{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:23:46Z","timestamp":1760145826925,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T00:00:00Z","timestamp":1725494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Lymphoscintigraphy evaluates the lymphatic system using radiocolloid compounds like 99mTc-sulfur colloid and 99mTc-nanocolloid, which vary in particle size and distribution timing. A local in-house Dextran kit (15\u201340 nm) was developed in 2005 and began clinical use in 2008 to localize sentinel lymph nodes; diagnose lymphedema; and detect lymphatic leakage. The normal drainage pattern remains unexplored. We retrospectively analyzed 84 upper extremity lymphoscintigraphies from 2008 to 2021. 99mTc in-house Dextran was intradermally injected into both hands, followed by whole-body imaging at specified intervals (\u226415 min; 16\u201330 min; 31\u201345 min; 46\u201360 min), with some receiving delayed imaging. Visual and quantitative analyses recorded axillary and forearm lymph nodes and liver, kidney, and urinary bladder activity. Results showed 92% (77\/84) upper extremity lymphatic tract visualization within 45 min. Axillary node detection rates increased from 46% (\u226415 min) to 86% (46\u201360 min). Delayed imaging further revealed nodes. Epitrochlear or brachial node visualization was rare (4%, 3\/84). Hepatic, renal, and urinary bladder activity was noted in 54%, 71%, and 93% at 1 h, respectively. The axillary node uptake ratio was minimal (&lt;2.5% of injection site activity; median 0.33%). This study characterizes normal upper extremity lymphatic drainage using 99mTc in-house Dextran, offering insights into its clinical application<\/jats:p>","DOI":"10.3390\/diagnostics14171960","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T02:34:06Z","timestamp":1725503646000},"page":"1960","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing Normal Upper Extremity Lymphatic Flow with 99mTc In-House Dextran: A Retrospective Study"],"prefix":"10.3390","volume":"14","author":[{"given":"Wiroj","family":"Katiyarangsan","sequence":"first","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"},{"name":"Division of Nuclear Medicine, Department of Radiology, Maha Vajiralongkorn Thanyaburi Hospital, Pathum Thani 12110, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Putthiporn","family":"Charoenphun","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"},{"name":"Master of Science Program in Medical Physics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0362-9125","authenticated-orcid":false,"given":"Krisanat","family":"Chuamsaamarkkee","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"},{"name":"Master of Science Program in Medical Physics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suchawadee","family":"Musikarat","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0409-1125","authenticated-orcid":false,"given":"Kidakorn","family":"Kiranantawat","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Department Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaninart","family":"Sakulpisuti","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0128-651X","authenticated-orcid":false,"given":"Kanungnij","family":"Thamnirat","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arpakorn","family":"Kositwattanarerk","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7607-1786","authenticated-orcid":false,"given":"Chanika","family":"Sritara","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8781-1265","authenticated-orcid":false,"given":"Wichana","family":"Chamroonrat","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1089\/lrb.2007.5306","article-title":"Clinical assessment of human lymph flow using removal rate constants of interstitial macromolecules: A critical review of lymphoscintigraphy","volume":"5","author":"Modi","year":"2007","journal-title":"Lymphat. Res. Biol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1002\/1097-0142(195311)6:6<1238::AID-CNCR2820060618>3.0.CO;2-6","article-title":"Lymph-node concentration of radioactive colloidal gold following interstitial injection","volume":"6","author":"Sherman","year":"1953","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1024\/0301-1526\/a000622","article-title":"Clinical and diagnostic aspects of lymphedema","volume":"46","author":"Keo","year":"2017","journal-title":"Vasa"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.ejso.2004.02.008","article-title":"Variation in lymphatic function may predispose to development of breast cancer-related lymphoedema","volume":"30","author":"Pain","year":"2004","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_5","first-page":"86","article-title":"Lymphedema: A Practical Approach and Clinical Update","volume":"32","author":"Bittar","year":"2020","journal-title":"Wounds"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"51","DOI":"10.2967\/jnmt.119.230011","article-title":"Buffering the Suffering of Breast Lymphoscintigraphy","volume":"48","author":"Holliday","year":"2020","journal-title":"J. Nucl. Med. Technol."},{"key":"ref_7","unstructured":"Ranzenberger, L.R., and Pai, R.B. (2021). Lymphoscintigraphy. StatPearls, Treasure Island."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/01.SLA.0000055226.89022.90","article-title":"Lymphoscintigraphic visualization of internal mammary nodes with subtumoral injection of radiocolloid in patients with breast cancer","volume":"237","author":"Shimazu","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ahmadzadehfar, H., Biersack, H.J., Freeman, L., and Zuckier, L. (2020). Lymphoscintigraphy in the Management of Lymphatic Disorders. Clinical Nuclear Medicine, Springer.","DOI":"10.1007\/978-3-030-39457-8"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s13139-018-0565-2","article-title":"Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: The Genoa Protocol","volume":"53","author":"Villa","year":"2019","journal-title":"Nucl. Med. Mol. Imaging."},{"key":"ref_11","first-page":"43","article-title":"The third circulation: Radionuclide lymphoscintigraphy in the evaluation of lymphedema","volume":"44","author":"Szuba","year":"2003","journal-title":"J. Nucl. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1259\/0007-1285-64-768-1119","article-title":"Quantitative lymphoscintigraphy using 99Tcm human serum albumin in patients with previously treated uterine cancer","volume":"64","author":"Kataoka","year":"1991","journal-title":"Br. J. Radiol."},{"key":"ref_13","first-page":"923","article-title":"Lymphoscintigraphy with Tc-99m-labeled dextran","volume":"23","author":"Henze","year":"1982","journal-title":"J. Nucl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1148\/90.5.905","article-title":"Clinical evaluation of lymph node scanning utilizing colloidal gold 198","volume":"90","author":"Kazem","year":"1968","journal-title":"Radiology"},{"key":"ref_15","first-page":"1038","article-title":"Quantitative lymphoscintigraphy I: Basic concepts for optimal uptake of radiocolloids in the parasternal lymph nodes of rabbits","volume":"20","author":"Strand","year":"1979","journal-title":"J. Nucl. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/S0001-2998(83)80031-2","article-title":"Particle sizing and biokinetics of interstitial lymphoscintigraphic agents","volume":"13","author":"Bergqvist","year":"1983","journal-title":"Semin. Nucl. Med."},{"key":"ref_17","first-page":"1895","article-title":"Filtered technetium-99m-sulfur colloid evaluated for lymphoscintigraphy","volume":"36","author":"Hung","year":"1995","journal-title":"J. Nucl. Med."},{"key":"ref_18","first-page":"460","article-title":"Particle size analysis of (99m)Tc-labeled and unlabeled antimony trisulfide and rhenium sulfide colloids intended for lymphoscintigraphic application","volume":"42","author":"Tsopelas","year":"2001","journal-title":"J. Nucl. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1055\/s-0038-1623908","article-title":"First experiences with a new radiopharmaceutical for sentinel lymph node detection in malignant melanoma: 99mTc colloidal rhenium sulphide","volume":"43","author":"Weiss","year":"2004","journal-title":"Nuklearmedizin"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1007\/s00259-013-2544-2","article-title":"The EANM and SNMMI practice guideline for lymphoscintigraphy and sentinel node localization in breast cancer","volume":"40","author":"Giammarile","year":"2013","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_21","first-page":"319","article-title":"The radiopharmaceutical chemistry of 99mTc-tin fluoride colloid-labeled-leukocytes","volume":"49","author":"Tsopelas","year":"2005","journal-title":"Q. J. Nucl. Med. Mol. Imaging"},{"key":"ref_22","first-page":"923","article-title":"A rapid and accurate method for sizing radiocolloids","volume":"15","author":"Davis","year":"1974","journal-title":"J. Nucl. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.2147\/OTT.S155265","article-title":"99mTc-labeled sodium phytate and stannous chloride injection accurately detects sentinel lymph node in axillary of early stage breast cancer: A randomized, controlled study","volume":"11","author":"Yang","year":"2018","journal-title":"Onco Targets Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1097\/00003072-198609000-00015","article-title":"Dynamic lymph flow imaging in lymphedema. Normal and abnormal patterns","volume":"11","author":"Nawaz","year":"1986","journal-title":"Clin. Nucl. Med."},{"key":"ref_25","first-page":"25","article-title":"Diagnostic and interventional imaging of lymphatic disorders","volume":"18","author":"Witte","year":"1999","journal-title":"Int. Angiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1007\/PL00014793","article-title":"Radiopharmaceuticals in sentinel lymph-node detection-an overview","volume":"26","author":"Wilhelm","year":"1999","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"283","DOI":"10.2967\/jnmt.114.145391","article-title":"Particle-size and radiochemical purity evaluations of filtered 99mTc-sulfur colloid prepared with different heating times","volume":"42","author":"Michenfelder","year":"2014","journal-title":"J. Nucl. Med. Technol."},{"key":"ref_28","unstructured":"Charoenphun, P., Thongklam, K., and Wittayachokkitikhun, S. (November, January 28). In-house radiocolloid development for sentinel lymph node detection. Proceedings of the International Symposium on Trends in Radiopharmaceuticals (ISTR), Vienna, Austria."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.5535\/arm.2017.41.6.1065","article-title":"Quantitative Lymphoscintigraphy to Predict the Possibility of Lymphedema Development After Breast Cancer Surgery: Retrospective Clinical Study","volume":"41","author":"Kim","year":"2017","journal-title":"Ann. Rehabil. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.apradiso.2009.02.091","article-title":"99mTc Nanocoll: A radiopharmaceutical for sentinel node localisation in breast cancer-in vitro and in vivo results","volume":"67","author":"Gommans","year":"2009","journal-title":"Appl. Radiat. Isot."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/BF02987244","article-title":"The role of radionuclide lymphoscintigraphy in extremity lymphedema","volume":"20","author":"Yuan","year":"2006","journal-title":"Ann. Nucl. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"931","DOI":"10.5535\/arm.2015.39.6.931","article-title":"Validity of Quantitative Lymphoscintigraphy as a Lymphedema Assessment Tool for Patients With Breast Cancer","volume":"39","author":"Yoo","year":"2015","journal-title":"Ann. Rehabil. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1590\/S1516-89132005000700023","article-title":"Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema","volume":"48","author":"Dalia","year":"2005","journal-title":"Braz. Arch. Biol. Technol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S212","DOI":"10.1097\/SAP.0000000000001839","article-title":"Lymphoscintigraphic Evaluation of Systemic Tracer Uptake in Patients With Primary Lymphedema","volume":"82","author":"Goss","year":"2019","journal-title":"Ann. Plast. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1089\/lrb.2018.0058","article-title":"Surgical Treatment of Advanced Lymphatic Filariasis of Lower Extremity Combining Vascularized Lymph Node Transfer and Excisional Procedures","volume":"17","author":"Chilgar","year":"2019","journal-title":"Lymphat. Res. Biol."},{"key":"ref_36","unstructured":"Munjal, A., and Gupta, N. (2022). Radiopharmaceuticals. StatPearls, Treasure Island."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1071\/EN06025","article-title":"Aquatic Colloids and Nanoparticles: Current Knowledge and Future Trends","volume":"3","author":"Lead","year":"2006","journal-title":"Environ. Chem."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/med.21855","article-title":"The lymphatic vasculature: An active and dynamic player in cancer progression","volume":"42","author":"Rezzola","year":"2022","journal-title":"Med. Res. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/0010-4825(77)90023-3","article-title":"A computer model of the lymphatic system","volume":"7","author":"Reddy","year":"1977","journal-title":"Comput. Biol. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1089\/lrb.2006.4.159","article-title":"Lymphoscintigraphy to evaluate the effect of high versus low intensity upper body dynamic exercise on lymphatic function in healthy females","volume":"4","author":"Lane","year":"2006","journal-title":"Lymphat. Res. Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/S0104-4230(11)70108-7","article-title":"Preoperative upper limb lymphatic function in breast cancer surgery","volume":"57","author":"Rezende","year":"2011","journal-title":"Rev. Assoc. Med. Bras."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1089\/lrb.2015.0048","article-title":"Lymphatic Function in the Early Postoperative Period of Breast Cancer Has No Short-Term Clinical Impact","volume":"14","author":"Sarian","year":"2016","journal-title":"Lymphat. Res. Biol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1097\/PRS.0000000000002763","article-title":"Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls","volume":"138","author":"Rossi","year":"2016","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1089\/lrb.2013.0034","article-title":"Reproducibility of lymphoscintigraphic evaluation of the upper limb","volume":"12","author":"Devoogdt","year":"2014","journal-title":"Lymphat. Res. Biol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1007\/s10549-018-5041-2","article-title":"Predictive value of lymphoscintigraphy in patients with breast cancer-related lymphedema undergoing complex decongestive therapy","volume":"173","author":"Kim","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s00259-003-1399-3","article-title":"Finding an optimal method for imaging lymphatic vessels of the upper limb","volume":"31","author":"Rose","year":"2004","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/17\/1960\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:48:47Z","timestamp":1760111327000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/17\/1960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,5]]},"references-count":46,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2024,9]]}},"alternative-id":["diagnostics14171960"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14171960","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2024,9,5]]}}}