Learning objectives
- To learn about a new modified MR lymphangiography technique of extremities using an intravenous ultrasmall superparamagnetic iron oxide (USPIO) agent in combination with long echo times for blood pool suppression.
- To learn about examples and pitfalls in image interpretation of intravenous Ferumoxytol.
Background
Lymphatic Channels – Function and Anatomy
Responsible for drainage of fluid (lymph) from the interstitial space
Begin as blind ending interstitial sinuses that progressively coalesce into larger channels that flow to lymph nodes and then to larger ductal systems including the cisterna chyli and thoracic duct
Peripherallymphatic channels are much more present in the subcutaneous tissues than in muscles and deep tissues.
Lymphatic channels describe a slightlyspiral coursetoward proximally (Fig. 1)
Lymphatic channels have a slightly irregular caliber and beaded or discontinued appearance
Important diagnostic...
Findings and procedure details
Ferumoxytol as a dual contrast agent
Ferumoxytol is theinjectable solution ofultrasmall super-paramagnetic iron oxide (USPIO)nanoparticle ferumoxide,
used for the treatment of iron deficiency anemia in patients with chronic renal insufficiency.
Ferumoxytol functions as a dual relaxation MR contrast agent providing high signal intensity (SI) with short echo times (TE),
and lower signal with longer TE due to its high R2* relaxivity on T1 weighted images.
With the intravascular blood pool signal suppressed,
intralymphatic gadolinium can easily bedistinguished since venous contamination with gadolinium would also be...
Conclusion
USPIO-enhanced peripheral MR lymphangiography is an effective method to reduce venous contrast contamination through selective blood pool suppression.
Personal information
Orpheus Kolokythas,
MD,
FSAR
Associate Professor
Director of Body Imaging at Harborview Medical Center
Director of BodyImaging MR
Department of Radiology
University of Washington
1959NE Pacific St.,
Box 357115
Seattle,
WA 98195
[email protected]
References
Landry R,
Jacobs PM,
Davis R,
et al.
Pharmacokinetic study of ferumoxytol: A new iron replacement therapy in normal subjects and hemodialysis patients.
Am J Nephrol 2005;25:400–10.
Adkinson NF,
Strauss WE,
Macdougall IC,
Bernard KE,
Auerbach M,
Kaper RF,
Chertow GM,
Krop JS.Comparative safety of intravenous ferumoxytol versus ferric carboxymaltose in iron deficiency anemia: A randomized trial.Am J Hematol.
2018;93(5):683.
Damstra RJ,
Voesten HG,
van Schelven WD,
van der Lei B.
Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema.
a prospective study of...