title: Contrast-enhanced magnetic resonance lymphography in the assessment of lower limb lymphoedema.
abstract: Chronic lower limb lymphoedema is a debilitating condition that may occur as a primary disorder or secondary to other conditions. Satisfactory visualization of the lymphatic vessels to aid diagnosis and surgical planning has been problematic. Historically, direct lymphography was used to visualize lymphatic vessels, although the significant surgical risks involved led to this being largely abandoned as a technique. Technetium-99m lymphoscintigraphy has been the mainstay of diagnosis for over two decades, but is hampered by inherently poor temporal and spatial resolution and limited anatomical detail. Contrast-enhanced magnetic resonance lymphography (MRL) is a relatively new technique that shows early promise in the evaluation of chronic lymphoedema. This article provides the procedural technique for lower limb MRL at both 1.5 and 3 T, discusses pathophysiology and classifications of lymphoedema, provides an overview of relevant lower limb lymphatic anatomy using MRL imaging, compares the various techniques used in the diagnosis of lower limb lymphoedema, shows common pathological MRL imaging findings, and describes alternative uses of MRL. Utilization of this technique will allow more accurate diagnosis and classification of patients suffering from lymphoedema.
authors: Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK; Department of Clinical Radiology, University Hospital of Wales, Cardiff CF14 4XW, UK.
authors: R D
authors: RD
authors: White
authors: Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK.
authors: J R
authors: JR
authors: Weir-McCall
authors: Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK.
authors: M J
authors: MJ
authors: Budak
authors: Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK.
authors: S A
authors: SA
authors: Waugh
authors: Department of Plastic Surgery, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK.
authors: D A
authors: DA
authors: Munnoch
authors: Department of Clinical Radiology, Ninewells Hospital and Medical School, Ninewells Avenue, Dundee DD1 9SY, UK. Electronic address: tsudarshan@nhs.net.
authors: T A P
authors: TA
authors: Sudarshan
mesh_terms: D002908:Chronic Disease; D003287:Contrast Media; D006801:Humans; D035002:Lower Extremity; D008209:Lymphedema / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media