title: Anatomic and functional evaluation of the lymphatics and lymph nodes in diagnosis of lymphatic circulation disorders with contrast magnetic resonance lymphangiography.
abstract: OBJECTIVE
  Owing to its structural and anatomic characteristics, imaging of the lymphatic system has been difficult. The conventional diagnostic method of radionuclide-based imaging has the disadvantage of poor resolution. Recent work has shown that magnetic resonance imaging (MRI) can depict lymphatic channels in patients with lymphedema. This study evaluated the anatomic and functional images of contrast MR lymphangiography in the diagnosis of limb lymphatic circulation disorders.
  
  
  METHODS
  The study enrolled 27 patients with primary lymphedema. Four patients had bilateral disease, and 23 had unilateral disease. Contrast-enhanced lymphangiography was performed with a 3.0-T MR unit after the intracutaneous injection of gadobenate dimeglumine into the interdigital webs of the dorsal foot. The kinetics of enhanced lymph flow within the lymphatic system were calculated using the formula [speed in cm = total length of visualized lymph vessel in cm/inspection time in minutes] and by comparing dynamic nodal enhancement and time-signal intensity curves between edematous and contralateral limbs. Morphologic abnormalities of the lymphatic system were also evaluated.
  
  
  RESULTS
  Examination of the MRIs after injection of the contrast agent showed enhanced lymphatic channels consistently visualized in all clinical lymphedematous limbs and in five contralateral limbs of unilateral lymphedema patients. The speed of flow within the lymphatics of lymphedematous limbs was 0.3 to 1.48 cm/min. Contrast enhancement in inguinal nodes of edematous limbs was significantly less than that of contralateral limbs (P < .01). Dynamic measurement of contrast enhancement showed a remarkable lowering of peak time (P < .01) and peak enhancement (P < .01), and a delay in outflow in inguinal nodes of affected limbs compared with that of control limbs. Postcontrast MRI also depicted varied distribution patterns of lymphatics and abnormal lymph flow pathways within lymph nodes in the limbs with lymphatic circulation disorders.
  
  
  CONCLUSIONS
  Contrast MR lymphangiography with gadobenate dimeglumine is capable of visualizing the precise anatomy of lymphatic vessels and lymph nodes in lymphedematous limbs. It also provides information concerning the functional status of lymph flow transport in the lymphatic vessels and lymph nodes of these limbs.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Ning-Fei
authors.initials: NF
authors.lastname: Liu
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.forename: Zhao-Hua
authors.initials: ZH
authors.lastname: Jiang
authors.forename: Chen-Guang
authors.initials: CG
authors.lastname: Wang
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003287:Contrast Media; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007700:Kinetics; D008196:Lymph / Q000378:metabolism; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology*; D042601:Lymphatic Vessels / Q000378:metabolism / Q000473:pathology*; D008209:Lymphedema / Q000378:metabolism / Q000473:pathology*; D008220:Lymphography / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives*; D008875:Middle Aged; D009942:Organometallic Compounds; D010865:Pilot Projects; D011237:Predictive Value of Tests; D055815:Young Adult
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine