Przydatność limfoscyntygrafii w ocenie rehabilitacji chorych z obrzękiem limfatycznym

Lymphoedema is the progressive accumulation of protein-rich fluid in the tissue, resulting froman anatomic or functional obstruction of the lymphatic system. Worldwide about 10 million people have lymphoedema secondary to breast and pelvic cancer therapy, recurrent infections, injuries or vascular surgery. The disease is frequently misdiagnosed treated too late or not treated at all. At the initial medical evaluation of patients with suspected extremity lymphoedema, it is highly desirable for physicians to define the abnormality; to determine whether the suspected abnormality is, in fact, a lymphatic one. The disease is often possible to be diagnosed by its characteristic clinical presentation, yet, in some cases, ancillary tests might be necessary to establish the diagnosis. The presentation overviews the problem of clinical basis, diagnosis and therapy of lymphoedema. Regarding diagnostics the measurement of circumference and volume of the limb are presented, as well as diagnostic imaging modalities. These include direct and indirect lymphography, MRI, CT, ultrasound imaging and lymphoscintigraphy, which are currently considered to be a leading technique in the primary diagnosis of lymphoedema and its follow-up. The paper presents the usefulness of lymphoscintigraphy in: - diagnosis of lymphatic oedema; - assessment of the efficacy of therapeutic methods; - prediction of the outcome of therapy; - assessment of the risk of development of lymphoedema. The role of lymphoscintigraphy in the management of lymphoedema will be probably growing for a few reasons: - the higher incidence of breast cancer and longer survival of patients; - the need of early diagnostic methods, evaluation of lymphoedema over a period of time, development of new therapeutic techniques and finding methods to assess objectively the effect of therapy