Contrast-enhanced magnetic resonance lymphography in the assessment of lower limb lymphoedema

White, Richard D.; Weir-McCall, JR; Budak, Matthew; Waugh, Shelley A.; Munnoch, D. Alex; Sudarshan, Thiru

doi:10.1016/j.crad.2014.06.007

Cited by 23 publications

(29 citation statements)

References 46 publications

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“…In fact while the colloid-binding tracer of lymphoscintigraphy is very specific for the lymphatic system, gadolinium chelates are water soluble and diffusible, so that venous drainage of the contrast agent may also be present. Regarding this limitation, despite White et al reporting the need of an intradermal injection rather than a subcutaneous injection for the optimal visualization of lymphatics and poor venous contamination [3], we did not find significant differences between the two approaches. In our experience, the only precaution adopted before the contrast medium injection was to withdraw the syringe plunger in order to avoid a small vein cannulation.…”

Section: Discussioncontrasting

confidence: 82%

“…Lymphedema is a chronic debilitating condition that is frequently misdiagnosed and traditionally regarded as incurable [3, 9, 13]. It results from impaired lymphatic transport caused by damage to lymphatic vessels, infection, or congenital abnormality [14, 15].…”

Section: Discussionmentioning

confidence: 99%

“…The imaging protocol generally consists of a heavily T2-weighted sequence in order to evaluate the extent and distribution of the lymphedema and of a 3D fast spoiled gradient-echo T1-weighted sequence with a fat-saturation technique for the lymphatic visualization [3, 9, 10]. In our experience we performed a 3D steady-state free precession (SSFP) balanced electrocardiography- (ECG-) triggered sequence (FIESTA, GE) with spectral fat saturation (SPECtral inversion at lipid, SPECIAL, GE) instead of a heavily T2-weighted sequence in order to obtain a good visualization of both the venous system and the distribution of the lymphedema within the same sequence and at the same time.…”

Section: General Technique Of High-resolution Mr Lymphangiographymentioning

confidence: 99%

“…In this scenario, Magnetic Resonance Lymphangiography (MRL), combining morphological and functional information in a single examination, could play a pivotal role in treatment planning. In particular the entire lower or upper extremity can be examined in several steps with high spatial and temporal resolution, obtaining dynamic information of contrast agent uptake of both lymph nodes and lymphatic vessels [3]. Thanks to the detailed anatomical information regarding the lymphatic system, MRL could also be useful in evaluating changes in the lymphatic circulation postoperatively or in the event of surgical complications [4].…”

Section: Introductionmentioning

confidence: 99%

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MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View

Mazzei

Gentili

Guerrini

et al. 2017

BioMed Research International

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We propose a practical approach for performing high-resolution MR lymphangiography (MRL). We shall discuss and illustrate the technical approach for the visualization of lymphatic vessels in patients suffering from lymphedema, how to distinguish lymphatic vessels from veins, and MRL role in supermicrosurgery treatment planning. A brief review of literature, from a technical point of view, is also reported.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: General Technique Of High-resolution Mr Lymphangiographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View

Mazzei

Gentili

Guerrini

et al. 2017

BioMed Research International

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“…However, the localization of the responsible lymph vessels related to lymphedema remains to be a challenge and a time-consuming difficult procedure [7] due to visibility limitations such as diameter of lymph vessels (0.4–0.8 mm) which contains few cells with mainly clear lymph fluid, long-term chronic fibrosis and inflammatory stimulations [8]. To overcome the challenge, various imaging modalities have been applied to assess lymphatic vessels, such as optical imaging by injecting a fluorescent indocyanine green (ICG) dye to provide intraoperative guidance [8–11], magnetic resonance lymphangiography (MRL) [12] and radionuclide lymphoscintigraphy for preoperative evaluation [11, 13–15]. …”

Section: Introductionmentioning

confidence: 99%

Microsurgery guided by sequential preoperative lymphography using 68Ga-NEB PET and MRI in patients with lower-limb lymphedema

Long

Zhang

et al. 2017

Eur J Nucl Med Mol Imaging

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Objective The popularity of contemporary microsurgical techniques in treatment of lower-limb lymphedema calls for better visualization of the lymphatic system, both preoperatively and intraoperatively. The aim of this prospective study was to investigate the feasibility of a novel combination of 68Ga-NEB PET with MR lymphography (MRL) in evaluating lymphedema and guiding surgical intervention. Methods A total of 11 patients (F 9, M 2, age range 29–69 y) with lower limb lymphedema classified into stage I to III were recruited. PET acquisition was performed at 30, 60, and 90 min after subcutaneous injection of the albumin-binding radiotracer 68Ga-NEB into the bilateral first web spaces of the feet. All the patients were also subjected to 99mTc-sulfur colloid (SC) lymphoscintigraphy for comparison. Gd-DTPA enhanced MRI was performed using sequences specialized for lymphatic vessel scans. All the patients underwent surgical interventions within a week. The surgical approach includes the use of linear marker for edema localization and ICG lymphography with near-infrared surgical navigation system intraoperatively. Results Lymph transport in lymphatic channels was clearly observed by visualization of 68Ga-NEB activity in the lymphatic vessels and within lymph nodes for all the 11 patients as well as the visualization of edema section plane with dermal backflow (DB), abnormally increased and disconnected uptake along the lymphatic channels. Preoperative 68Ga-NEB PET combined with MRL provides advantageous 3-dimensional images, higher temporal resolution, significantly shorter time lapse before image acquisition after tracer injection, more accurate pathological lymphatic vessel distribution than 99mTc-SC lymphoscintigraphy combined with MRI. Conclusion This study documented an effective imaging pattern to combine 68Ga-NEB PET and MRL in patients with lower-limb lymphedema. This strategy demonstrated significant advantage over 99mTc-SC lymphoscintigraphy/MRL in the evaluation of lymphedema severity, staging and pathological location of lymph vessels to make individualized treatment plan. Dual 68Ga-NEB PET/MRL is thus recommended before the operation for staging and therapy planning.

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Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective

Mills

Zanten

Borri

et al. 2021

Magnetic Resonance Imaging

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Background Clinical examination and lymphoscintigraphy are the current standard for investigating lymphatic function. Magnetic resonance imaging (MRI) facilitates three‐dimensional (3D), nonionizing imaging of the lymphatic vasculature, including functional assessments of lymphatic flow, and may improve diagnosis and treatment planning in disease states such as lymphedema. Purpose To summarize the role of MRI as a noninvasive technique to assess lymphatic drainage and highlight areas in need of further study. Study Type Systematic review. Population In October 2019, a systematic literature search (PubMed) was performed to identify articles on magnetic resonance lymphangiography (MRL). Field Strength/Sequence No field strength or sequence restrictions. Assessment Article quality assessment was conducted using a bespoke protocol, designed with heavy reliance on the National Institutes of Health quality assessment tool for case series studies and Downs and Blacks quality checklist for health care intervention studies. Statistical Tests The results of the original research articles are summarized. Results From 612 identified articles, 43 articles were included and their protocols and results summarized. Field strength was 1.5 or 3.0 T in all studies, with 25/43 (58%) employing 3.0 T imaging. Most commonly, imaging of the peripheries, upper and lower limbs including the pelvis (32/43, 74%), and the trunk (10/43, 23%) is performed, including two studies covering both regions. Imaging protocols were heterogenous; however, T2‐weighted and contrast‐enhanced T1‐weighted images are routinely acquired and demonstrate the lymphatic vasculature. Edema, vessel, quantity and morphology, and contrast uptake characteristics are commonly reported indicators of lymphatic dysfunction. Data Conclusion MRL is uniquely placed to yield large field of view, qualitative and quantitative, 3D imaging of the lymphatic vasculature. Despite study heterogeneity, consensus is emerging regarding MRL protocol design. MRL has the potential to dramatically improve understanding of the lymphatics and detect disease, but further optimization, and research into the influence of study protocol differences, is required before this is fully realized. Level of Evidence 2 Technical Efficacy Stage 2

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Contrast-enhanced magnetic resonance lymphography in the assessment of lower limb lymphoedema

Cited by 23 publications

References 46 publications

MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View

MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View

Microsurgery guided by sequential preoperative lymphography using 68Ga-NEB PET and MRI in patients with lower-limb lymphedema

Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective

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