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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

Gorham disease in a 63-year-old female with idiopathic chylothorax. A, Enhanced axial CT with mediastinal window setting shows large right pleural effusion and abnormal fluid density lesion (white arrow) in the anterior mediastinum. B, Axial CT with bone window setting reveals a mottled osteolytic lesion (white arrow) in vertebral body. C, D, Axial heavily T2-weighted MR imaging obtained the same day demonstrates abrupt discontinuation of the thoracic duct (open arrow) with dispersion of chyle into the mediastinum (thin arrows), suggesting leakage around the cistern chyli. The mottled osteolytic lesion mentioned above showed high T2 signal intensity (thick arrow), suggesting a dilated lymphatic channel within the vertebral body. CT computed = tomography, MR = magnetic resonance.
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Figure 3: Gorham disease in a 63-year-old female with idiopathic chylothorax. A, Enhanced axial CT with mediastinal window setting shows large right pleural effusion and abnormal fluid density lesion (white arrow) in the anterior mediastinum. B, Axial CT with bone window setting reveals a mottled osteolytic lesion (white arrow) in vertebral body. C, D, Axial heavily T2-weighted MR imaging obtained the same day demonstrates abrupt discontinuation of the thoracic duct (open arrow) with dispersion of chyle into the mediastinum (thin arrows), suggesting leakage around the cistern chyli. The mottled osteolytic lesion mentioned above showed high T2 signal intensity (thick arrow), suggesting a dilated lymphatic channel within the vertebral body. CT computed = tomography, MR = magnetic resonance.

Mentions: One patient with recurrent idiopathic chylothorax underwent chest CT and MR lymphangiography. Imaging showed a large bilateral pleural effusion with suspicious leakage around the proximal thoracic duct and an abnormal cystic lesion in the anterior mediastinum (Figure 3, Supplemental Digital Content 3; which demonstrates chyle leakage site; annotated with open arrows and course of thoracic duct; annotated with arrows). There were also multiple osteolytic lesions in the thoracic spine with high signal intensity within that lesion on T2-weighted images, representing dilated lymphatic channels (Figure 3). On the basis of radiologic and clinical features, Gorham disease (osteolysis associated with intraosseous vascular anomalies) was diagnosed. Video-assisted thoracoscopic surgery (VATS) was performed and the thoracic duct was ligated at the significant leakage point seen on MR lymphangiographic images (see video, Supplemental Digital Content 2, which demonstrates the chyle leakage site; annotated with arrows and course of thoracic duct; annotated with circle).


Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography
Gorham disease in a 63-year-old female with idiopathic chylothorax. A, Enhanced axial CT with mediastinal window setting shows large right pleural effusion and abnormal fluid density lesion (white arrow) in the anterior mediastinum. B, Axial CT with bone window setting reveals a mottled osteolytic lesion (white arrow) in vertebral body. C, D, Axial heavily T2-weighted MR imaging obtained the same day demonstrates abrupt discontinuation of the thoracic duct (open arrow) with dispersion of chyle into the mediastinum (thin arrows), suggesting leakage around the cistern chyli. The mottled osteolytic lesion mentioned above showed high T2 signal intensity (thick arrow), suggesting a dilated lymphatic channel within the vertebral body. 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 3: Gorham disease in a 63-year-old female with idiopathic chylothorax. A, Enhanced axial CT with mediastinal window setting shows large right pleural effusion and abnormal fluid density lesion (white arrow) in the anterior mediastinum. B, Axial CT with bone window setting reveals a mottled osteolytic lesion (white arrow) in vertebral body. C, D, Axial heavily T2-weighted MR imaging obtained the same day demonstrates abrupt discontinuation of the thoracic duct (open arrow) with dispersion of chyle into the mediastinum (thin arrows), suggesting leakage around the cistern chyli. The mottled osteolytic lesion mentioned above showed high T2 signal intensity (thick arrow), suggesting a dilated lymphatic channel within the vertebral body. CT computed = tomography, MR = magnetic resonance.
Mentions: One patient with recurrent idiopathic chylothorax underwent chest CT and MR lymphangiography. Imaging showed a large bilateral pleural effusion with suspicious leakage around the proximal thoracic duct and an abnormal cystic lesion in the anterior mediastinum (Figure 3, Supplemental Digital Content 3; which demonstrates chyle leakage site; annotated with open arrows and course of thoracic duct; annotated with arrows). There were also multiple osteolytic lesions in the thoracic spine with high signal intensity within that lesion on T2-weighted images, representing dilated lymphatic channels (Figure 3). On the basis of radiologic and clinical features, Gorham disease (osteolysis associated with intraosseous vascular anomalies) was diagnosed. Video-assisted thoracoscopic surgery (VATS) was performed and the thoracic duct was ligated at the significant leakage point seen on MR lymphangiographic images (see video, Supplemental Digital Content 2, which demonstrates the chyle leakage site; annotated with arrows and course of thoracic duct; annotated with circle).

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