patients (15 males, 57.7%) aged 9 months to 68 years were enrolled in the study. Based on the reference standard, 17 had chylothorax or chylous ascites (9 with surgical history). Lymphoscintigraphy was positive in 16 (with 1 false positive) and negative in 10 (with 2 false negatives). The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of lymphoscintigraphy were 88.2% (63.6?98.5%), 88.9% (51.8?99.7%), 80.0% (51.6?93.8%), 93.8% (70.1?99.0%), and 88.5% (69.9?97.6%), respectively. SPECT/CT could localize sites of leaks in 61.5% (8/13) with a localization rate of 77.8% (7/9) and 25.0% (1/4) in patients with surgical and nonsurgical causes, respectively.
Conclusion : 99mTc-sulfur colloid lymphoscintigraphy is a highly efficacious noninvasive modality to diagnose chylothorax or chylous ascites with a high positive predictive value. SPECT/CT could localize the sites of leaks more frequently in patients with surgical causes.
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KEYWORD
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Lymphoscintigraphy, SPECT/CT, Chylous effusion, Chyle leak, Chylothorax, Chylous ascites
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