Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lymphat Res Biol. 2023 Apr;21(2):141-151. doi: 10.1089/lrb.2021.0106. Epub 2022 Aug 17.
To demonstrate the magnetic resonance lymphangiography (MRL) imaging findings of lymphatic diseases and the clinical outcomes of lymphatic embolization in pediatric patients. This retrospective study included 10 consecutive pediatric patients who underwent MRL for lymphatic diseases between June 2017 and June 2021. Nine patients underwent dynamic contrast-enhanced MRL with bilateral inguinal lymph node injection of diluted gadolinium, and one patient underwent nonenhanced MRL with a heavily T2-weighted image. The etiology of lymphatic disease was classified into three categories based on the magnetic resonance findings. The resolution of chylous fluid and weight-adjusted amounts of chylous fluid collected from a drainage tube were evaluated as outcomes. Patients were classified as postoperative lymphatic leak ( = 3), pulmonary lymphatic perfusion syndrome ( = 3), central lymphatic flow disorder (CLFD; = 3), and primary lymphatic dysfunction (Gorham-Stout syndrome; = 1). Three patients underwent radiological lymphatic intervention, and one CLFD patient underwent surgical intervention. In patients with postoperative lymphatic leak, the median chest tube drainage decreased significantly after the intervention [from 87.9 to 12.4 mL/(kg·d); = 0.02]. However, in one CLFD patient, the amount of chylous fluid did not decrease until 7 days after intervention. The etiology of lymphatic disease in pediatrics can be recognized on MRL, and lymphatic intervention can be performed for cessation of lymphatic leak, even though the treatment outcomes may differ according to the underlying etiology. MRL can play an important role in classifying lymphatic disease, and in planning treatment on the basis of the lymphatic anatomy and underlying etiology.
为了展示磁共振淋巴造影术（MRL）在儿科患者中对淋巴疾病的成像发现和淋巴栓塞的临床结果。本回顾性研究纳入了 2017 年 6 月至 2021 年 6 月期间因淋巴疾病接受 MRL 的 10 例连续儿科患者。9 例患者接受双侧腹股沟淋巴结注射稀释钆的动态对比增强 MRL，1 例患者接受重 T2 加权图像的非增强 MRL。根据磁共振成像结果，将淋巴疾病的病因分为三类。评估乳糜液的吸收和引流管中收集的乳糜液的重量调整量作为结果。患者分为术后淋巴漏（ = 3）、肺淋巴灌注综合征（ = 3）、中央淋巴流障碍（CLFD； = 3）和原发性淋巴功能障碍（Gorham-Stout 综合征； = 1）。3 例患者接受了放射学淋巴介入治疗，1 例 CLFD 患者接受了手术干预。在术后淋巴漏患者中，干预后胸腔引流管引流量中位数显著降低[从 87.9 至 12.4 mL/（kg·d）； = 0.02]。然而，在 1 例 CLFD 患者中，直到干预后 7 天，乳糜液量才减少。儿科淋巴疾病的病因可在 MRL 上识别，并且可以进行淋巴介入治疗以停止淋巴漏，尽管治疗结果可能因潜在病因而异。MRL 可以在分类淋巴疾病方面发挥重要作用，并根据淋巴解剖结构和潜在病因制定治疗计划。
