Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Radiology, Zuyderland Medical Center, Geleen, The Netherlands; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
J Vasc Surg Venous Lymphat Disord. 2020 Sep;8(5):882-892.e2. doi: 10.1016/j.jvsv.2020.03.007. Epub 2020 May 13.
Visualization of the lymphatic system is necessary for both early diagnosis and associated treatments. A promising imaging modality is magnetic resonance lymphography (MRL). The aim of this review was to summarize different MRL protocols, to assess the clinical value in patients with peripheral lymphedema, and to define minimal requirements necessary for visualization of lymphatics.
A systematic literature search was conducted in PubMed, Embase, and the Cochrane Library in December 2018. Studies performing MRL in patients with peripheral lymphedema or healthy participants were included. Study design, population, etiology, duration of lymphedema, clinical staging, contrast agent, dose, injection site, and technical magnetic resonance imaging details were analyzed. No meta-analyses were performed because of different study aims and heterogeneity of the study populations.
Twenty-five studies involving 1609 patients with both primary lymphedema (n = 669) and secondary lymphedema (n = 657) were included. Upper and lower limbs were examined in 296 and 602 patients, respectively. Twenty-two studies used a gadolinium-based contrast agent that was injected intracutaneously or subcutaneously in the interdigital web spaces. Contrast-enhanced T1-weighted combined with T2-weighted protocols were most frequently used. T1-weighted images showed lymphatics in 63.3% to 100%, even in vessels with a diameter of ≥0.5 mm. Dermal backflow and a honeycomb pattern were clearly recognized.
MRL identifies superficial lymphatic vessels with a diameter of ≥0.5 mm with high sensitivity and specificity and accurately shows abnormal lymphatics and lymphatic drainage patterns. Therefore, MRL could be of clinical value in both early and advanced stages of peripheral lymphedema. Minimum requirements of an MRL protocol should consist of a gadolinium-based contrast-enhanced T1-weighted gradient-recalled echo sequence combined with T2-weighted magnetic resonance imaging, with acquisition at least 30 minutes after injection of contrast material.
淋巴系统的可视化对于早期诊断和相关治疗都非常必要。一种有前途的成像方式是磁共振淋巴造影术（MRL）。本综述的目的是总结不同的 MRL 方案，评估其在周围性淋巴水肿患者中的临床价值，并确定可视化淋巴管所需的最低要求。
我们于 2018 年 12 月在 PubMed、Embase 和 Cochrane 图书馆中进行了系统的文献检索。纳入了在周围性淋巴水肿患者或健康参与者中进行 MRL 的研究。分析了研究设计、人群、病因、淋巴水肿持续时间、临床分期、对比剂、剂量、注射部位以及磁共振成像技术细节。由于研究目的和研究人群的异质性，未进行荟萃分析。
共纳入 25 项研究，包括 1609 例原发性淋巴水肿（n=669）和继发性淋巴水肿（n=657）患者。上肢和下肢分别检查了 296 例和 602 例患者。22 项研究使用了钆基对比剂，这些对比剂被注射到手指间或皮下的间隔空间中。最常使用的是联合 T1 加权和 T2 加权的增强 T1 加权对比协议。T1 加权图像显示淋巴管的敏感性和特异性均为 63.3%~100%，甚至在直径≥0.5mm 的血管中也能显示。真皮逆流和蜂窝状模式都能清晰识别。
MRL 可以高灵敏度和特异性地识别直径≥0.5mm 的浅表淋巴管，并准确显示异常的淋巴管和淋巴引流模式。因此，MRL 可能对周围性淋巴水肿的早期和晚期都具有临床价值。MRL 方案的最低要求应包括基于钆的增强 T1 加权梯度回波序列，联合 T2 加权磁共振成像，在注射对比剂后至少 30 分钟进行采集。
