Interstitial MR lymphangiography - a diagnostic imaging method for the evaluation of patients with clinically advanced stages of lymphedema.
BACKGROUND
To assess the feasibility of interstitial magnetic resonance lymphangiography with intracutaneous injection of a commercially available, non-ionic, extracellular paramagnetic contrast agent, to visualize lymphatic vessels in patients with clinically advanced stages of primary lymphedema.


METHODS
Sixteen lower extremities in 8 patients with clinically advanced stages of primary lymphedema were examined with magnetic resonance lymphangiography. A 18 mL of gadodiamide and 2 mL of mepivacainhydrochloride 1% were subdivided into 10 portions and injected intracutaneously into the dorsal aspect of both feet. For MRL, a 3D spoiled gradient-echo sequence (Volumetric Interpolated Breathold Examination, VIBE) was performed.


RESULTS
The beaded appearance of lymphatic vessels extending from the injection site was detected in all 16 lower extremities (100%). In 10 lower extremities (63%), lymphatic vessels of the upper leg could be visualized. A contrast enhancement was observed in 10/16 inguinal lymph node groups (63%). In 12 lower extremities (75%) collateral vessels with dermal back-flow areas between lymphatic vessels were seen.


CONCLUSIONS
Magnetic resonance lymphangiography is safe, technically feasible, and assists the clinician in the therapeutic planning of patients with clinically advanced stages of primary lymphedema by imaging the pathologically modified lymphatic vessels and accompanying complications non-invasively.
Lohrmann
Christian
C
Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106 Freiburg, Germany. christian.lohrmann@uniklinik-freiburg.de
Foeldi
Etelka
E
Bartholomä
Jean-Paul
JP
Langer
Mathias
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging / Q000473:pathology; D019786:Gadolinium DTPA; D006801:Humans; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000473:pathology; D008220:Lymphography / Q000379:methods*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA