Lohrmann Christian, Foeldi Etelka, Langer Mathias
Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg i. Br., Germany.
Microvasc Res. 2009 May;77(3):335-9. doi: 10.1016/j.mvr.2009.01.005. Epub 2009 Jan 27.
To assess for the first time the morphology of the lymphatic system in patients with lipedema and lipo-lymphedema of the lower extremities by MR lymphangiography.
26 lower extremities in 13 consecutive patients (5 lipedema, 8 lipo-lymphedema) were examined by MR lymphangiography. 18 mL of gadoteridol and 1 mL of mepivacainhydrochloride 1% were subdivided into 10 portions and injected intracutaneously in the forefoot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For MR lymphangiography, a 3D-spoiled gradient-echo sequence was used. For evaluation of the lymphedema a heavily T2-weighted 3D-TSE sequence was performed.
In all 16 lower extremities (100%) with lipo-lymphedema, high signal intensity areas in the epifascial region could be detected on the 3D-TSE sequence. In the 16 examined lower extremities with lipo-lymphedema, 8 lower legs and 3 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 3 mm. In two lower legs with lipo-lymphedema, an area of dermal back-flow was seen, indicating lymphatic outflow obstruction. In the 10 examined lower extremities with clinically pure lipedema, 4 lower legs and 2 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 2 mm, indicating a subclinical status of lymphedema. In all examined extremities, the inguinal lymph nodes demonstrated a contrast material enhancement in the first image acquisition 15 min after injection.
MR lymphangiography is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic circulation in patients with lipedema and lipo-lymphedema of the lower extremities. If the extent of lymphatic involvement is unclear at the initial clinical examination or requires a better definition for optimal therapeutic planning, MR lymphangiography is able to identify the anatomic and physiological derangements and to establish an objective baseline.
首次通过磁共振淋巴造影评估下肢脂肪性水肿和脂肪 - 淋巴水肿患者的淋巴系统形态。
对连续13例患者（5例脂肪性水肿，8例脂肪 - 淋巴水肿）的26条下肢进行磁共振淋巴造影检查。将18 mL钆特醇和1 mL 1%盐酸甲哌卡因分成10份，在前足皮内注射。使用配备高性能梯度的1.5-T系统进行磁共振成像。磁共振淋巴造影采用三维扰相梯度回波序列。为评估淋巴水肿，进行重T2加权三维快速自旋回波序列成像。
在所有16条（100%）脂肪 - 淋巴水肿下肢中，三维快速自旋回波序列上可在筋膜上区域检测到高信号强度区。在16条检查的脂肪 - 淋巴水肿下肢中，8条小腿和3条大腿显示淋巴管扩张，直径达3 mm。在两条脂肪 - 淋巴水肿小腿中，可见真皮反流区域，提示淋巴流出道梗阻。在10条临床诊断为单纯脂肪性水肿的检查下肢中，4条小腿和2条大腿显示淋巴管扩张，直径达2 mm，提示淋巴水肿亚临床状态。在所有检查的肢体中，腹股沟淋巴结在注射后15分钟的首次图像采集时显示造影剂增强。
磁共振淋巴造影是一种安全、准确的微创成像方法，用于评估下肢脂肪性水肿和脂肪 - 淋巴水肿患者的淋巴循环。如果在初始临床检查时淋巴受累程度不明确，或为了优化治疗方案需要更好地明确，磁共振淋巴造影能够识别解剖和生理紊乱，并建立客观基线。
