Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Radiol Med. 2021 May;126(5):737-743. doi: 10.1007/s11547-020-01309-5. Epub 2021 Jan 4.
Central conducting lymphatics (CCLs) disorders represent a broad spectrum of clinical entities ranging from self-limiting traumatic leaks treated by conservative strategies, to complex lymphatic circulation abnormalities that are progressive and unresponsive to currently available treatments. Dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) performed by intranodal injection of gadolinium-based contrast material is a recently developed technique which allows a minimally invasive evaluation of the CCL abnormalities providing a dynamic assessment of lymph flow and its pathways. In our institution, DCMRL is performed after bilateral cannulation of inguinal lymph nodes, using a MR protocol which includes volumetric 3D T2-SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) and free-breathing respiratory navigated sequence and TWIST (time-resolved angiography with Interleaved stochastic trajectories) MR angiography sequence, during intranodal injection of paramagnetic contrast medium. Although DCMRL applications in clinical practice are still improving, a minimally invasive assessment of lymphatic pathways is particularly important both in pediatric patients with primitive lymphatic system disorders and in children with complex congenital heart disease associated with CCL impairment.
中央淋巴导管（CCL）疾病表现为广泛的临床实体，范围从自限性创伤性渗漏，通过保守策略治疗，到复杂的淋巴循环异常，这些异常是进行性的，对目前可用的治疗方法无反应。通过在淋巴结内注射钆基造影剂进行动态对比增强磁共振淋巴造影术（DCMRL）是一种最近开发的技术，它允许对 CCL 异常进行微创评估，提供对淋巴流动及其途径的动态评估。在我们的机构中，在双侧腹股沟淋巴结插管后进行 DCMRL，使用包括容积 3D T2-SPACE（使用不同翻转角演化的应用优化对比进行采样完美）和自由呼吸呼吸导航序列和 TWIST（具有交织随机轨迹的时间分辨血管造影）MR 血管造影序列的 MR 协议，在淋巴结内注射顺磁造影剂期间。尽管 DCMRL 在临床实践中的应用仍在不断改进，但对淋巴途径进行微创评估在原发性淋巴系统疾病的儿科患者和伴有 CCL 损伤的复杂先天性心脏病的儿童中尤为重要。
