title: Indirect magnetic resonance lymphangiography in patients with lymphedema preliminary results in humans.
abstract: OBJECTIVE
  To assess the feasibility of indirect magnetic resonance (MR) lymphangiography with intracutaneous injection of gadodiamide, a commercially available, non-ionic, extracellular paramagnetic contrast agent for the detection of lymphatic vessels in patients with lymphedema.
  
  
  METHODS
  In 2005, three patients with lymphedema of the lower extremities (1 primary, 2 secondary) were referred by the Foeldi Clinic for Lymphology for indirect magnetic resonance lymphangiography. 4.5 mL of gadodiamide and 0.5 mL of mepivacainhydrochloride 1% were injected intracutaneously into the dorsal aspect of each foot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For indirect magnetic resonance lymphangiography, a 3D Fast Low Angle Shot (FLASH) sequence (TR/TE: 5.1/1.23; flip angle: 25; matrix: 448 x 448; bandwidth: 330 Hz/pixel; 6/8 rectangular field of view with a maximum dimension of 500 mm; slices: 88; voxel size: 2.0 mm x 1.0 mm x 1.0mm; acquisition time: 0 min 31 s) was used.
  
  
  RESULTS
  Indirect magnetic resonance lymphangiography depicted lymphatic vessels of the lower and upper leg, and inguinal lymph nodes in all three patients. After 5 min of contrast material application, concomitant venous enhancement was detected. Collateral vessels with dermal back-flow were seen in two patients. A lymphocele in the inguinal region with the afferent lymphatic vessel was depicted in one patient.
  
  
  CONCLUSIONS
  In the presented small study group, indirect magnetic resonance lymphangiography was technically feasible, and no complications were observed after intracutaneous injection of gadodiamide. Visualizing the lymphatic vessels and accompanying complications non-invasively and without the use of radiation, the presented method has the capability to become a routine diagnostic imaging tool in patients with primary and secondary lymphedema. The method is not able to characterize lymph node morphology, but could provide additional information about the lymphatic vessels when lymph nodes are examined, e.g. with super-paramagnetic iron oxide particles.
authors.affiliation: Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany. lohrmann@mrs1@ukl.uni-freiburg.de
authors.forename: Christian
authors.initials: C
authors.lastname: Lohrmann
authors.forename: Etelka
authors.initials: E
authors.lastname: Foeldi
authors.forename: Mathias
authors.initials: M
authors.lastname: Langer
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007267:Injections; D008209:Lymphedema / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA