Interstitial Transpedal MR-Lymphangiography of Central Lymphatics Using a Standard MR Contrast Agent: Feasibility and Initial Results in Patients with Chylous Effusions.

Purpose: To describe a novel technique for transpedal magnetic resonance lymphangiography (tMRL) with interstitial injection of a standard gadolinium-based contrast agent, and to assess its ability to visualize the central lymphatic system (CLS) in patients with chylous effusions.

Materials And Methods: Experiences with tMRL were retrospectively reviewed in seven patients with chylous effusions. High-resolution three-dimensional multi-echo (mDIXON) images of the entire torso were obtained before and after interstitial injection of an extracellular gadolinium-based contrast agent. MR examinations were assessed qualitatively by two radiologists with respect to visualization of central lymphatics, delineation of their anatomy and presence of a lymphatic pathology (chylolymphatic leakage or reflux).

Results: Examination was technically successful in 6/7 patients. tMRL confirmed the location of chylolymphatic leakage in 3/7, demonstrated a lymphatic malformation in 1/7, chylolymphatic reflux in 1/7, and confirmed normal chylolymphatic flow in the central lymphatics in 1/7 patients. In one patient neither CLS enhancement nor leakage were detectable. tMRL findings were considered helpful in all technically successful cases, and considerably influenced further treatment in four patients. All examinations were well tolerated without complications. No general anesthesia or conscious sedation was necessary.

Conclusion: Transpedal MR-lymphangiography with interstitial injection of a standard extracellular gadolinium-based contrast agent is feasible in clinical routine without general anesthesia and allows for assessment of pathologic conditions of central lymphatics.

Key Points: · Transpedal MR-lymphangiography of central lymphatics is technically feasible.. · A standard extracellular gadolinium-based contrast agent can be used for tMRL.. · tMRL allows for evaluation of anatomy and pathologies of central lymphatics.. · tMRL is a useful tool for treatment planning in chylous effusions..

Citation Format: · Pieper CC, Schild HH. Interstitial Transpedal MR-Lymphangiography of Central Lymphatics Using a Standard MR Contrast Agent: Feasibility and Initial Results in Patients with Chylous Effusions. Fortschr Röntgenstr 2018; 190: 938 - 945.