Loo Billy W, Draney Mary T, Sivanandan Ranjiv, Ruehm Stefan G, Pawlicki Todd, Xing Lei, Herfkens Robert J, Le Quynh-Thu
Department of Radiation Oncology, Stanford University, Stanford, CA 94305-5847, USA, and Department of General Surgery, Singapore General Hospital, Singapore.
Int J Radiat Oncol Biol Phys. 2006 Oct 1;66(2):462-8. doi: 10.1016/j.ijrobp.2006.05.045.
To evaluate indirect magnetic resonance lymphangiography (MR-LAG) using interstitial injection of conventional gadolinium contrast (gadoteridol and gadopentetate dimeglumine) for delineating the primary lymphatic drainage of head-and-neck sites.
We performed head-and-neck MR-LAG in 5 healthy volunteers, with injection of dermal and mucosal sites. We evaluated the safety of the procedure, the patterns of enhancement categorized by injection site and nodal level, the time course of enhancement, the optimal concentration and volume of contrast, and the optimal imaging sequence.
The worst side effects of interstitial contrast injection were brief, mild pain and swelling at the injected sites that were self-limited. MR-LAG resulted in consistent visualization of the primary lymphatic drainage pattern specific to each injected site, which was reproducible on repeated examinations. The best enhancement was obtained with injection of small volumes (0.3-0.5 mL) of either agent diluted, imaging within 5-15 min of injection, and a three-dimensional fast spoiled gradient echo sequence with magnetization transfer.
We found head-and-neck MR-LAG to be a safe, convenient imaging method that provides functional information about the lymphatic drainage of injected sites. Applied to head-and-neck cancer, it has the potential to identify sites at highest risk of occult metastatic spread for radiotherapy or surgical planning, and possibly to visualize micrometastases.
评估使用传统钆造影剂（钆特醇和钆喷酸葡胺）间质注射的间接磁共振淋巴造影（MR-LAG）用于描绘头颈部区域的主要淋巴引流情况。
我们对5名健康志愿者进行了头颈部MR-LAG检查，在皮肤和黏膜部位进行注射。我们评估了该操作的安全性、根据注射部位和淋巴结水平分类的强化模式、强化的时间进程、造影剂的最佳浓度和体积以及最佳成像序列。
间质注射造影剂最严重的副作用是注射部位短暂、轻微的疼痛和肿胀，这些症状会自行缓解。MR-LAG能够一致地显示每个注射部位特有的主要淋巴引流模式，在重复检查时具有可重复性。注射小体积（0.3 - 0.5 mL）稀释后的任何一种造影剂，在注射后5 - 15分钟内成像，并采用带有磁化传递的三维快速扰相梯度回波序列，可获得最佳强化效果。
我们发现头颈部MR-LAG是一种安全、便捷的成像方法，可提供有关注射部位淋巴引流的功能信息。应用于头颈部癌症时，它有可能识别出放疗或手术规划中隐匿性转移扩散风险最高的部位，并可能显示微转移灶。
