Learning objectives
To learn some basic concepts about lymphedema (LE)
To become familiar with the acquisition technique of non -contrast MR lymphography
To learn how to interpret MR lymphangiography findings
Background
LE is a progressive condition,
characterised by an accumulation of protein rich lymph in the interstitial space.
It is caused by failure of the lymphatic system to conduct lymph back to the blood circulation,
which leads to chronic inflammation [1]
LE is rarely fatal,
but it is a disabling disorder that affects the patients' quality of life and causes significant morbidity.
It's management is very difficult: traditionally,
LE has been commonly treated with a conservative approach,
such as physiotherapy,
lymphatic massage,
wrapping and controlled compression...
Findings and procedure details
MRI lymphography is an alternative to invasive methods such as oil-contrast lymphangiography and lymphoscintigraphy.
There are 2 types of MRL:
Contrast-enhanced MRL (CERML) based on T1-weighted sequences; it involves
subcutaneous injection of paramagnetic contrast medium; safe technique,
with high spatial resolution and able to provide a good visualization of the lymphatic drainage.
Gadolinium injection in the interdigital spaces ican cause patients’ discomfort and local reactions.
Due to the recent evidence of intracranial gadolinium deposition after contrast-enhanced MR imaging,
the effort to use magnetic resonance imaging...
Conclusion
NCMRL is a non-invasive imaging technique,
useful for the analysis of LE.
It seems to be a valuable tool in the diagnosis and the surgical planning of LE,
providing helpful anatomical information on the type of LE,
on the lymph nodes number and the sites suitable for nodal transplantation and LE follow up after surgery.
References
1.Cho S.
Am J Med.
2002 Nov;113(7):580-6.
2.Cheville AL.
Semin Radiat Oncol.
2003 Jul; 13[3]:290-301
3.Campisi C.
Microsurgery.
2010 May;30(4):256-60
4.Olszewski WL.
Eur J Vasc Endovasc Surg.
2013 Mar;45(3):282-90