title: MR lymphangiography: How i do it.
abstract: Lymphedema is a chronic progressive edematous disease that in the United States is most commonly related to malignancy and its treatment. Lymphaticovenular anastomosis is a recently introduced microsurgical treatment option for lymphedema that requires the identification and mapping of individual lymphatic channels. While nuclear medicine lymphoscintigraphy has been the primary imaging modality performed to evaluate suspected lymphedema, lymphoscintigraphy does not provide the spatial information necessary for presurgical planning. High-resolution dynamic 3D magnetic resonance imaging (MRI) can noninvasively image abnormal lymphatic channels to both diagnose lymphedema and depict the location and number of individual lymphatic channels for surgical planning. MR lymphangiography can be performed at 1.5T or 3.0T using multichannel phased array surface coils. The main components of the exam are a heavily T2 -weighted 3D sequence to define the severity and extent of edema, a high-resolution dynamic 3D gradient echo imaging after intracutaneous contrast injection to visualize lymphatic channels, and a delayed 3D gradient echo sequence after intravenous contrast to define veins. This article reviews the pathophysiology and microsurgical treatment of lymphedema, presents the imaging protocol used at our institution, and describes exam interpretation and the image postprocessing performed for surgical planning.
authors.affiliation: Department of Radiology, Straub Clinic and Hospital, Honolulu, Hawaii, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Mitsumori
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: McDonald
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Wilson
authors.affiliation: Department of Plastic Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Neligan
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Minoshima
authors.affiliation: Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Maki
mesh_terms: D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008209:Lymphedema / Q000473:pathology* / Q000601:surgery*; D008220:Lymphography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods
keywords: MR lymphangiography; breast cancer; image postprocessing; lymphaticovenular anastomosis; lymphedema; microsurgery