Chavhan Govind B, Amaral Joao G, Temple Michael, Itkin Maxim
From the Department of Diagnostic Imaging (G.B.C., J.G.A., M.T.) and Division of Image Guided Therapy, Department of Diagnostic Imaging (J.G.A., M.T.), The Hospital for Sick Children, Medical Imaging, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Center for Lymphatic Imaging and Interventions, Children's Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.I.).
Radiographics. 2017 Oct;37(6):1775-1790. doi: 10.1148/rg.2017170014.
The lymphatic system, an important component of the circulatory system with essential physiologic functions, can be affected by various disease processes. There has been a delay in the development of effective imaging methods for the lymphatic system due to its small size, which limits visualization as well as introduction of contrast material. Traditionally, the lymphatic system has been imaged by injecting contrast material or radiotracers into the feet or hands. This is not sufficient for assessment of the central conducting lymphatics (CCLs) (such as the thoracic duct or the cisterna chyli). Fluoroscopic intranodal lymphangiography with injection of oil-based contrast material into groin lymph nodes improves visualization of CCLs but is limited in practice owing to the use of radiation and the potential risk for paradoxical embolization in children with left-to-right shunt. Dynamic contrast material-enhanced (DCE) magnetic resonance (MR) lymphangiography, which is performed by injecting gadolinium-based contrast material into groin lymph nodes, overcomes these limitations. T2-weighted imaging plays a complementary role to DCE MR lymphangiography in the assessment of CCLs. DCE MR lymphangiography demonstrates preserved integrity or any abnormality of the CCLs (including blockage or leak). The technique has recently been used in evaluating pulmonary lymphatic perfusion syndrome in children with plastic bronchitis, neonatal lymphatic flow disorders, and nontraumatic chylothorax. It is useful in identification of the source of chylous ascites and contributes to understanding of the anatomy of lymphatic malformations. It is successfully used for planning of embolization of aberrant lymphatic channels in a variety of lymphatic flow disorders. This review discusses the anatomy and function of the lymphatic system, the evolution of imaging of the lymphatic system, and DCE MR lymphangiography technique and its applications in children. RSNA, 2017.
淋巴系统是循环系统的重要组成部分，具有重要的生理功能，可受到各种疾病过程的影响。由于其体积小，限制了可视化以及造影剂的引入，因此有效成像方法在淋巴系统的开发方面一直存在延迟。传统上，通过将造影剂或放射性示踪剂注入足部或手部来对淋巴系统进行成像。这对于评估中央传导淋巴管（CCL）（如胸导管或乳糜池）是不够的。向腹股沟淋巴结注射油基造影剂的荧光镜下结内淋巴管造影可改善CCL的可视化，但由于使用辐射以及左向右分流儿童发生矛盾栓塞的潜在风险，在实践中受到限制。动态对比剂增强（DCE）磁共振（MR）淋巴管造影通过向腹股沟淋巴结注射钆基造影剂来进行，克服了这些限制。在CCL评估中，T2加权成像对DCE MR淋巴管造影起补充作用。DCE MR淋巴管造影可显示CCL的完整性或任何异常（包括阻塞或渗漏）。该技术最近已用于评估患有塑料支气管炎的儿童的肺淋巴灌注综合征、新生儿淋巴流动障碍和非创伤性乳糜胸。它有助于识别乳糜性腹水的来源，并有助于了解淋巴管畸形的解剖结构。它已成功用于规划各种淋巴流动障碍中异常淋巴管的栓塞。本综述讨论了淋巴系统的解剖结构和功能、淋巴系统成像的演变、DCE MR淋巴管造影技术及其在儿童中的应用。RSNA，2017年。
