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Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Cavernous lymphangioma in a 41-year-old female. A, Enhanced axial CT scan demonstrates a well-defined homogenous low attenuating mass encasing the esophagus in the posterior mediastinum. B, T2-weighted MR imaging shows high signal intensity with a multilocular septum within the mass. C, T1-weighted MR imaging shows an isosignal intensity with faint high signal intensity (white arrow), which led to suspicion of hemorrhage. D, Coronal heavily T2-weighted maximum intensity projection (MIP) image reveals continuation between the thoracic duct (arrow head) and mass. CT computed = tomography, MR = magnetic resonance.
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Figure 2: Cavernous lymphangioma in a 41-year-old female. A, Enhanced axial CT scan demonstrates a well-defined homogenous low attenuating mass encasing the esophagus in the posterior mediastinum. B, T2-weighted MR imaging shows high signal intensity with a multilocular septum within the mass. C, T1-weighted MR imaging shows an isosignal intensity with faint high signal intensity (white arrow), which led to suspicion of hemorrhage. D, Coronal heavily T2-weighted maximum intensity projection (MIP) image reveals continuation between the thoracic duct (arrow head) and mass. CT computed = tomography, MR = magnetic resonance.

Mentions: Three patients with mediastinal masses underwent chest CT and MR lymphangiography. Imaging showed a fluid-filled cystic mass with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images (Figure 2). These imaging findings suggested mediastinal cystic lymphangioma. In 2 of 3 patients who were suspected to have lymphangioma, a definite connection with the thoracic duct was noted in heavily T2-weighted MR lymphangiographic images. One of these patients underwent posterolateral thoracotomy. The thoracic duct was carefully ligated on the basis of MR lymphangiographic findings, and then the mass was resected without complication.


Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography
Cavernous lymphangioma in a 41-year-old female. A, Enhanced axial CT scan demonstrates a well-defined homogenous low attenuating mass encasing the esophagus in the posterior mediastinum. B, T2-weighted MR imaging shows high signal intensity with a multilocular septum within the mass. C, T1-weighted MR imaging shows an isosignal intensity with faint high signal intensity (white arrow), which led to suspicion of hemorrhage. D, Coronal heavily T2-weighted maximum intensity projection (MIP) image reveals continuation between the thoracic duct (arrow head) and mass. CT computed = tomography, MR = magnetic resonance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998379&req=5

Figure 2: Cavernous lymphangioma in a 41-year-old female. A, Enhanced axial CT scan demonstrates a well-defined homogenous low attenuating mass encasing the esophagus in the posterior mediastinum. B, T2-weighted MR imaging shows high signal intensity with a multilocular septum within the mass. C, T1-weighted MR imaging shows an isosignal intensity with faint high signal intensity (white arrow), which led to suspicion of hemorrhage. D, Coronal heavily T2-weighted maximum intensity projection (MIP) image reveals continuation between the thoracic duct (arrow head) and mass. CT computed = tomography, MR = magnetic resonance.
Mentions: Three patients with mediastinal masses underwent chest CT and MR lymphangiography. Imaging showed a fluid-filled cystic mass with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images (Figure 2). These imaging findings suggested mediastinal cystic lymphangioma. In 2 of 3 patients who were suspected to have lymphangioma, a definite connection with the thoracic duct was noted in heavily T2-weighted MR lymphangiographic images. One of these patients underwent posterolateral thoracotomy. The thoracic duct was carefully ligated on the basis of MR lymphangiographic findings, and then the mass was resected without complication.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus