Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.
Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
Radiol Med. 2017 Dec;122(12):918-927. doi: 10.1007/s11547-017-0795-x. Epub 2017 Aug 2.
This article illustrates the feasibility of MR lymphangiography (MRL) for imaging lymphatic vessels in patients with lymphedema, its accuracy in distinguishing lymphatic vessels from veins, and its utility for planning Lymphaticovenous anastomosis (LVA) treatment.
We prospectively enrolled 30 patients (24 women, range 18-70, 17 cases of lower limb lymphedema, 6 cases of primary lymphedema). All the patients underwent MRL, using a 1.5T MR unit (Signa Twin Speed Hdxt; GE), after the subcutaneous injection of gadobenate dimeglumine (Gd-BOPTA) with a little dose of lidocaine into the interdigital webs of the dorsal foot or hand. Lymphatic vessels identified for the LVA at MRL were histologically confirmed after surgery. Enhancement of lymphatic vessels and veins at different times after injection of contrast medium and their diameters were measured.
A total of 79 lymphatic vessels were clearly identified in 29 patients at MRL; their morphology was tortuous in 22 patients and rectilinear in 7, whereas, the adjacent veins were straight with focal bulging only at the level of venous valve; the enhancement kinetic of the two different structures were different (p < 0.05) but the mean diameter of affected lymphatic vessels was similar to the adjacent veins (p > 0.05). Thirty-four out of 38 specimens of presumed lymphatic vessels at MRL, collected during surgery, resulted positive at the immunoistochemical marker d2-40, with a significant association (Chi-square = 40.421, DF = 1, p < 0.05, contingency coefficent 0.644). One patient had an early complication 1 month after treatment.
MRL is easy and safe to use and combines extensive information on the anatomy and functionality of lymphatic vessels and veins in a single process; therefore, it could be useful in LVA treatment planning and evaluating possible super-microsurgical treatment complications in patients with lymphedema.
本文旨在展示磁共振淋巴造影术（MRL）在成像淋巴水肿患者的淋巴管、区分淋巴管和静脉的准确性以及对淋巴管静脉吻合术（LVA）治疗规划的实用性。
我们前瞻性纳入了 30 名患者（24 名女性，年龄 18-70 岁，17 例下肢淋巴水肿，6 例原发性淋巴水肿）。所有患者均在 1.5T MR 设备（Signa Twin Speed Hdxt；GE）下行 MRL，经皮于足背或手掌的蹼间皮下注射少量利多卡因和钆贝葡胺（Gd-BOPTA）。在手术中，对 MRL 识别的 LVA 淋巴管进行了组织学确认。测量不同时间点注射造影剂后淋巴管和静脉的增强情况及其直径。
29 例患者的 MRL 共清晰显示 79 条淋巴管；22 例淋巴管形态迂曲，7 例呈直线状，而相邻静脉呈直线状，仅在静脉瓣水平有局灶性膨出；两种不同结构的增强动力学不同（p<0.05），但受影响的淋巴管平均直径与相邻静脉相似（p>0.05）。MRL 术中采集的 38 个疑似淋巴管标本中，34 个免疫组化标志物 d2-40 呈阳性，相关性显著（卡方=40.421，自由度=1，p<0.05，列联系数 0.644）。1 例患者在治疗后 1 个月出现早期并发症。
MRL 操作简便、安全，可在单次过程中提供广泛的淋巴管和静脉解剖学和功能信息，因此对 LVA 治疗规划和评估淋巴水肿患者可能的超显微手术治疗并发症具有重要意义。
