Diagnostic value of combined computed tomography lymphangiography and technetium-99m dextran lymphoscintigraphy in systemic lupus erythematosus complicated with chylous effusion and/or lymphedema

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Abstract
Background: When systemic lupus erythematosus (SLE) affects the lymphatic system, it disrupts the normal physiological function of the lymphatic circulation, leading to clinical chylous effusion and lymphedema. Currently, the computed tomography lymphangiography (CTL) or technetium-99m dextran (99Tcm-DX) lymphoscintigraphy features of patients with SLE complicated by chylous effusion and lymphedema have not been published, and studies on the imaging features of different subtypes are lacking. This study aimed to analyze the imaging characteristics of CTL and 99Tcm-DX lymphoscintigraphy in 23 patients with SLE complicated with chylous effusion and/or lymphedema, and describe the differences in imaging findings among different subtypes, so as to provide a reference for the clinical understanding of this disease. Methods: A retrospective analysis was conducted on the clinical and imaging data of 23 patients with SLE complicated by chylous effusion and/or lymphedema. All patients underwent CTL and 99Tcm-DX lymphoscintigraphy. The patients were divided into three subgroups: chylous effusion (n=19), chylous effusion and lymphedema (n=3), and lymphedema (n=3). The signs of lymphatic abnormalities detected by the two examinations were compared using the McNemar test (with the exact probability method), and diagnostic consistency was evaluated using the kappa test (PResults: No significant differences were found between CTL and 99TCm-DX lymphoscintigraphy in depicting thoracic duct outlet obstruction, thoracic segment tortuosity or dilation of the thoracic duct, left subclavian trunk visualization, abnormal perineal distribution, chylothorax, or chylous ascites (P>0.05), with kappa values of 0.623, 0.862, 0.511, 0.646, 0.425, and 0.777, indicating diagnostic agreement levels of good, almost perfect, good, good, moderate, and good, respectively. However, the two methods differed significantly in showing combined chylothorax and chylous ascites (PConclusions: CTL demonstrates subtle morphological abnormalities of lymphatic vessels and provides precise anatomical localization. 99TCm-DX lymphoscintigraphy is useful for dynamically evaluating lymphatic drainage and detecting chylous effusion. The two modalities are complementary and provide comprehensive information for SLE complicated by chylous effusion and/or lymphedema. Distinct imaging patterns among the three subgroups may support clinical subtyping of this condition.

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