Fei Ying, Lu Yanli, Yao Zhichao, Yin Kongxiang, Zhou Dayong, Liu Zhanao
Department of Medical Imaging, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 210011, China.
Department of Vascular Surgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou 215002, China.
Diagnostics (Basel). 2025 May 20;15(10):1288. doi: 10.3390/diagnostics15101288.
To investigate the diagnostic value of various lymphatic imaging techniques for thoracic duct (TD) outlet obstruction in patients with chylous leakage. A retrospective analysis was conducted on 23 patients with chylous leakage who were radiologically diagnosed with a TD outlet obstruction and underwent a TD exploration and reconstruction between January 2022 and February 2025. Non-enhanced magnetic resonance lymphangiography (MRL), Tc-DX lymphoscintigraphy, and intranodal lymphangiography were employed to detect abnormalities in the central lymphatic vessels. The Receiver Operating Characteristic (ROC) curve was utilized to analyze the diagnostic performance of these imaging methods for TD outlet obstruction in lymphatic disorders. Twenty-three patients (fifteen males and eight females) with chylous leakage were included in this study, with an average age of 59.78 ± 13.08 years. Non-enhanced MRL, Tc-DX lymphoscintigraphy, and intranodal lymphangiography revealed TD outlet obstructions in 13, 17, and 18 patients, respectively. Twenty patients exhibited findings consistent with preoperative imaging during TD explorations; the intraoperative microscopic visualization demonstrated the difficulty of white chyle entering the bloodstream for these patients. The ROC curve analysis indicated that "at least two imaging modalities were positive" and had the highest Area Under the Curve (AUC) value (0.90); "intranodal lymphangiography" and "non-enhanced magnetic resonance lymphangiography" followed closely with respective AUC values of 0.76 and 0.73, and Tc-DX lymphoscintigraphy exhibited a lower AUC value 0.63. The combined utilization of multimodal lymphatic imaging techniques demonstrated a high diagnostic accuracy in identifying TD outlet obstruction in patients with chylous leakage.
探讨各种淋巴成像技术对乳糜漏患者胸导管（TD）出口梗阻的诊断价值。对2022年1月至2025年2月期间23例经放射学诊断为TD出口梗阻并接受TD探查和重建的乳糜漏患者进行回顾性分析。采用非增强磁共振淋巴造影（MRL）、Tc-DX淋巴闪烁造影和结内淋巴造影检测中央淋巴管异常。利用受试者操作特征（ROC）曲线分析这些成像方法对淋巴疾病中TD出口梗阻的诊断性能。本研究纳入了23例乳糜漏患者（15例男性和8例女性），平均年龄为59.78±13.08岁。非增强MRL、Tc-DX淋巴闪烁造影和结内淋巴造影分别在13例、17例和18例患者中发现TD出口梗阻。20例患者在TD探查期间表现出与术前成像一致的结果；术中显微镜观察显示这些患者的白色乳糜进入血流困难。ROC曲线分析表明，“至少两种成像方式呈阳性”的曲线下面积（AUC）值最高（0.90）；“结内淋巴造影”和“非增强磁共振淋巴造影”紧随其后，各自的AUC值分别为0.76和0.73，而Tc-DX淋巴闪烁造影的AUC值较低，为0.63。多模态淋巴成像技术的联合应用在识别乳糜漏患者的TD出口梗阻方面显示出较高的诊断准确性。
