Department of Clinical Radiology, Clinic of Nuclear Medicine, University Hospitals Munich, and Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
Radiology. 2012 Jul;264(1):78-87. doi: 10.1148/radiol.12110229. Epub 2012 Apr 20.
To prospectively compare findings of magnetic resonance (MR) lymphangiography with those of lymphoscintigraphy, evaluate the pattern and delay of lymphatic drainage, compare typical findings, and investigate discrepancies between the techniques.
This prospective study was performed according to the Declaration of Helsinki and was approved by the local ethics committee. Thirty consecutive patients with uni- or bilateral lymphedema and lymph vessel transplants of the lower extremities were examined with 3.0-T fat-saturated three-dimensional gradient-echo MR after gadopentetate dimeglumine injection. Results of all examinations were correlated with corresponding results of lymphoscintigraphy examinations. Results of both techniques were separately reviewed in consensus by a radiologist and a nuclear physician, who rated delay and pattern of drainage, number of enhancing levels, and quality of conspicuity of the depiction of lymph nodes and lymph vessels. Sensitivity and specificity were calculated by using combined results of both techniques and clinical presentation findings as reference standard. Correlation was calculated with weighted k coefficients.
Weak lymphatic drainage at lymphoscintigraphy correlated with lymphangiectasia at MR lymphangiography (13 of 33 affected extremities). Lymph vessels were clearly visualized with MR lymphangiography (five of 24 affected extremities), while they were not detectable with lymphoscintigraphy. Depiction of inguinal lymph nodes was clearer with lymphoscintigraphy (five of 60 extremities). Correlation of both techniques was excellent for delay (κ=0.93) and pattern (κ=0.84) of drainage, good for depiction of lymph nodes (κ=0.67) and number of enhancing levels (κ=0.77), and moderate for depiction of lymph vessels (κ=0.50). Sensitivity and specificity for delay and pattern of drainage were concordant, whereas MR lymphangiography showed a higher sensitivity for lymph vessel abnormalities (100% vs 79%) and lower specificity for lymph node abnormalities (78% vs 100%).
Imaging findings of MR lymphangiography and lymphoscintigraphy show a clear concordance. With lymphoscintigraphy, better visualization of inguinal lymph nodes was achieved, whereas with MR lymphangiography, better depiction of lymph vessels and morphologic features of lymph vessel abnormalities were achieved.
前瞻性比较磁共振（MR）淋巴管造影与淋巴闪烁显像的结果，评估淋巴引流的模式和延迟，比较典型表现，并探讨两种技术之间的差异。
这项前瞻性研究遵循赫尔辛基宣言，并获得了当地伦理委员会的批准。30 例单侧或双侧下肢淋巴水肿和淋巴管移植患者，在下肢注射钆喷酸葡胺后，行 3.0T 脂肪饱和三维梯度回波 MR 检查。所有检查结果均与相应的淋巴闪烁显像检查结果相关联。由一名放射科医生和一名核医学医师分别对两种技术的结果进行一致的回顾，评估引流的延迟和模式、增强水平的数量以及淋巴结和淋巴管显示的清晰度。通过使用两种技术的联合结果和临床表现作为参考标准计算敏感性和特异性。相关性通过加权 k 系数计算。
淋巴闪烁显像显示淋巴引流弱与 MR 淋巴管造影显示淋巴管扩张（33 个受累肢体中有 13 个）相关。MR 淋巴管造影可清晰显示淋巴血管（24 个受累肢体中有 5 个），而淋巴闪烁显像则无法显示。淋巴闪烁显像显示腹股沟淋巴结的显示更清晰（60 个肢体中有 5 个）。两种技术的延迟（κ=0.93）和引流模式（κ=0.84）的相关性良好，淋巴结（κ=0.67）和增强水平数量（κ=0.77）的相关性较好，而淋巴血管（κ=0.50）的相关性中等。延迟和引流模式的敏感性和特异性一致，而 MR 淋巴管造影对淋巴管异常的敏感性更高（100%比 79%），对淋巴结异常的特异性更低（78%比 100%）。
MR 淋巴管造影和淋巴闪烁显像的影像学表现具有明显的一致性。淋巴闪烁显像对腹股沟淋巴结的显示更好，而 MR 淋巴管造影对淋巴血管和淋巴管异常的形态特征的显示更好。
