Lohrmann Christian, Foeldi Etelka, Bartholomä Jean-Paul, Langer Mathias
Division of Diagnostic Radiology, Department of Radiology, University Hospital of Freiburg, Freiburg, Germany.
J Comput Assist Tomogr. 2007 Mar-Apr;31(2):303-8. doi: 10.1097/01.rct.0000237814.33925.32.
To assess the feasibility of a time-efficient, high-resolution magnetic resonance lymphangiography (HR MRL) protocol without image subtraction for the detection of lymphatic vessels in patients with primary and secondary lymphedema.
Three consecutive patients with lymphedema of the lower extremities (2 primary bilateral, 1 secondary unilateral) underwent HR MRL without image subtraction. An amount of 9 mL of gadodiamide and 1 mL of mepivacaine hydrochloride 1% were subdivided into 5 portions and injected intracutaneously into the dorsal aspect of each foot outside the scanner before image acquisition. Magnetic resonance imaging was performed with a 1.5-T system equipped with high-performance gradients. For HR MRL, a 3-dimensional, spoiled gradient-echo sequence (Volumetric Interpolated Breath-hold Examination) was used. The extent and distribution of the lymphedema was evaluated using a heavily T2-weighted, 3-dimensional turbo-spin echo sequence.
The HR MRL bilaterally detected the inguinal lymph nodes and the lymphatic vessels in the lower and upper leg in the 2 patients with primary lymphedema. In the patient with left-sided secondary lymphedema, the inguinal lymph nodes and the lymphatic vessels in the lower and upper leg were depicted on the right side. The diameter of the displayed lymphatic vessels varied between 1 and 5 mm. Three-dimensional, maximum-intensity projection images of different angles of view provided detailed outlining of the lymphatic vessels and differentiation from veins, which showed a lower signal intensity.
The HR MRL without image subtraction is safe, technically feasible, and has the potential to become a diagnostic imaging tool in daily clinical practice because of its time efficiency.
评估一种无需图像减影的高效、高分辨率磁共振淋巴造影（HR MRL）方案用于检测原发性和继发性淋巴水肿患者淋巴管的可行性。
连续3例下肢淋巴水肿患者（2例原发性双侧、1例继发性单侧）接受了无需图像减影的HR MRL检查。在图像采集前，将9 mL钆双胺和1 mL 1%盐酸甲哌卡因分成5份，经皮注射到扫描仪外每只脚的背侧。使用配备高性能梯度的1.5-T系统进行磁共振成像。对于HR MRL，采用三维扰相梯度回波序列（容积内插屏气检查）。使用重T2加权三维快速自旋回波序列评估淋巴水肿的范围和分布。
在2例原发性淋巴水肿患者中，HR MRL双侧检测到腹股沟淋巴结以及小腿和大腿的淋巴管。在左侧继发性淋巴水肿患者中，右侧显示出腹股沟淋巴结以及小腿和大腿的淋巴管。所显示淋巴管的直径在1至5 mm之间。不同视角的三维最大强度投影图像提供了淋巴管的详细轮廓，并与静脉区分开来，静脉显示出较低的信号强度。
无需图像减影的HR MRL安全、技术上可行，且因其时间效率有潜力成为日常临床实践中的诊断成像工具。
