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[淋巴管成像——适应证与临床应用]

[Lymphatic vessel imaging-Indications and clinical applications].

作者信息

Pieper Claus C

机构信息

Sektion für minimal invasive Lymphgefäßtherapie, Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.

出版信息

Radiologie (Heidelb). 2025 May;65(5):316-324. doi: 10.1007/s00117-025-01451-z. Epub 2025 Apr 17.

DOI:10.1007/s00117-025-01451-z
PMID:40244423
Abstract

BACKGROUND

The armamentarium of lymphatic imaging techniques and treatment concepts available at specialized centers has significantly increased in recent years. The rarity and complexity of lymphatic vascular diseases presents the particular challenge of implementing these methods in a meaningful and targeted manner in patient care; however, there are currently no generally accepted diagnostic guidelines.

OBJECTIVE

Which lymphatic imaging technique is useful in which clinical situations?

MATERIAL AND METHODS

This article provides an overview of clinical and technical considerations that are relevant for a targeted evaluation of indications for lymphatic imaging in a multidisciplinary diagnostic and therapeutic approach.

RESULTS

The lymphatic vascular system can be affected by a wide range of primary and secondary pathologies, which often lead to relatively uniform clinical presentations (especially localized swellings, chylolymphatic effusions). In general, dedicated imaging should be discussed if a lymphatic vascular disease is suspected based on such a typical presentation. The choice of imaging strategy is then individually determined by the urgency of treatment, suspected localization and etiology of the pathology, comorbidities, specific properties of the imaging techniques, the treatment strategy pursued and local availability. When interpreting imaging and planning treatment, in addition to the large spectrum of different pathologies, the individual variability of the lymphatic system must also be taken into account.

CONCLUSION

An individual pretherapeutic assessment of lymphatic flow should nowadays be mandatory in order to be able to optimize the therapeutic approach for each patient with a suspected lymphatic vascular disease. Interdisciplinary patient care is of decisive importance.

摘要

背景

近年来,专业中心可用的淋巴成像技术和治疗理念显著增加。淋巴血管疾病的罕见性和复杂性给在患者护理中以有意义且有针对性的方式应用这些方法带来了特殊挑战;然而,目前尚无普遍接受的诊断指南。

目的

哪种淋巴成像技术在哪些临床情况下有用?

材料与方法

本文概述了在多学科诊断和治疗方法中,与有针对性地评估淋巴成像适应证相关的临床和技术考量。

结果

淋巴血管系统可受到多种原发性和继发性病变的影响,这些病变常导致相对一致的临床表现(尤其是局部肿胀、乳糜淋巴积液)。一般来说,如果基于这种典型表现怀疑有淋巴血管疾病,就应讨论进行专门的成像检查。然后,成像策略的选择由治疗的紧迫性、病变的可疑定位和病因、合并症、成像技术的特定属性、所采用的治疗策略以及当地的可及性来单独确定。在解读成像结果和规划治疗方案时,除了要考虑大范围的不同病变外,还必须考虑淋巴系统的个体变异性。

结论

如今,对淋巴流动进行个体化的治疗前评估应成为必需,以便能够为每位疑似淋巴血管疾病的患者优化治疗方法。跨学科的患者护理至关重要。

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本文引用的文献

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Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions.《回到未来 II-淋巴管成像和介入治疗领域的快速发展全面更新》。
Invest Radiol. 2023 Aug 1;58(8):610-640. doi: 10.1097/RLI.0000000000000966. Epub 2023 Apr 11.
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MR lymphangiography of lymphatic abnormalities in children and adults with Noonan syndrome.磁共振淋巴管成像在儿童和成人努南综合征中的淋巴异常诊断。
Sci Rep. 2022 Jul 1;12(1):11164. doi: 10.1038/s41598-022-13806-w.
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Lymphatic Interventions in the Cancer Patient.癌症患者的淋巴介入治疗。
Curr Oncol Rep. 2022 Oct;24(10):1351-1361. doi: 10.1007/s11912-022-01293-1. Epub 2022 May 31.
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Ultrasound-guided needle positioning for nodal dynamic contrast-enhanced MR lymphangiography.超声引导下的淋巴结动态对比增强磁共振淋巴管造影的针定位。
Sci Rep. 2022 Mar 7;12(1):3621. doi: 10.1038/s41598-022-07359-1.
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The management of chyle leak post-oesophagectomy for oesophageal carcinoma: a systematic review.食管癌术后乳糜漏的管理:系统评价。
Ann R Coll Surg Engl. 2022 Jul;104(7):480-489. doi: 10.1308/rcsann.2021.0199. Epub 2021 Dec 3.
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Chylothorax and Pseudochylothorax.乳糜胸和假性乳糜胸。
Clin Chest Med. 2021 Dec;42(4):667-675. doi: 10.1016/j.ccm.2021.08.003.
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Intranodal CT Lymphangiography with Water-soluble Iodinated Contrast Medium for Imaging of the Central Lymphatic System.腔内 CT 淋巴管造影术联合水溶性碘对比剂在中央淋巴系统成像中的应用。
Radiology. 2022 Jan;302(1):228-233. doi: 10.1148/radiol.2021210294. Epub 2021 Oct 26.
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Lymphatic Dysregulation in Patients With Heart Failure: JACC Review Topic of the Week.心力衰竭患者的淋巴功能失调:JACC 本周综述主题。
J Am Coll Cardiol. 2021 Jul 6;78(1):66-76. doi: 10.1016/j.jacc.2021.04.090.
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Radiological management of postoperative lymphorrhea.术后淋巴漏的放射学管理。
Langenbecks Arch Surg. 2021 Jun;406(4):945-969. doi: 10.1007/s00423-021-02094-z. Epub 2021 Apr 12.
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Impact of transjugular intrahepatic portosystemic shunt creation on the central lymphatic system in liver cirrhosis.经颈静脉肝内门体分流术创建对肝硬化中央淋巴系统的影响。
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