Mike Notohamiprodjo, Presenter: Nothing to Disclose

Tobias Franz Jakobs MD, Abstract Co-Author: Speaker, Sirtex Medical Ltd, Europe

Stefan Oswald Schoenberg MD, PhD, Abstract Co-Author: Nothing to Disclose

Ruediger Baumeister, Abstract Co-Author: Nothing to Disclose

Mayo Weiss, Abstract Co-Author: Nothing to Disclose

Christian Glaser MD, Abstract Co-Author: Nothing to Disclose

Maximilian F. Reiser MD, Abstract Co-Author: Nothing to Disclose

Karin Anna Herrmann MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate contrast-enhanced MR-Lymphangiography (MRL) at 3.0T for detection and visualization of pathologies of the peripheral lymphatic system

The study was performed in accordance to the declaration of Helsinki. Sixteen consecutive patients with unilateral lymphedema(11), bilateral lymphedema(2), lymphoceles(2) and lymph vessel transplant(1) were included. MRL was performed with a fat-saturated T1w-3D-GRE-(FLASH) sequence (TR 3.76ms/TE 1.45ms/FA 30°/voxel size 0.83mm3) on a 3.0T scanner (Magnetom TRIO/VERIO). A mixture of 0.9ml Gd-DTPA and 0.1ml Mepivacaine was injected intracutaneously into three interdigital spaces prior to image acquisition. Three levels were examined: lower leg, upper leg and pelvis. Two radiologists evaluated overall image quality, contrast of lymph vessels, venous contamination, visualized levels and fat saturation homogeneity on 3D-maximum-intensity projections. Correlation with lymphoscintigraphy was performed.

All examinations except one were diagnostic. Overall image quality was good to excellent in 12/16 cases, lymph vessel contrast good to excellent in 15/16 cases. Venous contamination was always present, but only diagnostically impairing in one case. Normal lymph vessels showed a beaded appearance. Instant lymphatic drainage was observed in unaffected extremities shortly after contrast application, reaching the pelvic level after approximately 10 minutes. In extremities with lymphedema, lymphatic drainage was considerably delayed. As morphologic correlates, ectatic lymphatic vessels, contrast entrapment and dermal capillary drainage could be depicted. In two patients the feeder vessels of the lymphocele were identified. In one patient the lymph vessel transplant was visualized and proven patent. The MRL-findings were widely concordant with lymphoscintigraphy results.

MR-Lymphangiography at 3.0T provides very high spatial resolution and anatomical detail of peripheral lymph vessels. It allows the depiction of pathologies of the peripheral lymphatic system correlating with functional impairment at lymphoscintigraphy and may thereby become a valuable tool for planning and monitoring of microsurgical therapy.

MR-Lymphangiography at 3.0T provides very high spatial resolution and anatomical detail of peripheral lymph vessels and may become valuable for planning and monitoring of microsurgical therapy.

Notohamiprodjo, M, Jakobs, T, Schoenberg, S, Baumeister, R, Weiss, M, Glaser, C, Reiser, M, Herrmann, K, et al, , MR-Lymphangiography at 3.0 T for Detection and Visualization of Pathologies of the Peripheral Lymphatic System.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6020323.html