Primary Lymphedema of the Lower Limb: The Clinical Utility of Single Photon Emission Computed Tomography/CT
Identifieur interne : 000F59 ( Pmc/Checkpoint ); précédent : 000F58; suivant : 000F60Primary Lymphedema of the Lower Limb: The Clinical Utility of Single Photon Emission Computed Tomography/CT
Auteurs : Mayo Weiss [Allemagne] ; Ruediger G. H. Baumeister [Allemagne] ; Andreas Frick [Allemagne] ; Jens Wallmichrath [Allemagne] ; Peter Bartenstein [Allemagne] ; Axel Rominger [Allemagne]Source :
- Korean Journal of Radiology [ 1229-6929 ] ; 2015.
Abstract
The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb.
For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65).
In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%).
As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.
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DOI: 10.3348/kjr.2015.16.1.188
PubMed: 25598689
PubMed Central: 4296269
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Baumeister</name><affiliation wicri:level="4"><nlm:aff id="A2">Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Frick, Andreas" sort="Frick, Andreas" uniqKey="Frick A" first="Andreas" last="Frick">Andreas Frick</name><affiliation wicri:level="4"><nlm:aff id="A2">Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Wallmichrath, Jens" sort="Wallmichrath, Jens" uniqKey="Wallmichrath J" first="Jens" last="Wallmichrath">Jens Wallmichrath</name><affiliation wicri:level="4"><nlm:aff id="A2">Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Bartenstein, Peter" sort="Bartenstein, Peter" uniqKey="Bartenstein P" first="Peter" last="Bartenstein">Peter Bartenstein</name><affiliation wicri:level="4"><nlm:aff id="A1">Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region 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Louis-et-Maximilien de Munich</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25598689</idno><idno type="pmc">4296269</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296269</idno><idno type="RBID">PMC:4296269</idno><idno type="doi">10.3348/kjr.2015.16.1.188</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">004176</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004176</idno><idno type="wicri:Area/Pmc/Curation">004175</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004175</idno><idno type="wicri:Area/Pmc/Checkpoint">000F59</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000F59</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Primary Lymphedema of the Lower Limb: The Clinical Utility of Single Photon Emission Computed Tomography/CT</title><author><name sortKey="Weiss, Mayo" sort="Weiss, Mayo" uniqKey="Weiss M" first="Mayo" last="Weiss">Mayo Weiss</name><affiliation wicri:level="4"><nlm:aff id="A1">Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Baumeister, Ruediger G H" sort="Baumeister, Ruediger G H" uniqKey="Baumeister R" first="Ruediger G. H." last="Baumeister">Ruediger G. H. Baumeister</name><affiliation wicri:level="4"><nlm:aff id="A2">Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Frick, Andreas" sort="Frick, Andreas" uniqKey="Frick A" first="Andreas" last="Frick">Andreas Frick</name><affiliation wicri:level="4"><nlm:aff id="A2">Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Wallmichrath, Jens" sort="Wallmichrath, Jens" uniqKey="Wallmichrath J" first="Jens" last="Wallmichrath">Jens Wallmichrath</name><affiliation wicri:level="4"><nlm:aff id="A2">Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Bartenstein, Peter" sort="Bartenstein, Peter" uniqKey="Bartenstein P" first="Peter" last="Bartenstein">Peter Bartenstein</name><affiliation wicri:level="4"><nlm:aff id="A1">Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Rominger, Axel" sort="Rominger, Axel" uniqKey="Rominger A" first="Axel" last="Rominger">Axel Rominger</name><affiliation wicri:level="4"><nlm:aff id="A1">Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author></analytic><series><title level="j">Korean Journal of Radiology</title><idno type="ISSN">1229-6929</idno><idno type="eISSN">2005-8330</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb.</p></sec><sec><title>Materials and Methods</title><p>For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65).</p></sec><sec><title>Results</title><p>In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%).</p></sec><sec><title>Conclusion</title><p>As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Pecking, Ap" uniqKey="Pecking A">AP Pecking</name></author><author><name sortKey="Alberini, Jl" uniqKey="Alberini J">JL Albérini</name></author><author><name sortKey="Wartski, M" uniqKey="Wartski M">M Wartski</name></author><author><name sortKey="Edeline, V" uniqKey="Edeline V">V Edeline</name></author><author><name sortKey="Cluzan, Rv" uniqKey="Cluzan R">RV Cluzan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiss, M" uniqKey="Weiss M">M Weiss</name></author><author><name sortKey="Gildehaus, Fj" uniqKey="Gildehaus F">FJ Gildehaus</name></author><author><name sortKey="Brinkb Umer, K" uniqKey="Brinkb Umer K">K Brinkbäumer</name></author><author><name sortKey="Makowski, M" uniqKey="Makowski M">M Makowski</name></author><author><name sortKey="Hahn, K" uniqKey="Hahn K">K Hahn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiss, M" uniqKey="Weiss M">M Weiss</name></author><author><name sortKey="Baumeister, Rg" uniqKey="Baumeister R">RG Baumeister</name></author><author><name sortKey="Hahn, K" uniqKey="Hahn K">K Hahn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baulieu, F" uniqKey="Baulieu F">F Baulieu</name></author><author><name sortKey="Bourgeois, P" uniqKey="Bourgeois P">P Bourgeois</name></author><author><name sortKey="Maruani, A" uniqKey="Maruani A">A Maruani</name></author><author><name sortKey="Belgrado, Jp" uniqKey="Belgrado J">JP Belgrado</name></author><author><name sortKey="Tauveron, V" uniqKey="Tauveron V">V Tauveron</name></author><author><name sortKey="Lorette, G" uniqKey="Lorette G">G 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P" uniqKey="Bourgeois P">P Bourgeois</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Monnin Delhom, Ed" uniqKey="Monnin Delhom E">ED Monnin-Delhom</name></author><author><name sortKey="Gallix, Bp" uniqKey="Gallix B">BP Gallix</name></author><author><name sortKey="Achard, C" uniqKey="Achard C">C Achard</name></author><author><name sortKey="Bruel, Jm" uniqKey="Bruel J">JM Bruel</name></author><author><name sortKey="Janbon, C" uniqKey="Janbon C">C Janbon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baumeister, Rg" uniqKey="Baumeister R">RG Baumeister</name></author><author><name sortKey="Seifert, J" uniqKey="Seifert J">J Seifert</name></author><author><name sortKey="Hahn, D" uniqKey="Hahn D">D Hahn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Mahony, S" uniqKey="O Mahony S">S O'Mahony</name></author><author><name sortKey="Rose, Sl" uniqKey="Rose S">SL 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Korean J Radiol</journal-id><journal-id journal-id-type="iso-abbrev">Korean J Radiol</journal-id><journal-id journal-id-type="publisher-id">KJR</journal-id><journal-title-group><journal-title>Korean Journal of Radiology</journal-title></journal-title-group><issn pub-type="ppub">1229-6929</issn><issn pub-type="epub">2005-8330</issn><publisher><publisher-name>The Korean Society of Radiology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25598689</article-id><article-id pub-id-type="pmc">4296269</article-id><article-id pub-id-type="doi">10.3348/kjr.2015.16.1.188</article-id><article-categories><subj-group subj-group-type="heading"><subject>Nuclear Medicine</subject><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></subj-group></article-categories><title-group><article-title>Primary Lymphedema of the Lower Limb: The Clinical Utility of Single Photon Emission Computed Tomography/CT</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Weiss</surname><given-names>Mayo</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Baumeister</surname><given-names>Ruediger G.H.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Frick</surname><given-names>Andreas</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wallmichrath</surname><given-names>Jens</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Bartenstein</surname><given-names>Peter</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Rominger</surname><given-names>Axel</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</aff><aff id="A2"><label>2</label>Department of Micro-, Hand-, and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Muenchen D-81377, Germany.</aff><author-notes><corresp>Corresponding author: Mayo Weiss, MD, Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, Muenchen D-81377, Germany. Tel: (4989) 440077638, Fax: (4989) 440077646, <email>mayo.weiss@med.uni-muenchen.de</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jan-Feb</season><year>2015</year></pub-date><pub-date pub-type="epub"><day>09</day><month>1</month><year>2015</year></pub-date><volume>16</volume><issue>1</issue><fpage>188</fpage><lpage>195</lpage><history><date date-type="received"><day>07</day><month>6</month><year>2014</year></date><date date-type="accepted"><day>04</day><month>11</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2015 The Korean Society of Radiology</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec><title>Objective</title><p>The aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb.</p></sec><sec><title>Materials and Methods</title><p>For a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65).</p></sec><sec><title>Results</title><p>In comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%).</p></sec><sec><title>Conclusion</title><p>As an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.</p></sec></abstract><kwd-group><kwd>Lymphoscintigraphy</kwd><kwd>SPECT/CT</kwd><kwd>Hybrid imaging</kwd><kwd>Lymphedema</kwd><kwd>Dermal backflow</kwd></kwd-group></article-meta></front><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><p><bold>60-year-old female patient with clinically swelling of lower right leg suspicious for primary lymphedema.</bold> Lymphatic transport disorders (diffuse distribution of radiopharmaceutical at right lower leg, delayed/missing inguinal lymph nodes of right leg, transport-index 39) were properly detected in planar lymphoscintigraphy (4.5 hours after injection), but only tomographic acquisition by means of single photon emission computed tomography/CT (SPECT/CT) confirmed "dermal backflow" at posterior right lower leg (red colored); additional value of SPECT/CT in terms of dermal backflow consists of three-dimensional spatial resolution and definable location of anatomical margins. Physiological lymph transport and distinct visualization of inguinal and iliacal lymph nodes of left leg.</p></caption><graphic xlink:href="kjr-16-188-g001"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><p><bold>46-year-old female patient with clinically swelling of right leg suspicious for primary lymphedema.</bold> Planar lymphoscintigraphy clearly depicted diffuse distribution of radiopharmaceutical at right lower leg and upper leg. In comparison to contralateral side, likely decreased number of inguinal lymph nodes could be suspected, which was reliably confirmed with three-dimensional anatomical correlation by means of single photon emission computed tomography/CT (SPECT/CT). While planar scintigraphy is limited to functionally demonstrate (inguinal) lymph nodes, CT-component of SPECT/CT serves to verify morphological presence of lymph nodes in this area. Physiological lymph transport and distinct visualization of inguinal lymph nodes of left leg.</p></caption><graphic xlink:href="kjr-16-188-g002"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p><bold>65-year-old female patient with clinically swelling of lower left leg suspicious for primary lymphedema.</bold> Lymphatic transport disorders (e.g., diffuse distribution of radiopharmaceutical at left lower leg, delayed/missing inguinal lymph nodes of left leg, transport-index 11) were properly detected in planar lymphoscintigraphy (4 hours after injection); due to its three-dimensional imaging options, additionally performed single photon emission computed tomography/CT (SPECT/CT) enables differentiation of anterior versus posterior lymph transport, thus providing accurate anatomic correlation and functional assessment of extent of edema (red colored). Planar lymphoscintigraphy cannot provide these special kinds of morphological information. Physiological lymph transport and distinct visualization of inguinal and iliacal lymph nodes of right leg.</p></caption><graphic xlink:href="kjr-16-188-g003"></graphic></fig><table-wrap id="T1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Additional Diagnostic Information from SPECT/CT</p></caption><graphic xlink:href="kjr-16-188-i001"></graphic><table-wrap-foot><fn><p>Note.- Number of tomographically investigated anatomic sites, as well as improvements of diagnostic value by additional use of SPECT/CT compared to planar scintigraphy. SPECT/CT = single photon emission computed tomography/CT</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Calculation of Transport-Index</p></caption><graphic xlink:href="kjr-16-188-i002"></graphic><table-wrap-foot><fn><p>Note.- Calculation of transport-index (TI); resulting TI values range from 0 (normal) to 45 (most pathological), where any TI less than ten is considered normal.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Allemagne</li></country><region><li>Bavière</li><li>District de Haute-Bavière</li></region><settlement><li>Munich</li></settlement><orgName><li>Université Louis-et-Maximilien de Munich</li></orgName></list><tree><country name="Allemagne"><region name="Bavière"><name sortKey="Weiss, Mayo" sort="Weiss, Mayo" uniqKey="Weiss M" first="Mayo" last="Weiss">Mayo Weiss</name></region><name sortKey="Bartenstein, Peter" sort="Bartenstein, Peter" uniqKey="Bartenstein P" first="Peter" last="Bartenstein">Peter Bartenstein</name><name sortKey="Baumeister, Ruediger G H" sort="Baumeister, Ruediger G H" uniqKey="Baumeister R" first="Ruediger G. H." last="Baumeister">Ruediger G. H. Baumeister</name><name sortKey="Frick, Andreas" sort="Frick, Andreas" uniqKey="Frick A" first="Andreas" last="Frick">Andreas Frick</name><name sortKey="Rominger, Axel" sort="Rominger, Axel" uniqKey="Rominger A" first="Axel" last="Rominger">Axel Rominger</name><name sortKey="Wallmichrath, Jens" sort="Wallmichrath, Jens" uniqKey="Wallmichrath J" first="Jens" last="Wallmichrath">Jens Wallmichrath</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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