Huo Meng, Zhang Chunyan, Li Ling, Xin Jianfeng, Li Xingpeng, Zhang Yimeng, Zhang Mingxia, Sun Ying, Sun Lei, Wang Rengui, Yue Yunlong
Department of Medical Imaging, Beijing Shijitan Hospital, Capital Medical University, Yangfangdian Tieyi Road No.10, Haidian District, Beijing, 100038, China.
Department of Lymph Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
BMC Med Imaging. 2025 May 3;25(1):146. doi: 10.1186/s12880-025-01689-y.
To explore the value of non-enhanced magnetic resonance thoracic ductography (NMRTD) combined with MR abdominopelvic scanning in the diagnosis of chylous leakage of the female reproductive system.
A retrospective analysis was conducted on the multimodal imaging data from non-enhanced magnetic resonance thoracic ductography (NMRTD), direct lymphangiography (DLG), and abdominopelvic magnetic resonance imaging (MRI) for 18 female patients with reproductive system chylous leakage. Among these patients, 7 had vaginal chylous leakage, 10 had vulvar cutaneous chylous leakage, and 1 had both conditions.The rate of successful visualization of the thoracic duct, the consistency of the drainage directions of the outlet of the thoracic duct, and the degree of visualization of each segment of the thoracic duct by NMRTD and DLG were analyzed. A retrospective analysis was performed on the abnormal manifestations of abdominopelvic MR.
NMRTD had a significant advantage over DLG in terms of successful visualization of the thoracic duct (94.4% vs. 66.7%, P = 0.035). The display of the drainage directions in the outlet area of the thoracic duct by the two methods showed excellent consistency (kappa value = 0.815) in 12 patients whose outlet areas were visualized by both methods. The degrees of visualization of the upper, middle, and lower segments of the thoracic duct in the NMRTD group were significantly greater than those in the DLG group (P values were 0.02, 0.00 and 0.00, respectively). All 18 patients (100%) showed dilatation of the lymph vessels in the pelvic cavity and retroperitoneum on abdominopelvic MR and DLG as well as pelvic perineal reflux or leakage on DLG. MR revealed multiple-site abnormalities that could not be detected by DLG, including multiple long T1 and long T2 lesions of the spleen in 8 patients (44.4%), of the subcutaneous in 7 patients (38.9%), of the bone in 6 patients (33.3%), perineal lymphedema in 18 patients (100%), and abdominopelvic effusion in 10 patients (55.6%).
NMRTD combined with abdominopelvic MR has advantages in comprehensively evaluating the thoracic duct and multiple systemic abnormalities in patients with chylous leakage of the female reproductive system.
探讨非增强磁共振胸导管造影（NMRTD）联合腹部盆腔磁共振扫描在女性生殖系统乳糜漏诊断中的价值。
对18例女性生殖系统乳糜漏患者的非增强磁共振胸导管造影（NMRTD）、直接淋巴管造影（DLG）及腹部盆腔磁共振成像（MRI）的多模态影像数据进行回顾性分析。其中阴道乳糜漏7例，外阴皮肤乳糜漏10例，1例同时存在两种情况。分析NMRTD和DLG对胸导管的显影成功率、胸导管出口引流方向的一致性以及胸导管各段的显影程度。对腹部盆腔磁共振的异常表现进行回顾性分析。
在胸导管显影成功率方面，NMRTD显著优于DLG（94.4%对66.7%，P = 0.035）。在12例两种方法均能显示出口区域的患者中，两种方法对胸导管出口区域引流方向的显示具有良好的一致性（kappa值 = 0.815）。NMRTD组胸导管上、中、下段的显影程度均显著高于DLG组（P值分别为0.02、0.00和0.00）。18例患者（100%）在腹部盆腔磁共振和DLG上均显示盆腔及腹膜后淋巴管扩张，DLG上显示盆腔会阴反流或漏出。磁共振显示了DLG无法检测到的多部位异常，包括8例患者（44.4%）脾脏多发长T1和长T2信号灶、7例患者（38.9%）皮下多发长T1和长T2信号灶、6例患者（33.3%）骨骼多发长T1和长T2信号灶、18例患者（100%）会阴淋巴水肿以及10例患者（55.6%）腹部盆腔积液。
NMRTD联合腹部盆腔磁共振在综合评估女性生殖系统乳糜漏患者的胸导管及多系统异常方面具有优势。
