Acta Medica Eurasica2413-48642413-486410.47026/2413-4864-2026-1-76-90OtherРадионуклидная лимфосцинтиграфия в современной диагностике хронической венозной недостаточностиRadionuclide lymphoscintigraphy in modern diagnosis of chronic venous insufficiencyФоминаЕлена ЕвгеньевнаFominaElena E.eefomina@mail.ruhttps://orcid.org/0000-0003-0667-6127ЧесноковаАнна СергеевнаChesnokovaAnna S.anatchesnockowa@yandex.ruБашировРустем АлековичBashirovRustem A.bashirov6939@gmail.comhttps://orcid.org/0000-0002-0128-5605РыжкинСергей АлександровичRyzhkinSergey A.rsa777@inbox.ruhttps://orcid.org/0000-0003-2595-353XЗиганшинаЛилия ФаридовнаZiganshinaLilia F.zig.lilia@yandex.ruСамойленкоЛюдмила ЕвгеньевнаSamoylenkoLyudmila E.lesamoylenko@gmail.comKazan State Medical Academy – Branch Campus of the Russian Medical Academy of Continuous Professional EducationКазанская государственная медицинская академия – филиал Российской медицинской академии непрерывного профессионального образованияN.N. Blokhin Russian Cancer Research CenterНациональный медицинский исследовательский центр онкологии имени Н.Н. БлохинаRussian Medical Academy of Postgraduate Education; Kazan State Medical UniversityРоссийская медицинская академия непрерывного профессионального образования; Казанский государственный медицинский университетTatarstan Academy of Sciences; Russian Medical Academy of Postgraduate Education; Kazan State Medical University; Kazan (Volga Region) Federal UniversityАкадемия наук Республики Татарстан; Российская медицинская академия непрерывного профессионального образования; Казанский государственный медицинский университет; Казанский (Приволжский) федеральный университетKazan State Medical UniversityКазанский государственный медицинский университетRussian Medical Academy of Postgraduate EducationРоссийская медицинская академия непрерывного профессионального образования3003202617690https://acta-medica-eurasica.ru/single/2026/1/8/

В обзоре систематизированы современные представления и обоснована роль радионуклидной лимфосцинтиграфии в оценке лимфатического компонента при хронической венозной недостаточности нижних конечностей. На фоне ограничений анатомически ориентированных методик (ультразвуковой диагностики, магнитно-резонансной лимфоангиографии, флуоресцентной лимфографии с индоцианином зеленым) радионуклидная лимфосцинтиграфия обеспечивает воспроизводимую оценку лимфодренажа, выявляет ранние нарушения, разграничивает венозный и лимфатический вклад в развитие отеков и позволяет контролировать эффективность терапии. Особое внимание уделено препарату 99mTc-Нанотоп как широко используемому наноколлоидному радиофармпрепарату, обладающему оптимальными физико-химическими характеристиками для количественной радионуклидной лимфосцинтиграфии, а также вопросам сопоставимости результатов при использовании альтернативных препаратов. Систематизированы ключевые сцинтиграфические признаки лимфатической дисфункции и проанализирована их клиническая значимость. Интеграция радионуклидной лимфосцинтиграфии в алгоритмы обследования при хронической венозной недостаточности повышает точность верификации флеболимфедемы и поддерживает персонализированный выбор лечения.

The review systematizes modern concepts and substantiates the role of radionuclide lymphoscintigraphy in assessing the lymphatic component in chronic venous insufficiency of the lower extremities. Given the limitations of anatomically oriented techniques (ultrasound diagnostics, magnetic resonance lymphangiography, and indocyanine green fluorescence lymphography), radionuclide lymphoscintigraphy provides a reproducible assessment of lymphatic drainage, detects early abnormalities, distinguishes between venous and lymphatic contributions to the development of edemas, and enables to monitor the effect of therapy. Special attention is paid to the preparation 99mTc-Nanotope as a widely used nanocolloidal radiopharmaceutical with optimal physico-chemical characteristics for quantitative radionuclide lymphoscintigraphy, as well as issues of results comparability when using alternative preparations. The key scintigraphic signs of lymphatic dysfunction are systematized and their clinical significance is analyzed. Integration of radionuclide lymphoscintigraphy into examination algorithms for chronic venous insufficiency increases the accuracy of phlebolymphedema verification and supports personalized treatment choice.

лучевая диагностикалимфосцинтиграфиятехнеций-99mлимфатическая недостаточностьфлеболимфедемаradiation diagnosticslymphoscintigraphytechnetium-99mlymphatic insufficiencyphlebolymphedemaДиагностика лимфедемы конечностей / П.Н. Мышенцев, С.А. Сушков, С.Е. Каторкин, С.И. Демидов // Флебология. 2017. Т. 11, № 4. С. 228–237. DOI: 10.17116/flebo2017114228-236.Инструкция по медицинскому применению набора «Нанотоп 0,5 мг для приготовления радиофармпрепарата “99mTc-Нанотоп”» (РУ № РЗН 2014/1389 от 14.08.2023) [Электронный ресурс]. URL: https://www.rotop-pharmaka.de/wp-content/uploads/2025/01/SmPC-NanoHSAMRP-RU-rus-02_A4.pdf (дата обращения: 12.01.2026).Непрямая радионуклидная лимфосцинтиграфия в оценке лимфостаза верхних конечностей после лечения рака молочной железы / Е.А. Николаева, С.А. Шаповалов, Е.С. Копосова и др. // Медицинская радиология и радиационная безопасность. 2025. Т. 70, № 4. С. 87–95. DOI: 10.33266/1024-6177-2025-70-4-87-95.Особенности радионуклидной диагностики сигнальных лимфатических узлов у больных раком молочной железы с помощью нового отечественного радиофармпрепарата на основе оксида алюминия, меченного 99mТс / А.А. Медведева, В.И. Чернов, Р.В. Зельчан и др. // Медицинская радиология и радиационная безопасность. 2022. Т. 67, № 4. С. 74–79. DOI: 10.33266/1024-6177-2022-67-4-74-79.Флеболимфедема: современные представления и возможности коррекции / К.В. Лобастов, М.Ю. Каплина (Демехова), Ю.А. Кононова и др. // Флебология. 2024. Т. 18, № 4. С. 339–350. DOI: 10.17116/flebo202418041339.Шевчук А.С., Князев Р.И. Биопсия сторожевых лимфатических узлов при онкогинекологических заболеваниях с применением лимфотропного радиофармпрепарата 99mTc-Нанотоп. Новосибирск: СибАК, 2025. 48 с.Aron A., Zavaleta C. Current and developing lymphatic imaging approaches for elucidation of functional mechanisms and disease progression. Molecular Imaging and Biology, 2024, vol. 26, pp. 1–16. DOI: 10.1007/s11307-023-01827-4.Attaran R.R., Carr J.G. Chronic Venous Disease of the Lower Extremities: A State-of-the Art Review. Journal of the Society for Cardiovascular Angiography & Interventions, 2023, vol. 2(1), 100538. DOI: 10.1016/j.jscai.2022.100538.Babaei M., Afrooghe A., Rafati A. et al. Prevalence and associated factors of chronic venous disease among the modern Iranian urban population. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2023, vol. 11(6), pp. 1098–1106. DOI: 10.1016/j.jvsv.2023.06.005.Beebe-Dimmer J.L., Pfeifer J.R., Engle J.S., Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Annals of Epidemiology, 2005, vol. 15(3), pp. 175–184. DOI: 10.1016/j.annepidem.2004.05.015.Boisseau M.R. Mechanisms of onset of chronic venous insufficiency (CVI). Phlebolymphology, 2003, no. 41, pp. 161–167.Bourgeois P., Leduc O. Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas. PLoS One, 2021, vol. 16(7), e0253900. DOI: 10.1371/journal.pone.0253900.Dalia R., Martins G., Barbosa R. et al. Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema. Brazilian Archives of Biology and Technology, 2005, vol. 48, pp. 159–162. DOI: 10.1590/S1516-89132005000700023.Eberhardt R.T., Raffetto J.D. Chronic venous insufficiency. Circulation, 2014, vol. 130(4), pp. 333–346. DOI: 10.1161/CIRCULATIONAHA.113.006898.Ebrahim M., Savitcheva I., Axelsson R. Reliability of a Scoring System for Qualitative Evaluation of Lymphoscintigraphy of the Lower Extremities. J. Nucl. Med. Technol., 2017, vol. 45(3), pp. 219–224. DOI: 10.2967/jnmt.116.185710.Fujiyoshi T., Mikami T., Hashimoto K. et al. Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images. Lymphatic Research and Biology, 2022, vol. 20(2), pp. 144–152. DOI: 10.1089/lrb.2021.0040.Gupta R., Mathijs E., Hart J. et al. May-Thurner Syndrome and Lymphedema Reconstruction. Plastic and Reconstructive Surgery – Global Open, 2022, vol. 10(6), e4377. DOI: 10.1097/GOX.0000000000004377.Han E.J., Moon J.W., Son J.M. et al. Predicting the Outcome of Lymphovenous Anastomosis for Lower Extremity Lymphedema through Lymphoscintigraphy. International Journal of Medical Sciences, 2025, vol. 22(13), pp. 3174–3181. DOI: 10.7150/ijms.111506.Kim P., Lee J., Lim O. et al. Quantitative Lymphoscintigraphy to Predict the Possibility of Lymphedema Development After Breast Cancer Surgery: Retrospective Clinical Study. Annals of Rehabilitation Medicine, 2017, vol. 41(6), pp. 1065–1075. DOI: 10.5535/arm.2017.41.6.1065.Lee B.B. et al. IUA–ISVI consensus for diagnosis guideline of chronic lymphedema of the limbs. International Angiology, 2015, vol. 34(4), pp. 311–332.Lee B.B., Laredo J. Contemporary role of lymphoscintigraphy: we can no longer afford to ignore! Phlebology: The Journal of Venous Disease, 2011, vol. 26(5), pp. 177–178. DOI: 10.1258/phleb.2011.011e01.Lee B.B. Phlebolymphedema: Neglected Outcome of Combined Venous and Lymphatic Insufficiency. Vasc Specialist Int., 2020, vol. 36(1), pp. 1–3. DOI: 10.5758/vsi.2020.36.1.1.Lurie F., Passman M., Meisner M. et al. The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2020, vol. 8(3), pp. 342–352. DOI: 10.1016/j.jvsv.2019.12.075.Manca G., Trimboli P., Sadeghi R. et al. Novel experience in hybrid tracers: Clinical evaluation of feasibility and efficacy in using ICG-99mTc Nanotop for sentinel node procedure in breast cancer patients. Clin. Nucl. Med., 2021, vol. 46(4), pp. e181–e187. DOI: 10.1097/RLU.0000000000003478.McMeekin H.J., Peters A.M., Burniston M.T., Vadrucci M. Quantitative lymphoscintigraphy of the lower limbs for the diagnosis of phlebolymphoedema. Nuclear Medicine Communications, 2023, vol. 44(12), pp. 1080–1086. DOI: 10.1097/MNM.0000000000001769.Mortimer P.S., Pearson I.C. Lymphatic function in severe chronic venous insufficiency. Phlebolymphology, 2004, no. 44, pp. 253–257.Mortimer P.S., Rockson S.G. New developments in clinical aspects of lymphatic disease. Journal of Clinical Investigation, 2014, vol. 124(3), pp. 915–921. DOI: 10.1172/JCI71608.Nagy B.I., Mohos B., Tzou C.J. Imaging Modalities for Evaluating Lymphedema. Medicina (Kaunas), 2023, vol. 59(11), Art. 2016. DOI: 10.3390/medicina59112016.Nganga E.C., Makhdomi K. Comparison of quantitative analysis to qualitative analysis for interpretation of lower-limb lymphoscintigraphy. World Journal of Nuclear Medicine, 2019, vol. 18(1), pp. 36–41. DOI: 10.4103/wjnm.WJNM_17_18.Nuri T., Yamamoto T., Yoshimatsu H. et al. Lymphoscintigraphy for prediction of effect of lymphaticovenular anastomosis for treatment of secondary lower limb lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2022, vol. 10(5), pp. 1079–1086.e2.O’Donnell T.F. Jr., Rasmussen J.C., Sevick-Muraca E.M. New diagnostic modalities in the evaluation of lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2017, vol. 5(2), pp. 261–273. DOI: 10.1016/j.jvsv.2016.10.083.Pappalardo M., Cheng M.H. Lymphoscintigraphy for the diagnosis of extremity lymphedema: Current controversies regarding protocol, interpretation, and clinical application. J. Surg. Oncol., 2020, vol. 121(1), pp. 37–47. DOI: 10.1002/jso.25526.Ranzenberger L.R., Pai R.B. Lymphoscintigraphy [Электронный ресурс] // In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK563213/ (Accessed Date: 2025, Nov. 14).Rasmussen J.C., Sevick-Muraca E.M., Aldrich M.B. et al. Degradation of lymphatic anatomy and function in early venous insufficiency. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021, vol. 9(3), pp. 720–730.e2. DOI: 10.1016/j.jvsv.2020.09.007.Sampathirao N., Indirani M., Manokaran G. et al. Assessment of lymphedema with lymphoscintigraphy: Can nodal quantification help? Lymphology, 2021, vol. 54, pp. 92–105. DOI: 10.2458/lymph.4730.Sansilvestri-Morel P. et al. Imbalance in the synthesis of collagen types in varicose veins. Journal of Vascular Research, 2001, vol. 38, pp. 560–568. DOI: 10.1159/000051092.Szuba A. et al. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. Journal of Nuclear Medicine, 2003, vol. 44(1), pp. 43–57.van Schaik C.J., Boer L.L., Draaisma J.M.T. et al. The lymphatic system throughout history: From hieroglyphic translations to state of the art radiological techniques. Clinical Anatomy, 2022, vol. 35(6), pp. 701–710. DOI: 10.1002/ca.23867.Vargo M., Aldrich M., Donahue P. et al. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Medical Oncology, 2024, vol. 41, Art. 241. DOI: 10.1007/s12032-024-02472-9.Weissleder H., Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology, 1988, vol. 167(3), pp. 729–735. DOI: 10.1148/radiology.167.3.3363131.Zöller B., Ji J., Sundquist J., Sundquist K. Family history and risk of hospital treatment for varicose veins in Sweden. British Journal of Surgery, 2012, vol. 99(7), pp. 948–953. DOI: 10.1002/bjs.8779.Myshentsev P.N., Sushkov S.A., Katorkin S.E., Demidov S.I. Diagnostika limfedemy konechnostei [Diagnostics of lower limb lymphedema]. Flebologiya, 2017, vol. 11, no. 4, pp. 228–237. DOI: 10.17116/flebo2017114228-236.Instruktsiya po meditsinskomu primeneniyu nabora “Nanotop 0.5 mg dlya prigotovleniya radiofarmpreparata 99mTc-Nanotop” [Instructions for medical use of the kit “Nanotop 0.5 mg for the preparation of the radiopharmaceutical 99mTc-Nanotop”]. (RU No. RZN 2014/1389 dated 2023, Aug. 14). Available at: https://www.rotop-pharmaka.de/wp-content/uploads/2025/01/SmPC-NanoHSAMRP-RU-rus-02_A4.pdf (Accessed Date: 2026, Jan. 12).Nikolaeva E.A., Shapovalov S.A., Koposova E.S. et al. Nepryamaya radionuklidnaya limfostsintigrafiya v otsenke limfostaza verkhnikh konechnostei posle lecheniya raka molochnoi zhelezy [Indirect radionuclide lymphoscintigraphy in the assessment of upper limb lymphostasis after breast cancer treatment]. Meditsinskaya radiologiya i radiatsionnaya bezopasnost, 2025, vol. 70, no. 4, pp. 87–95. DOI: 10.33266/1024-6177-2025-70-4-87-95.Medvedeva A.A., Chernov V.I., Zel’chan R.V. et al. Osobennosti radionuklidnoi diagnostiki signal’nykh limfaticheskikh uzlov u bol’nykh rakom molochnoi zhelezy s pomoshch’yu novogo otechestvennogo radiofarmpreparata na osnove oksida alyuminiya, mechennogo 99mTs [Peculiarities of radionuclide diagnosis of sentinel lymph nodes in breast cancer patients using a new domestic radiopharmaceutical based on 99mTc-labeled gamma-aluminum oxide]. Meditsinskaya radiologiya i radiatsionnaya bezopasnost, 2022, vol. 67, no. 4, pp. 74–79. DOI: 10.33266/1024-6177-2022-67-4-74-79.Lobastov K.V., Kaplina (Demekhova) M.Yu., Kononova Yu.A. et al. Flebolimfedema: sovremennye predstavleniya i vozmozhnosti korrektsii [Phlebolymphedema: modern concepts and possibilities for correction]. Flebologiya, 2024, vol. 18, no. 4, pp. 339–350. DOI: 10.17116/flebo202418041339.Shevchuk A.S., Knyazev R.I. Biopsiya storozhevykh limfaticheskikh uzlov pri onkoginekologicheskikh zabolevaniyakh s primeneniem limfotropnogo radiofarmpreparata 99mTc-Nanotop [Sentinel lymph node biopsy in gynecologic oncology using the lymphotropic radiopharmaceutical 99mTc-Nanotop]. Novosibirsk, SibAK Publ., 2025, 48 p.Aron A., Zavaleta C. Current and developing lymphatic imaging approaches for elucidation of functional mechanisms and disease progression. Molecular Imaging and Biology, 2024, vol. 26, pp. 1– DOI: 10.1007/s11307-023-01827-4.Attaran R.R., Carr J.G. Chronic Venous Disease of the Lower Extremities: A State-of-the Art Review. Journal of the Society for Cardiovascular Angiography & Interventions, 2023, vol. 2(1), 100538. DOI: 10.1016/j.jscai.2022.100538.Babaei M., Afrooghe A., Rafati A. et al. Prevalence and associated factors of chronic venous disease among the modern Iranian urban population. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2023, vol. 11(6), pp. 1098–1106.e10. DOI: 10.1016/j.jvsv.2023.06.005.Beebe-Dimmer J.L., Pfeifer J.R., Engle J.S., Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Annals of Epidemiology, 2005, vol. 15(3), pp. 175–184. DOI: 10.1016/j.annepidem.2004.05.015.Boisseau M.R. Mechanisms of onset of chronic venous insufficiency (CVI). Phlebolymphology, 2003, no. 41, pp. 161–167.Bourgeois P., Leduc O. Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas. PLoS One, 2021, vol. 16(7), e0253900. DOI: 10.1371/journal.pone.0253900.Dalia R., Martins G., Barbosa R. et al. Qualitative and quantitative lymphoscintigraphy in the evaluation of lower limbs lymphedema. Brazilian Archives of Biology and Technology, 2005, vol. 48, pp. 159–162. DOI: 10.1590/S1516-89132005000700023.Eberhardt R.T., Raffetto J.D. Chronic venous insufficiency. Circulation, 2014, vol. 130(4), pp. 333–346. DOI: 10.1161/CIRCULATIONAHA.113.006898.Ebrahim M., Savitcheva I., Axelsson R. Reliability of a scoring system for qualitative evaluation of lymphoscintigraphy of the lower extremities. Nucl. Med. Technol., 2017, vol. 45(3), pp. 219–224. DOI: 10.2967/jnmt.116.185710.Fujiyoshi T., Mikami T., Hashimoto K. et al. Pathological changes in the lymphatic system of patients with secondary lower limb lymphedema based on single photon-emission computed tomogr-aphy/computed tomography/lymphoscintigraphy images. Lymphatic Research and Biology, 2022, vol. 20(2), pp. 144–152. DOI: 10.1089/lrb.2021.0040.Gupta R., Mathijs E., Hart J. et al. May-Thurner syndrome and lymphedema reconstruction. Plastic and Reconstructive Surgery – Global Open, 2022, vol. 10(6), e4377. DOI: 10.1097/GOX.0000000000004377.Han E.J., Moon J.W., Son J.M. et al. Predicting the outcome of lymphovenous anastomosis for lower extremity lymphedema through lymphoscintigraphy. International Journal of Medical Sciences, 2025, vol. 22(13), pp. 3174–3181. DOI: 10.7150/ijms.111506.Kim P., Lee J., Lim O. et al. Quantitative lymphoscintigraphy to predict the possibility of lymphedema development after breast cancer surgery: retrospective clinical study. Annals of Rehabilitation Medicine, 2017, vol. 41(6), pp. 1065–1075. DOI: 10.5535/arm.2017.41.6.1065.Lee B.B. et al. IUA–ISVI consensus for diagnosis guideline of chronic lymphedema of the limbs. International Angiology, 2015, vol. 34(4), pp. 311–332.Lee B.B., Laredo J. Contemporary role of lymphoscintigraphy: we can no longer afford to ignore! Phlebology: The Journal of Venous Disease, 2011, vol. 26(5), pp. 177–178. DOI: 10.1258/phleb.2011.011e01.Lee B.B. Phlebolymphedema: neglected outcome of combined venous and lymphatic insufficiency. Vasc Specialist Int., 2020, vol. 36(1), pp. 1–3. DOI: 10.5758/vsi.2020.36.1.1.Lurie F., Passman M., Meisner M. et al. The 2020 update of the CEAP classification system and reporting standards. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2020, vol. 8(3), pp. 342–352. DOI: 10.1016/j.jvsv.2019.12.075.Manca G., Trimboli P., Sadeghi R. et al. Novel experience in hybrid tracers: clinical evaluation of feasibility and efficacy in using ICG-99mTc Nanotop for sentinel node procedure in breast cancer patients. Nucl. Med., 2021, vol. 46(4), pp. e181–e187. DOI: 10.1097/RLU.0000000000003478.McMeekin H.J., Peters A.M., Burniston M.T., Vadrucci M. Quantitative lymphoscintigraphy of the lower limbs for the diagnosis of phlebolymphoedema. Nuclear Medicine Communications, 2023, vol. 44(12), pp. 1080–1086. DOI: 10.1097/MNM.0000000000001769.Mortimer P.S., Pearson I.C. Lymphatic function in severe chronic venous insufficiency. Phlebolymphology, 2004, no. 44, pp. 253–257.Mortimer P.S., Rockson S.G. New developments in clinical aspects of lymphatic disease. Journal of Clinical Investigation, 2014, vol. 124(3), pp. 915–921. DOI: 10.1172/JCI71608.Nagy B.I., Mohos B., Tzou C.J. Imaging modalities for evaluating lymphedema. Medicina (Kaunas), 2023, vol. 59(11), art. 2016. DOI: 10.3390/medicina59112016.Nganga E.C., Makhdomi K. Comparison of quantitative analysis to qualitative analysis for interpretation of lower-limb lymphoscintigraphy. World Journal of Nuclear Medicine, 2019, vol. 18(1), pp. 36–41. DOI: 10.4103/wjnm.WJNM_17_18.Nuri T., Yamamoto T., Yoshimatsu H. et al. Lymphoscintigraphy for prediction of effect of lymphaticovenular anastomosis for treatment of secondary lower limb lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2022, vol. 10(5), pp. 1079–1086.e2.O’Donnell T.F. Jr., Rasmussen J.C., Sevick-Muraca E.M. New diagnostic modalities in the evaluation of lymphedema. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2017, vol. 5(2), pp. 261–273. DOI: 10.1016/j.jvsv.2016.10.083.Pappalardo M., Cheng M.H. Lymphoscintigraphy for the diagnosis of extremity lymphedema: current controversies regarding protocol, interpretation, and clinical application. Surg. Oncol., 2020, vol. 121(1), pp. 37–47. DOI: 10.1002/jso.25526.Ranzenberger L.R., Pai R.B. Lymphoscintigraphy. In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 2025. Available at: https://www.ncbi.nlm.nih.gov/books/NBK563213/ (Accessed: 2025, Nov. 14).Rasmussen J.C., Sevick-Muraca E.M., Aldrich M.B. et al. Degradation of lymphatic anatomy and function in early venous insufficiency. Journal of Vascular Surgery: Venous and Lymphatic Disorders, 2021, vol. 9(3), pp. 720–730.e2. DOI: 10.1016/j.jvsv.2020.09.007.Sampathirao N., Indirani M., Manokaran G. et al. Assessment of lymphedema with lymphoscintigraphy: can nodal quantification help? Lymphology, 2021, vol. 54, pp. 92–105. DOI: 10.2458/lymph.4730.Sansilvestri-Morel P. et al. Imbalance in the synthesis of collagen types in varicose veins. Journal of Vascular Research, 2001, vol. 38, pp. 560–568. DOI: 10.1159/000051092.Szuba A. et al. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. Journal of Nuclear Medicine, 2003, vol. 44(1), pp. 43–57.van Schaik C.J., Boer L.L., Draaisma J.M.T. et al. The lymphatic system throughout history: from hieroglyphic translations to state of the art radiological techniques. Clinical Anatomy, 2022, vol. 35(6), pp. 701–710. DOI: 10.1002/ca.23867.Vargo M., Aldrich M., Donahue P. et al. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Medical Oncology, 2024, vol. 41, art. 241. DOI: 10.1007/s12032-024-02472-9.Weissleder H., Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology, 1988, vol. 167(3), pp. 729–735. DOI: 10.1148/radiology.167.3.3363131.Zöller B., Ji J., Sundquist J., Sundquist K. Family history and risk of hospital treatment for varicose veins in Sweden. British Journal of Surgery, 2012, vol. 99(7), pp. 948–953. DOI: 10.1002/bjs.8779.