Methodological Aspects of Lymphoscintigraphy: Bicompartmental Versus Monocompartmental Radiocolloid Administration

This chapter reviews the methodological aspects of peripheral lymphoscintigraphy. Advantages and disadvantages of intradermal versus subcutaneous radiopharmaceutical administration and subfascial injections are discussed. The protocol currently used at our site for bicompartmental peripheral lymphoscintigraphy, enabling investigation of the deep lymphatic circulation first followed by evaluation of the superficial lymphatic circulation, is described. Imaging protocols for peripheral lymphoscintigraphy as well as for intracavitary lymph effusions with the most widely employed stress tests to enhance lymphatic flow are also reviewed. Interpretation and reporting by visual qualitative analysis and by semiquantitative evaluation are carefully reported and discussed. The basic concepts of imaging lymphatic circulation with PET/CT, PET/MR, CT, and indocyanine green are also presented and discussed.