Mediastinal Lymphoscintigrahy after Intraperitoneal Injection of ^{99 m}Tc-HSA-D

Hidejirou Kawahara, Katsuya Hirai, Teruaki Aoki, Sumio Takayama, Yutaka Mori*

Department of Surgery and Department of Radiology*, The Jikei University School of Medicine

An intraperitoneal injection tube was inserted into the abdominal cavity (right subphrenic lesion 3, left sugphrenic lesion 3, Douglas pouch 3) in patients with recurrent gastric cancer and those receiving non curative resection. ^{99 m}Tc-HSA-D, 1 ml (740 MBq) was administered through the tube. After the injection, lymph flow dynamics was observed with a scinticamera. In the subphrenic injection group, there was no significant difference in the mediastinal lymphograhy between right and left subphrenic injection. In that group, mediastinal lymphograhy had been observed promptly after the administration. However, in the Douglas injection group, until ^{99 m}Tc-HSA-D reached the diaphragm no mediastinal lymphograhy was observed. The HSA-D count in the peripheral blood increased in the Douglas injection group but it remained low in the subphrenic injection group. Therefore it is conceivable that the main pathway was the diaphragm lymphatic system between the intraabdominal lymphatic system and the mediastinal lymphatic system. And intraperitoneal administration of the anticaner agent may not only have a sufficiently effect on the intraabdominal lymphatic system but also on the mediastinal lymphatic system. Especially subphrenic injection is very useful because concentration of the agent in peripheral blood may be held at a low level.

Key words
mediastinal lymphoscintigraphy with ^{99 m}Tc-HSA-D, intraperitoneal injection, virchow metastasis of gastric cancer

Reprint requests
Hidejiro Kawahara Department of Surgery, The Jikei University School of Medicine
3-25-8 Minato-ku, Nishishinbashi, 105-0003 JAPAN

Accepted
October 1, 1997

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