title: Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography.
abstract: Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.Ten patients (age range 42-72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems.
authors.affiliation: From the Department of Radiology and Center for Imaging Science (EYK, HSH, HYL, KSL); Department of Thoracic and Cardiovascular Surgery (JHC, HKK, YMS, JZ), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Radiology (EYK), Ajou University School of Medicine, Suwon, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Hwang
authors.forename: Ho Yun
authors.initials: HY
authors.lastname: Lee
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Cho
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.forename: Jaeil
authors.initials: J
authors.lastname: Zo
mesh_terms: D000328:Adult; D000368:Aged; D002916:Chylothorax / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008202:Lymphangioma / Q000175:diagnosis*; D008220:Lymphography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013897:Thoracic Duct / Q000473:pathology*