title: Chylothorax and chylous ascites. Clinical utility of planar scintigraphy and tomographic imaging with SPECT/CT.
abstract: The aim was to analyze conventional planar scintigraphy and SPECT/CT in patients clinically suspicious for chylothorax or chylous ascites. Lymphoscintigraphy was performed for two reasons: first, to help diagnose chylothorax or -abdomen, by demonstrating diffuse uptake in fluid accumulations, and then secondly, to detect the site of leakage to test the prediction that additional use of SPECT/CT-technique improves upon the diagnostic value of planar lymphoscintigraphy in the baseline detection of thoraco-abdominal lymphatic disorders.
  
  
  METHODS
  From 7/2008-7/2014 a total of 24 consecutive patients (8 woman, 16 men; age, range 31-79 years) presenting with clinical symptoms suspicious for chylothorax and/or chylous ascites were examined by planar lymphoscintigraphy (n = 26) and additional tomographic SPECT/CT- (n = 22) or SPECT-technique (n = 2).
  
  
  RESULTS
  Chylothorax could be scintigraphically confirmed in n = 9, chylous ascites in n = 5 scintigraphies, and excluded in n = 10 patients. In all planar scintigraphy findings of pathological lymph drainage regions (n = 14), SPECT/CT delivered additional relevant information, notably the anatomic localization of the lymphatic leakage. For the baseline detection of thoraco-abdominal lymphatic transport disorders, lymphoscintigraphy showed sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 80%.
  
  
  CONCLUSIONS
  Our findings show that due to the particular advantages presented by tomographic separation of overlapping sources, SPECT/CT specifies better the anatomical sites, improving the localization of lymphatic leakage in aid of planning surgical re-interventions.
authors.affiliation: Mayo Weiss MD, Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistr.15, 81377 Muenchen, Germany, Tel. +49/(0)89/440 07 76 38, E-mail: mayo.weiss@med.uni-muenchen.de.
authors.forename: M
authors.initials: M
authors.lastname: Weiss
authors.forename: F
authors.initials: F
authors.lastname: Schwarz
authors.forename: J
authors.initials: J
authors.lastname: Wallmichrath
authors.forename: R
authors.initials: R
authors.lastname: Baumeister
authors.forename: A
authors.initials: A
authors.lastname: Frick
authors.forename: P
authors.initials: P
authors.lastname: Bartenstein
authors.forename: A
authors.initials: A
authors.lastname: Rominger
mesh_terms: D000328:Adult; D000368:Aged; D002916:Chylothorax / Q000175:diagnosis*; D002915:Chylous Ascites / Q000175:diagnosis*; D005260:Female; D006801:Humans; D061305:Lymphoscintigraphy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Chylothorax; SPECT/CT; chylous ascites; hybrid imaging; lymphoscintigraphy