Interstitial MR lymphangiography -: A diagnostic imaging method for the evaluation of patients with clinically advanced stages of lymphedema

Background: To assess the feasibility of interstitial magnetic resonance lymphangiography with intracutaneous injection of a commercially available, non-ionic, extracellular paramagnetic contrast agent, to visualize lymphatic vessels inpatients with clinically advanced stages of primary lymphedema. Methods: Sixteen lower extremities in 8 patients with clinically advanced stages of primary lymphedema were examined with magnetic resonance lymphangiography. A 18 mL of gadodiamide and 2 mL of mepivacainhydrochloride 1% were subdivided into 10 portions and injected intracutaneously into the dorsal aspect of both feet. For MRL, a 3D spoiled gradient-echo sequence (Volumetric Interpolated Breathold Examination, VIBE) was performed. Results: The beaded appearance of lymphatic vessels extending from the injection site was detected in all 16 lower extremities (100%). In 10 lower extremities (63%), lymphatic vessels of the upper leg could be visualized. A contrast enhancement was observed in 10/16 inguinal lymph node groups (63%). In 12 lower extremities (75%) collateral vessels with dermal back-flow areas between lymphatic vessels were seen. Conclusion: Magnetic resonance lymph angiography is safe, technically feasible, and assists the clinician in the therapeutic planning of patients with clinically advanced stages of primary lymphedema by imaging the pathologically modified lymphatic vessels and accompanying complications non-invasively. (C) 2007 Elsevier B.V. All rights reserved.