Anatomic and functional evaluation of the lymphatics and lymph nodes in diagnosis of lymphatic circulation disorders with contrast magnetic resonance.

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Presentation transcript:

Anatomic and functional evaluation of the lymphatics and lymph nodes in diagnosis of lymphatic circulation disorders with contrast magnetic resonance lymphangiography Ning-Fei Liu, MD, PhD, Qing Lu, MD, Zhao-Hua Jiang, MD, PhD, Chen-Guang Wang, MD, PhD, Jian-Guo Zhou, MD Journal of Vascular Surgery Volume 49, Issue 4, Pages 980-987 (April 2009) DOI: 10.1016/j.jvs.2008.11.029 Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 1 A 3-dimensional contrast magnetic resonance lymphangiography displayed various lymphatic drainage pathways. a, Increased skin lymphatic and dermal back-flow in the media and lateral region of lower leg (arrow) and dilated collectors in the upper part of leg (arrowhead). b, Radiating arranged dilated vessels in the lower leg of primary lymphedema cases. c, Enhanced lymphatic vessels (arrowheads) distributed as a slender network over the lower extremity. d, Bunches of extremely dilated and significantly highlighted lymphatic vessels (arrowheads) located in the medial and lateral portion of the thigh. e, Single enhanced and dilated lymphatic (arrowheads) with irregular outline in the leg of primary lymphedema. f, An intensely enhanced dilated lymph vessel (arrowheads) with clear outline in the thigh. Journal of Vascular Surgery 2009 49, 980-987DOI: (10.1016/j.jvs.2008.11.029) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 2 Dynamic images of enhanced lymph flow. a, Observation of movement of contrast-enhanced flow in a lymphedematous limb. b, Enhanced flow speed (cm/min) at a series time points is shown for of 23 lymph vessels of lymphedematous limbs. c, Mean flow speed is charted at each time point of 23 tested vessels.* The horizontal line in the middle of each box indicates the median; the top and bottom borders of the box mark the 75th and 25th percentiles, respectively. The whiskers mark the 90th and 10th percentiles. d, Comparison of lymph speed in three groups with various vascular diameters, vascular numbers and disease durations. Data are presented with the standard deviation. Journal of Vascular Surgery 2009 49, 980-987DOI: (10.1016/j.jvs.2008.11.029) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 3 Contrast magnetic resonance lymphangiographic imaging of inguinal lymph nodes. a, asymmetrical accumulation of contrast between the nodes with heterogeneous appearance and poor enhancement in the edematous limb (arrow) and contralateral nodes that were evenly enhanced (arrowhead). b, Contrast-enhanced flow is detained in afferent collectors (arrowheads) of a limb with lymphangiectasia without enhancement in the drainage nodes (short arrow) in contrast to highlighted nodes (arrow) in a limb without edema. c, Contrast-enhanced central part of nodes (arrow) that are irregularly shaped are compared with evenly enhanced contralateral healthy nodes (arrowhead). d, Central region of the enhanced node with a regular outline in the edematous limb is shown. e, Contrast enhancement of contrast in the marginal region of the nodes and left central region unenhanced. Journal of Vascular Surgery 2009 49, 980-987DOI: (10.1016/j.jvs.2008.11.029) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions

Fig 4 Coronal images of dynamic enhancement of lymph nodes after contrast injection. a, Real-time record of comparison of nodal enhancement in edematous (arrow) and nonedematous (arrowhead) limbs in a series images. The wash-in curve was prolonged in (left) the affected limb in contrast with a quick wash-in and wash-out curve in (right) the unaffected limb. b, Peak time node vs muscle signal intensity ratios (n = 14) in affected limbs were significantly lower than that of unaffected limbs. c, Nodes of edematous limbs displayed significantly longer time to peak enhancement (n = 14). Data are presented as mean with the standard deviation. P < 0.01 indicates statistical significance. Journal of Vascular Surgery 2009 49, 980-987DOI: (10.1016/j.jvs.2008.11.029) Copyright © 2009 The Society for Vascular Surgery Terms and Conditions