Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography

Abstract

Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.Ten patients (age range 42–72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems.

Unilateral pedal lymphangiography plus computed tomography angiography for location of persistent idiopathic chyle leakage not detectable by ordinary contrast computed tomography

“…Evaluation of abdominal and retroperitoneal lymphatic abnormalities, including lymphatic leaks, using MRI lymphography with heavily T2-weighted fast spin echo sequences [ 10 ]. Nonenhanced MRI lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of chylothorax or lymphangioma [ 13 ]. However there been few reports have described its use in chyluria patients [ 14 ].…”

Initial Clinical Experience with Dual-Agent Relaxation Contrast for Isolated Lymphatic Channel Mapping

“…MR lymphangiography has many distinct advantages over other popular techniques used to depict lymphatics, such as fluorescent lymphangiography with indocyanine green. For example, (31,32), or susceptibility-weighted imaging could achieve similar results in patients with lymphedema. However, in general, we did not see the small-caliber extremity lymphatic channels seen on contrastenhanced MR lymphangiograms on our three-dimensional T2-weighted images.…”

A Case of Adult T-Cell Leukemia/Lymphoma Complicated with Bilateral Chylothorax

“…The gold standard for localizing lymph leakage is direct visualization at surgery or by lymphangiography. Specifically, case series have indicated that noncontrast magnetic resonance (MR) lymphangiography provides accurate visualization of the central thoracic lymphatics and sites of chyle leakage [12]. Dynamic contrast-enhanced MR lymphangiography with intranodal injection of a gadolinium-based contrast agent into the inguinal lymph nodes has also been reported to provide good spatial and temporal resolution for visualizing the anatomy and flow characteristics of the central lymphatic system [13].…”