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Dynamic contrast enhanced magnetic resonance lymphangiography: Categorization of imaging findings and correlation with patient management.
Pimpalwar, Sheena; Chinnadurai, Ponraj; Chau, Alex; Pereyra, Mercedes; Ashton, Daniel; Masand, Prakash; Krishnamurthy, Rajesh; Jadhav, Siddharth.
Affiliation
  • Pimpalwar S; Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: pimpalwars@health.missouri.edu.
  • Chinnadurai P; Advanced Therapies, Siemens Medical Solutions USA Inc., Hoffman Estates, IL, USA. Electronic address: ponraj.chinnadurai@siemens.com.
  • Chau A; Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: axchau@texaschildrens.org.
  • Pereyra M; Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: mmpereyr@texaschildrens.org.
  • Ashton D; Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: djashton@texaschildrens.org.
  • Masand P; Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: pmmasand@texaschildrens.org.
  • Krishnamurthy R; Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address: rajesh.krishnamurthy@nationwidechildrens.org.
  • Jadhav S; Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: spjadhav@texaschildrens.org.
Eur J Radiol ; 101: 129-135, 2018 Apr.
Article in En | MEDLINE | ID: mdl-29571786
OBJECTIVE: To review the technical aspects and categorize the imaging findings of dynamic contrast enhanced magnetic resonance lymphangiography (DCMRL) and correlate the findings with patient management options. MATERIALS AND METHODS: A retrospective review of patients who underwent DCMRL between June 2012 and August 2017 at a tertiary care paediatric hospital was performed. Twenty-five DCMRL studies were performed in 23 patients (9 males, 13 females, 1 ambiguous gender) with a median age of 4 years (range: 1 month-29 years). DCMRL imaging findings were reviewed, categorized and the impact on patient management was studied. RESULTS: DCMRL was technically successful in 23/25 (92%) studies. DCMRL findings were categorized based on the status of central conducting lymphatics (CCL) and alternate lymphatic pathways as follows: Type 1 - normal CCL with no alternate lymphatic pathways, Type 2 - partial (2a) or complete (2b) non-visualization of CCL with reflux of contrast into alternate pathways and Type 3 - normal CCL with additional filling of alternate pathways. Type 1 DCMRL patients (n = 5) were reassured and conservative management was continued, Type 2 patients (n = 10) had evidence of CCL obstruction hence thoracic duct ligation or embolization was avoided and other options such as lymphatic fluid diversion using Denver® shunt or lympho-venous anastomosis were used, and Type 3 patients (n = 8) were evaluated for elevated central venous pressure as a cause of lymphatic backflow in addition to Denver® shunt, lympho-venous anastomosis, thoracic duct ligation or embolization. CONCLUSION: DCMRL is an evolving imaging technique for understanding abnormalities of the central conducting lymphatics. Categorization of imaging findings may be helpful in guiding selection of management options.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Magnetic Resonance Imaging / Lymphography / Image Enhancement / Contrast Media / Lymphatic Diseases Type of study: Diagnostic_studies / Observational_studies Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Language: En Journal: Eur J Radiol Year: 2018 Document type: Article Country of publication: Ireland

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Magnetic Resonance Imaging / Lymphography / Image Enhancement / Contrast Media / Lymphatic Diseases Type of study: Diagnostic_studies / Observational_studies Limits: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Language: En Journal: Eur J Radiol Year: 2018 Document type: Article Country of publication: Ireland