Hyun Dongho, Lee Ho Yun, Cho Jong Ho, Kim Hong Kwan, Choi Yong Soo, Kim Jhingook, Zo Jae Ill, Shim Young Mog
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Republic of Korea.
Eur Radiol. 2022 Apr;32(4):2149-2157. doi: 10.1007/s00330-021-08342-6. Epub 2021 Oct 26.
To define the roles of noncontrast magnetic resonance lymphangiography (MRL) in the management of postoperative chylothorax or cervical chylous leakage.
A total of 50 consecutive patients underwent noncontrast MRL, intranodal lymphangiography, and thoracic duct embolization between May 2016 and April 2020. Their mean age was 62.6 years ± 10.3 (SD) years, and 35 of the participants were men. Conventional lymphangiographic images were sufficient in quality as a reference for the evaluation of diagnostic accuracy of leakage and location in 35 patients (70%) and for evaluation of anatomic details of the thoracic duct and jugulovenous junction in 34 patients (68%).
MRL showed that the sensitivity, specificity, and positive and negative predictive values for leakage detection were 100%, 97.1%, 100%, and 100%, respectively, and the concordance rate was 97.14% (95% confidence interval [CI], 85.08-99.93%; p < .001). Leakage location was concordant between MRL and conventional lymphangiography in 27 patients (77.1%, 27/35). Regarding anatomical details of the thoracic duct, variation of the thoracic duct was missed in 11.7% of patients (4/34). The jugulovenous junction was observed in 91.1% (31/34), and its opening into the central vein was depicted in 76.4% (26/34). The concordance rate was between 76.47 and 91.18.
Noncontrast MRL has a high sensitivity for the detection of postoperative thoracic and cervical chylous leakage but is suboptimal for the localization of the leak and depiction of anatomical details of the thoracic duct. This method is worthy of consideration as either a decision-making or planning tool for subsequent interventions.
• Noncontrast MRL provides limited resolution images of CLS but has a high sensitivity for the detection of postoperative chylous leakage in the thoracic and neck regions. • Noncontrast MRL is suboptimal for depicting anatomic details in the thoracic duct and jugulovenous junction but can play a role as a decision-making and a planning tool for subsequent lymphatic interventions.
明确非增强磁共振淋巴造影术（MRL）在术后乳糜胸或颈部乳糜漏管理中的作用。
2016年5月至2020年4月期间，共有50例连续患者接受了非增强MRL、结内淋巴造影术和胸导管栓塞术。他们的平均年龄为62.6岁±10.3（标准差）岁，其中35名参与者为男性。35例患者（70%）的传统淋巴造影图像质量足以作为评估漏出的诊断准确性和位置的参考，34例患者（68%）的传统淋巴造影图像质量足以用于评估胸导管和颈静脉交界处的解剖细节。
MRL显示，检测漏出的敏感性、特异性、阳性和阴性预测值分别为100%、97.1%、100%和100%，一致性率为97.14%（95%置信区间[CI]，85.08 - 99.93%；p < 0.001）。27例患者（77.1%，27/35）的MRL与传统淋巴造影在漏出位置上一致。关于胸导管的解剖细节，11.7%的患者（4/34）漏诊了胸导管的变异。91.1%（31/34）观察到了颈静脉交界处，76.4%（26/34）描绘了其进入中央静脉的开口。一致性率在76.47至91.18之间。
非增强MRL对术后胸段和颈段乳糜漏的检测具有高敏感性，但在漏出定位和胸导管解剖细节描绘方面欠佳。该方法作为后续干预的决策或规划工具值得考虑。
• 非增强MRL提供的乳糜漏综合征图像分辨率有限，但对检测术后胸段和颈部乳糜漏具有高敏感性。• 非增强MRL在描绘胸导管和颈静脉交界处的解剖细节方面欠佳，但可作为后续淋巴干预的决策和规划工具发挥作用。
