From the Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pa (S.P., T.K., S.S., M.I.); Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea (S.H.); and Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea (S.H.).
Radiology. 2022 Jan;302(1):228-233. doi: 10.1148/radiol.2021210294. Epub 2021 Oct 26.
Background Dynamic contrast-enhanced MR lymphangiography (DCMRL) is the reference standard used to diagnose various thoracic lymphatic disorders, such as traumatic chylothorax and plastic bronchitis. However, accessibility and logistical challenges have prevented the wide dissemination of this technology. Purpose To evaluate the feasibility of intranodal CT lymphangiography (ICTL) in the diagnosis and planning of subsequent intervention in patients with thoracic lymphatic disorders. Materials and Methods In this retrospective review, five women suspected of having lymphatic abnormalities (ranging from traumatic chylothorax to plastic bronchitis) and with contraindications to MRI underwent ICTL from September 2019 to May 2020. Needles (25 gauge) were placed in the bilateral inguinal lymph nodes with US guidance, and water-soluble iodinated contrast material was injected. CT fluoroscopy was used to monitor the opacification of the cisterna chyli to determine the timing of CT. After ICTL, the thoracic duct was catheterized, and lymphangiography was performed through the thoracic duct catheter. The ICTL and subsequent lymphangiographic findings were then visually compared by using three-dimensional reconstructions. Results Intranodal injection of water-soluble contrast medium was successful in all patients evaluated (five women; mean age, 68 years ± 11 [standard deviation]; range, 53-83 years). The central lymphatics were opacified in four of the five women, demonstrating abnormal pulmonary lymphatic flow from the thoracic duct into the lung parenchyma. In one of the five women, thoracic duct injection showed successful ligation of the thoracic duct. The time elapsed from injection of contrast medium to visualization of the thoracic duct ranged from 2 to 27 minutes. ICTL and lymphangiographic findings matched well. Conclusion Intranodal CT lymphangiography sufficiently depicted central lymphatic anatomy in patients with lymphatic abnormalities, thereby demonstrating its use as a feasible alternative to more technically challenging methods, such as dynamic contrast-enhanced MR lymphangiography. © RSNA, 2021.
背景 动态对比增强磁共振淋巴造影术（DCMRL）是诊断各种胸淋巴疾病的参考标准，例如创伤性乳糜胸和塑型性支气管炎。然而，由于可及性和后勤方面的挑战，该技术无法广泛传播。
目的 评估在诊断胸淋巴疾病患者中，经皮腔内 CT 淋巴造影术（ICTL）的可行性，以及评估其对后续介入治疗的规划作用。
材料与方法 在这项回顾性研究中，对 5 名疑似存在淋巴异常的女性患者（从创伤性乳糜胸到塑型性支气管炎不等）进行 ICTL 检查，这些患者因存在磁共振成像禁忌证而无法进行该检查。采用超声引导将 25 号针头置于双侧腹股沟淋巴结中，并注入水溶性碘造影剂。采用 CT 透视监测腹淋巴管的充盈情况，以确定 CT 扫描的时间。ICTL 后，通过胸导管导管对胸导管进行导管插入，并进行淋巴造影术。然后通过三维重建来直观比较 ICTL 和随后的淋巴造影结果。
结果 在所有接受评估的患者中（5 名女性；平均年龄 68 岁±11[标准差]；年龄范围，53-83 岁），均成功实现了经皮腔内淋巴结内水溶性造影剂的注射。在 5 名女性中的 4 名，中央淋巴管显影，显示异常的肺淋巴从胸导管流入肺实质。在 5 名女性中的 1 名，胸导管注射显示胸导管结扎成功。从注入造影剂到显影胸导管的时间范围为 2 至 27 分钟。ICTL 和淋巴造影的结果匹配良好。
结论 ICTL 充分描绘了淋巴异常患者的中央淋巴解剖结构，因此证明其可用作更具技术挑战性的方法（如动态对比增强磁共振淋巴造影术）的可行替代方法。
© 2021 RSNA。
