Objective To investigate the diagnostic value of combined 99m Tc-DX lymphoscintigraphy and CT lymphangi-ography(CTL)in primary chylopericardium.Methods Forty-eight patients diagnosed with primary chylopericardium clinically were retrospectively analyzed,and 99m Tc-DX lymphoscintigraphy and CT lymphangiography(CTL)were performed in all patients.According to the 99m Tc-DX lymphoscintigraphy results,primary chylopericardium was classified into three types:type I(abnormal concentration pattern,abnormal radioactive concentration at the angle of the left jugular vein),type Ⅱ(ectopic drainage pattern,persistent concentration of contrast in the right jugular angle with or without radiographic con-centration in the left jugular angle),and type Ⅲ(without image or transient image pattern,no visualization of the left jugular vein angle or a transient visualization during the examination).The evaluation indexes of CTL include:(1)abnormal distri-bution of contrast and reflux in the neck,subclavian region,end of thoracic duct,end of right lymphatic duct and axilla;(2)abnormal distribution of contrast in the chest,including abnormal distribution of contrast in the deep thorax(anterior medi-astinum,aortopulmonary window,peri-tracheal and bronchial,inferior bulge,posterior mediastinum,hilum,peri-bronchial vascular bundle,pericardium,etc.),abnormal distribution of contrast in the superficial thorax(intercostal,pleura);(3)di-lated thoracic duct was defined as dilated when the widest diameter of thoracic duct was>3 mm;(4)abnormal distribution of contrast agent in sub-diaphragm,ipsilateral iliac group,lumbar trunk,abnormal distribution of contrast agent in contralat-eral iliac group,contralateral lumbar trunk,abnormal distribution of retroperitoneal contrast agent.CTL characteristics were analyzed between different groups,and P<0.05 was considered a statistically significant difference.Results Primary chylopericardiumin 48 patients showed 12 cases of 99m Tc-DX lymphoscintigraphy imaging typeⅠ,14 patients with type Ⅱ,and 22 patients with type Ⅲ in 48 patients.The incidence of abnormal posterior mediastinal contrast distribution was greater in type Ⅰ than in type Ⅲ,with a statistically significant difference(P = 0.003).The incidence of abnormal distribution of contrast in the pericardial and aortopulmonary windows,99m Tc-DX lymphoscintigraphy group Ⅰ was greater than group Ⅲ,and the difference was statistically significant(P = 0.008).And the incidence of abnormal distribution of contrast agent in the bilateral cervical or subclavian region was greater in 99m Tc-DX lymphoscintigraphy type Ⅱ than type Ⅲ(P = 0.002),and the difference was statistically significant.Conclusion The 99m Tc-DX typing reflects the abnormal of thoracic duct and pericardial effusion in patients with primary chylopericardium,and CTL shows whether the systemic lymphatic vessels are abnormal and extra-lymphatic lesions.The combined application of the two methods is of great value for the localized and qualitative diagnosis of primary chylopericardium and the determination of the extent and involvement of lesions.
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