ABSTRACT
Radionuclide lymphoscintigraphy (LSG) remains the gold standard investigation for the diagnosis of primary lymphedema affecting the limbs. However, there is no internationally recognized standard protocol for either qualitative or quantitative LSG. The development of such a protocol, especially for quantitative LSG, would improve the diagnostic accuracy of LSG and allow comparison of images between institutions and in research reports. LSG is not able to provide good images of central conducting lymphatics, e.g., the thoracic duct and related structures, which can be affected in some types of primary lymphedema and lymphatic malformations. The new imaging technique of nodal magnetic resonance lymphangiography is able to demonstrate abnormalities of the central conducting vessels and has a role in facilitating interventional radiological treatment of abnormalities of these. LSG does not contribute greatly to the imaging of lymphatic malformations where magnetic resonance imaging is the most useful modality.
