MR Lymphangiography in Children: Technique and Potential Applications

Abstract

The lymphatic system, an important component of the circulatory system with essential physiologic functions, can be affected by various disease processes. There has been a delay in the development of effective imaging methods for the lymphatic system due to its small size, which limits visualization as well as introduction of contrast material. Traditionally, the lymphatic system has been imaged by injecting contrast material or radiotracers into the feet or hands. This is not sufficient for assessment of the central conducting lymphatics (CCLs) (such as the thoracic duct or the cisterna chyli). Fluoroscopic intranodal lymphangiography with injection of oil-based contrast material into groin lymph nodes improves visualization of CCLs but is limited in practice owing to the use of radiation and the potential risk for paradoxical embolization in children with left-to-right shunt. Dynamic contrast material-enhanced (DCE) magnetic resonance (MR) lymphangiography, which is performed by injecting gadolinium-based contrast material into groin lymph nodes, overcomes these limitations. T2-weighted imaging plays a complementary role to DCE MR lymphangiography in the assessment of CCLs. DCE MR lymphangiography demonstrates preserved integrity or any abnormality of the CCLs (including blockage or leak). The technique has recently been used in evaluating pulmonary lymphatic perfusion syndrome in children with plastic bronchitis, neonatal lymphatic flow disorders, and nontraumatic chylothorax. It is useful in identification of the source of chylous ascites and contributes to understanding of the anatomy of lymphatic malformations. It is successfully used for planning of embolization of aberrant lymphatic channels in a variety of lymphatic flow disorders. This review discusses the anatomy and function of the lymphatic system, the evolution of imaging of the lymphatic system, and DCE MR lymphangiography technique and its applications in children. RSNA, 2017.

Chylous Ascites and Lymphoceles: Evaluation and Interventions

“…In addition, it is helpful for planning lymphatic embolization or alternative percutaneous interventions depending on the lymphatic anatomy. [19][20][21] Nadolski et al reported nine patients who underwent DC-MRL in the setting of CA demonstrating lymphatic leakage in seven patients all of which had traumatic etiology. 22 Lymphangiography is an important technique for the detection and treatment of lymphatic leaks.…”

The Role of Interventional Radiologists in the Treatment of Congenital Lymphatic Malformations

“…73 Magnetic resonance lymphangiography (MRL) is also helpful in establishing the extent and involvement of complex lesions. 78 The technique for MRL has been described extensively by prior authors and commonly involves interventional radiologists.…”

Review of Non-Contrast MR-Lymphography Techniques and Findings: Challenges and Opportunities

“…Mazzei et al [12] Lymphoscintigraphy, Lymphangiography SPECT/CT, SPECT, US, MRL All Review China Xiong et al [13] GE, 1.5 T or 3.0 T, (Gd-BOPTA), Multi Hance The MR examination consists of 2 primary sequences. The first is a 3D heavily T2-weighted sequence Peripheral lymphedema NA USA Mitsumori et al [16] gadolinium-based contrast material T2-weighted imaging plays a complementary role to DCE MR lymphangiography in the assessment of CCLs MRL Review USA Chavhan et al [21] Preoperative and postoperative MRL Philips 3.0-T, Gd-BOPTA.3D fast spoiled gradient recalled echo T1-weighted images with a fat saturation technique(TR/TE: 3.5/1.7, flip angle: 25…”