title: Imaging the central conducting lymphatics: initial experience with dynamic MR lymphangiography.
abstract: OBJECTIVE
  To describe a dynamic magnetic resonance (MR) lymphangiography technique after intranodal injection of gadolinium-based contrast agent and to assess its feasibility for evaluation of the central conducting lymphatics (CCL) in patients with pathologic disorders that involve the CCL.
  
  
  METHODS
  A retrospective evaluation of experience with the dynamic MR lymphangiographic technique in six consecutive patients was performed after institutional review board approval. Written informed consent for the percutaneous procedure was obtained from the patient, parent, or the legally responsible guardian. The dynamic MR lymphangiographic technique involves ultrasonographically guided intranodal injection of gadolinium-based contrast material into the inguinal lymph nodes, combined with sequential imaging of the chest and abdomen with a three-dimensional sequence optimized for soft tissue with high spatial resolution that provides time-resolved imaging of lymphatic transit through the CCL. Qualitative assessment of the images was performed for reliability of CCL visualization and for associated findings that could explain the clinical symptoms, including lymphangiectasia, chylolymphatic reflux, and chylous leak.
  
  
  RESULTS
  The procedure was technically successful in all six patients. The dynamic MR lymphangiographic findings confirmed the presence of normal CCL morphologic structure in two patients and provided a possible explanation for clinical manifestations in the remaining four patients. The dynamic MR lymphangiographic procedure led to a change in management in two patients, continuation of conservative treatment in three patients, and confirmation of an alternative nonlymphatic diagnosis in one patient. Image quality for visualization of the CCL was considered good in all cases by the two readers. There were no known adverse effects related to the procedure.
  
  
  CONCLUSIONS
  The dynamic MR lymphangiographic technique with intranodal injection of gadolinium-based contrast material is feasible and can provide useful information in a variety of lymphatic flow abnormalities involving the CCL.
authors.affiliation: From the EB Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite 1280, Houston, TX 77030.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Krishnamurthy
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernandez
authors.forename: Serife
authors.initials: S
authors.lastname: Kavuk
authors.forename: Aparna
authors.initials: A
authors.lastname: Annam
authors.forename: Sheena
authors.initials: S
authors.lastname: Pimpalwar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D015552:Injections, Intralesional; D008206:Lymphatic Diseases / Q000175:diagnosis*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D008220:Lymphography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA