title: Indirect MR lymphangiography of the head and neck using conventional gadolinium contrast: a pilot study in humans.
abstract: OBJECTIVE
  To evaluate indirect magnetic resonance lymphangiography (MR-LAG) using interstitial injection of conventional gadolinium contrast (gadoteridol and gadopentetate dimeglumine) for delineating the primary lymphatic drainage of head-and-neck sites.
  
  
  METHODS
  We performed head-and-neck MR-LAG in 5 healthy volunteers, with injection of dermal and mucosal sites. We evaluated the safety of the procedure, the patterns of enhancement categorized by injection site and nodal level, the time course of enhancement, the optimal concentration and volume of contrast, and the optimal imaging sequence.
  
  
  RESULTS
  The worst side effects of interstitial contrast injection were brief, mild pain and swelling at the injected sites that were self-limited. MR-LAG resulted in consistent visualization of the primary lymphatic drainage pattern specific to each injected site, which was reproducible on repeated examinations. The best enhancement was obtained with injection of small volumes (0.3-0.5 mL) of either agent diluted, imaging within 5-15 min of injection, and a three-dimensional fast spoiled gradient echo sequence with magnetization transfer.
  
  
  CONCLUSIONS
  We found head-and-neck MR-LAG to be a safe, convenient imaging method that provides functional information about the lymphatic drainage of injected sites. Applied to head-and-neck cancer, it has the potential to identify sites at highest risk of occult metastatic spread for radiotherapy or surgical planning, and possibly to visualize micrometastases.
authors.affiliation: Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA, and Department of General Surgery, Singapore General Hospital, Singapore. BWLoo@Stanford.edu
authors.forename: Billy W
authors.initials: BW
authors.lastname: Loo
authors.forename: Mary T
authors.initials: MT
authors.lastname: Draney
authors.forename: Ranjiv
authors.initials: R
authors.lastname: Sivanandan
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Ruehm
authors.forename: Todd
authors.initials: T
authors.lastname: Pawlicki
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Herfkens
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005682:Gadolinium; D019786:Gadolinium DTPA / Q000009:adverse effects; D006257:Head / Q000000981:diagnostic imaging*; D006571:Heterocyclic Compounds / Q000009:adverse effects; D006801:Humans; D008220:Lymphography / Q000009:adverse effects / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging*; D009942:Organometallic Compounds / Q000009:adverse effects; D010865:Pilot Projects; D011877:Radionuclide Imaging
chemical_list: D003287:Contrast Media; D006571:Heterocyclic Compounds; D009942:Organometallic Compounds; C062402:gadoteridol; D005682:Gadolinium; D019786:Gadolinium DTPA