High-Resolution MR Lymphangiography in Patients with Primary and Secondary Lymphedema

Lohrmann, Christian; Foeldi, Etelka; Speck, Oliver; Langer, Mathias

doi:10.2214/ajr.05.1750

Cited by 95 publications

(84 citation statements)

References 7 publications

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“…As demonstrated in all four patients in this study, MRL is highly superior to lymphoscintigraphy when taking into account the detailed description, with high resolution of small lymphatic pathologies that are only a few millimetres in size and consecutive affection of the adjacent structures. Furthermore, MRL is able to delineate dermal backflow areas precisely, indicating a lymphatic outflow obstruction [11][12][13]. Additionally, similar to a lymphoscintigraphy study, it is possible to obtain functional information for a MRL study, since the image acquisitions of the T 1 weighted 3D spoiled gradient echo sequence are obtained sequentially 15, 25, 35, 45 and 55 min after intracutaneous contrast material injection [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, MRL is able to delineate dermal backflow areas precisely, indicating a lymphatic outflow obstruction [11][12][13]. Additionally, similar to a lymphoscintigraphy study, it is possible to obtain functional information for a MRL study, since the image acquisitions of the T 1 weighted 3D spoiled gradient echo sequence are obtained sequentially 15, 25, 35, 45 and 55 min after intracutaneous contrast material injection [11][12][13]. As seen N/A, not applicable; T 1 sequence (after intracutaneous contrast material injection at the region of the forefoot).…”

Section: Discussionmentioning

confidence: 99%

“…In coherence with previous MRL studies, the imaging protocol consisted of a heavily T 2 weighted threedimensional turbo spin echo (3D-TSE) sequence (repetition time/echo time (TR/TE), 2000/694; flip angle, 180 u ; matrix, 256 6 256, bandwidth, 247 Hz/pixel; 6/8 rectangular field of view 480 mm; slices, 96; voxel size, 2.0 6 1.9 6 1.7 mm; acquisition time, 4 min 48 s) to evaluate the extent and distribution of the lymphoedema [11,12] …”

Section: Methodsmentioning

confidence: 99%

“…Magnetic resonance lymphangiography (MRL) with intracutaneous injection of an extracelllular paramagnetic contrast agent is an innovative diagnostic imaging method for the evaluation of the lymphatic system. This method has proved to be feasible in patients with primary or secondary lymphoedema [11][12][13].…”

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confidence: 99%

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Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography

Lohrmann

Foeldi²,

Langer³

2011

BJR

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Objective: Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate diagnostic imaging modality is in existence to allow selection of the correct treatment option. The aim of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL). Methods: Eight lower extremities in four patients with lymphocutaneous fistulas were examined by MRL. Three locations were examined: first, the lower leg and foot regions; second, the upper leg and the knee region; and third, the pelvic and retroperitoneal regions. A T 1 weighted three-dimensional (3D) spoiled gradient echo and a heavily T 2 weighted 3D turbo spin echo (3D-TSE) sequence were utilised to undertake MRL. Results: In all four patients (100%), the clinically suspected lymphocutaneous fistulas (groin and forefoot) were exactly delineated by MRL. In two patients (50%) adjacent diffuse lymphangiomatous changes were detected, extending into the upper leg, pelvis, retroperitoneum, abdomen and abdominal walls. In one patient (25%) with primary lymphoedema of the right lower extremity, MRL revealed an aplasia of the lymphatic collectors at the levels of the lower and upper leg. All patients (100%) suffered from an ipsilateral lymphoedema of the lower extremity, whereby in two patients with diffuse lymphangiomatosis the lymphatic vessels were consecutively enlarged up to a diameter of 6 mm. Conclusion: MRL is a safe and accurate imaging modality for a comprehensive evaluation of the lymphatic system in patients suffering from lymphocutaneous fistulas.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography

Lohrmann

Foeldi²,

Langer³

2011

BJR

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“…23,24 However, most of these lymphotropic contrast agents are still in the preclinical phase or under development, and validation in larger studies is needed before their routine use in clinical practice. 24 …”

Section: Figurementioning

confidence: 99%

Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT

2014

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A 7-month-old girl with history of persistent left chylous pleural effusion was referred for lymphoscintigraphy. A previous chest computed tomography (CT) scan demonstrated a small to moderate-sized left pleural effusion but could not identify the lymphatic leakage site. Lymphoscintigraphy using filtered 99m Tc sulfur colloid showed minimal focal activity in the lower chest. A correlative single-photon emission computed tomography (SPECT)/CT localized this activity to distal paraesophageal region, being highly suggestive of the site of lymphatic leakage. Subsequent lymphangiography confirmed these findings, revealing an abnormal lymphatic branch at the level of T10 and T11 vertebrae with retrocrural extravasation toward the left hemithorax. Thoracic duct embolization was accomplished at and proximal to the site of chyle leak using a platinum coil and n-Butyl cyanoacrylate glue. The patient was followed up for .24 months and demonstrated no recurrence of pleural effusion. No ascites or other complications related to the procedure were noted. The case demonstrates that 99m Tc sulfur colloid lymphoscintigraphy SPECT/CT can be a useful modality for detecting the chyle leakage site in children with chylothorax even when the amount of leakage is minimal.

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Interstitial MR lymphography in mice with gadopentetate dimeglumine and gadoxetate disodium

Sheng

Inoue

Kiryu

et al. 2011

Magnetic Resonance Imaging

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Purpose: To investigate the utility of interstitial MR lymphography with gadopentetate dimeglumine (Gd-DTPA) or gadoxetate disodium (Gd-EOB-DTPA) in mice. Materials and Methods:We performed MR lymphography after the subcutaneous injection of Gd-DTPA or Gd-EOB-DTPA (0.1, 0.5, or 2.0 mmol per mouse) into the right footpad in six healthy mice, and the time courses of contrast enhancement were assessed. Additionally, the lymphatic pathways from two distinct sites were assessed in tandem by interstitial MR lymphography studies.Results: Subcutaneous injection of Gd-DTPA or Gd-EOB-DTPA caused lymph node enhancement immediately after injection, followed by a rapid decline. Dose dependency was shown for the lymph node enhancement, and a highdose injection caused prominent visualization of the veins. Lymph node enhancement did not differ significantly between Gd-DTPA and Gd-EOB-DTPA or between Gd-EOB-DTPA premixed and not premixed with bovine serum albumin. The tandem assessment of two lymphatic pathways was feasible, and image fusion aided detailed comparison. Conclusion:Interstitial MR lymphography with Gd-DTPA or Gd-EOB-DTPA allowed clear visualization of the lymphatic pathway in healthy mice, and no significant difference was found between the two agents. Their rapid kinetics limits the imaging timing window, however, facilitates repeated assessment in a single imaging session.

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High-Resolution MR Lymphangiography in Patients with Primary and Secondary Lymphedema

Abstract: High-resolution MR lymphangiography is safe, is technically feasible, and has the potential to become a diagnostic imaging tool for patients with lymphedema.

Cited by 95 publications

References 7 publications

Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography

Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography

Minimal Lymphatic Leakage in an Infant With Chylothorax Detected by Lymphoscintigraphy SPECT/CT

Interstitial MR lymphography in mice with gadopentetate dimeglumine and gadoxetate disodium

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