LIMFOGRAFIYA (Latin lympha pure water, moisture + grech, grapho to write, represent; synonym: rentgenolimfografiya, limforentgenografiya) — a method of X-ray inspection of various departments of lymphatic system using contrast agents. Radio isotope L. — a method of a research limf, systems using radio pharmaceuticals.
X-ray contrast L. it was offered and developed by the Soviet researchers A.S. Zolotukhin, M. G. Prives, T. N. Chernosvitova, D. A. Zhdanov, etc. (1928 — 1936). In development of L. it is possible to allocate three periods: development of a technique indirect L. (from 1928 to 1954); creation of a technique direct L. water-soluble iodide drugs (from 1954 to 1959); use for a straight line of L. oil iodide substances (since 1959).
L. allows it is intravital to study structure and function of various departments limf, system it is normal also of pathology (limf, nodes, vessels, textures and a chest channel). It is one of the most important ways of a research lymphatic system (see) in an experiment and in clinic.
Distinguish the straight line or ascending, and indirect L. At a straight line of L. a contrast agent is entered directly into a gleam limf, a vessel; at indirect L. create depot of a contrast agent in soft tissues or a parenchyma of bodies from where it arrives in limf. ways. At administration of contrast medium in limf, vessels receive the shadow image of various departments limf, systems. On it distinguish: 1) a limfangiografiya — contrasting limf, vessels of any localization by introduction to them of small amounts of a contrast agent; 2) a limfangioadenografiya — contrasting not only limf, vessels of any localization, but also regional nodes in the same way thanks to large amounts of contrast medium or by pushing through of a contrast agent other liquids, napr, isotonic solution of sodium chloride; 3) a limfangioadenoduktografiya (a synonym a limfoduktografiya) — contrasting limf, vessels of the lower extremities, inguinal, ileal, lumbar textures and a chest channel by administration of contrast medium in limf, vessels of the lower extremities.
Depending on the place of an injection of drug and area of a research distinguish options direct L.: lower (back, naruzhnolodyzhechny, superficial and deep vnutrennelodyzhechny and nadpodvzdoshny); upper (superficial ulnarny, superficial and deep radial); funicular; mammolimfografiya; cervical, etc.
The clinic found application, though limited, perlingvalny for L. and tireolimfografiya.
A. F. Tsyb and V. V. Yarzutkin in 1978 offered a step-by-step straight line of L. At the same time in limf, a vessel enter a small amount of oil contrast agent and make a X-ray analysis. Then oil substance by means of an endolymphatic injection isotonic solution of sodium chloride or a blood plasma is pushed in overlying departments limf, systems carry out roentgenograms (fig. 1) also again. The method excludes restretching limf, vessels and sine of nodes, their gaps with an ekstravazation of a contrast agent.
Multicollector straight line of L. represents a X-ray contrast research of superficial and deep departments limf, systems of upper or lower extremities by administration of contrast medium in limf, vessels (fig. 2).
Introduction at L. various pharmakol. drugs: Ridolum, a komplamin, the venalota, coumarin, adrenaline, etc. (pharmakolimfografiya) improves contrasting of these or those departments limf, systems (fig. 3) also are cut almost by half by duration of a limfografichesky research of the patient.
Main indications to L.: limfangiopatiya, secondary lymphatic hypostases, hypostases of extremities of not clear genesis, identification of metastasises of malignant tumors in limf, nodes, primary malignant defeats limf, systems, the inborn and acquired disturbances of venous outflow of top and bottom extremities, control of efficiency and radicalism of beam and operational methods of treatment and chemotherapy of malignant tumors, specific inflammatory processes in limf, nodes, primary or secondary pathology limf, systems of not clear character.
The general contraindications to L.: serious condition of the patient, cachexia, acute inf. diseases, diseases of lungs, hearts, a liver and kidneys with a heavy decompensation, sharply hypersensitivity to iodide drugs, and also purulent damages of skin and soft tissues in the field of the planned injection site of a contrast agent.
Special training of the patient for L. it is not required. It is made under local anesthesia. L. consists of four consecutive stages: 1) coloring limf, vessels; 2) a section of skin, allocation painted limf, a vessel and introduction of a needle to it; 3) injection of radiopaque substance; 4) rentgenol, research. Coloring is made by local hypodermic administration of dye. As dye use water solution of 0,5% of blue Evans or 2,5% of patent blue. The needle entered into a vessel by means of a thin polyethylene catheter connects to an injektor. The best is Injektor with heating of a contrast agent and the self-adjustment of speed of its introduction depending on endolymphatic resistance.
For L. apply superliquid oil radiopaque substances like Iodolipolum of UF, mayodit, etc. For obtaining the image only regional limf, vessels it is possible to use water-soluble triiodide drugs (60 — 76% Verografinum, etc.), to-rye inject with a speed of 2 — 3 ml of 1 min. Rate of administering of ultraliquid oil contrast agents and their volume depend on a look and methodical options L. Determination of quantity of the contrast medium entered in limf, vessels of one extremity during the performance lower back L. it is made by means of a simple formula:
Amount of contrast medium (ml) = (growth of the patient — 100)/10.
L. carry out on X-ray diagnostic installation with the electron-optical amplifier or television that allows to watch advance of a contrast agent on limf, to system, to choose optimum laying of the patient and facilitates the choice of the moment of shooting. L. it can be executed also on devices without electron-optical amplifier. In such cases control of degree of fullness limf, vessels and nodes is conducted by a X-ray analysis. The survey X-ray analysis is carried out right after the termination of an endolymphatic injection of water-soluble drug, and after administration of oil substance — in 10 — 30 min. (a vascular phase) and 24 or 48 hours (a nodal phase). Pictures make in direct and side projections or in a straight line and two zadnekosy (right and left). The survey X-ray analysis can be supplemented with multiprojective aim pictures, a tomography, a zonografiya, pictures with increase in the x-ray image. Inflammatory, dystrophic and tumoral processes in limf, nodes are shown (at a limfadenogrifiya) on limfogramma by increase in their sizes, change of a form and contours, development patol, structures of the limfonodulyarny drawing, emergence of defects of filling, blockade of ways of a lymph drainage with development of collaterals.
The antegrade limfoduktografiya of a chest channel allows to reveal its shifts, narrowings, expansions, disturbances of the central limfodinamika and other symptoms caused by a disease both the channel, and the structures surrounding it.
Radio isotope L. (limforadiografiya) is used for recognition of defeat limf, nodes at patients with general diseases, for identification of metastasises at malignant diseases and estimates of prevalence patol, process, and also during the planning of radiation therapy for the choice of optimum fields of radiation.
At the heart of radio isotope L. property of reticuloendothelial cells limf lies, nodes selectively to absorb radioactive colloids. For radio isotope L. colloid solutions of gold-198, indium-111 and albumine of human serum, marked are applied by iodine-131 (MuAA 131 I).
Assessment of a state limf, nodes is made by means of a stsintigrafiya, scannings (see) or definitions of their function. For scanning limf, nodes of a basin and retroperitoneal space use finely divided colloid gold (particle sizes 5 — 10 nanometers), for scanning of parasternal area preference are given to MuAA 131 I. The scintigraphic picture normal limf, nodes of a basin and retroperitoneal space (fig. 4) has the form of the turned letter Y, two branches a cut correspond inguinal and ileal limf, to nodes. These branches form the general trunk representing periaortal group limf, nodes. A part of a colloid gets into a liver and gives its image. Normal also other forms stsintigramm, the activities which are expressed in absence in symmetric sites of a chain limf, nodes meet that is caused by variability of their anatomic structure. A sign of metastatic defeat limf, nodes on stsintigramma is absence or considerable decrease in inclusion of a colloid, a cut looks as «a mute zone» or the decompression section with indistinct contours. Distalny «a mute zone» the strengthened accumulation of drug as a result of a lymphostasis is often noted. At early stages of process (a reactive state) on stsintigramma of the center of defeat intensive accumulation of drug is observed. Similar signs characterize a scintigraphic picture of defeat parasternal limf, nodes.
Informational content radio isotope L. increases by comparison of data of a stsintigrafiya to X-ray contrast L.
Issledovaniye's results funkts, states limf, systems (takholimfografiya) it is based on registration of speed of movement of marked colloid particles from intercellular intervals in limf, capillaries and their receipts in limf. nodes. It is carried out by means of multidetector installation, sensors a cut are located on both sides over area limf, nodes. On the speed of movement and accumulation in limf, nodes of colloid particles judge about funkts, a state of them is normal also at metastatic defeats.
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A. F. Tsyb, P. I. Gabuniya.