Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizon

Abstract

The lymphatic system is an anatomically complex vascular network that is responsible for interstitial fluid homeostasis, transport of large interstitial particles and cells, immunity, and lipid absorption in the gastrointestinal tract. This network of specially adapted vessels and lymphoid tissue provides a major pathway for metastatic spread. Many malignancies produce vascular endothelial factors that induce tumoral and peritumoral lymphangiogenesis, increasing the likelihood for lymphatic spread. Radiologic evaluation for disease staging is the cornerstone of oncologic patient treatment and management. Multiple imaging modalities are available to access both local and distant metastasis. In this manuscript, we review the anatomy, physiology, and imaging of the lymphatic system.

In Vitro, In Vivo, and In Silico Models of Lymphangiogenesis in Solid Malignancies

“…For example, Yang et al combined anti-podoplanin antibodies targeting lymphatic endothelium with GoldMag nanoparticles as a contrast agent and water-soluble polyethylene glycol to increase the stabilization and biocompatibility of the nanoparticles in order to evaluate breast cancer LA [154]. Other examples of in vivo imaging technologies of the lymphatic system are discussed by Polomska and Proulx [155] and by Elshikh et al [156], the latter focusing on different oncologic imaging techniques of the lymphatic system.…”

Recent advancement of imaging strategies of the lymphatic system: Answer to the decades old questions

“…For the intravenous injection, chelates of paramagnetic ions in combination with ethylenediaminetetraacetic acid (EDTA), that is, Gd‐DTPA are used 38 . In different MRL approaches, diluted gadolinium‐based contrast may be injected to the dorsal part of the foot or directly into inguinal lymph nodes 39 . The great advantage of MRI or MRL (magnetic resonance lymphography) is that it can image the dilated lymphatics, location, depth, the extent of dermal backflow.…”

“…The great advantage of MRI or MRL (magnetic resonance lymphography) is that it can image the dilated lymphatics, location, depth, the extent of dermal backflow. MRL has great advantages over the conventional lymphangiography because in the MRL, patients are not exposed to the ionizing radiation 39 . Additionally, MRI has a significant advantage over lymphoscintiography in providing 3D images compared with 2D images acquired with the latter.…”

“…38 In different MRL approaches, diluted gadolinium-based contrast may be injected to the dorsal part of the foot or directly into inguinal lymph nodes. 39 The great advantage of MRI or MRL (magnetic resonance lymphography) is that it can image the dilated lymphatics, location, depth, the extent of dermal backflow. MRL has great advantages over the conventional lymphangiography because in the MRL, patients are not exposed to the ionizing radiation.…”

“…MRL has great advantages over the conventional lymphangiography because in the MRL, patients are not exposed to the ionizing radiation. 39 Additionally, MRI has a significant advantage over lymphoscintiography in providing 3D images compared with 2D images acquired with the latter. However, apart from the technical advantages or disadvantages, the MRI or MRL is an expensive technique to use in the clinic.…”