Explore magnetic resonance lymphangiography, its clinical application and propose a protocol for localisation of sentinel lymph nodes.

Introduction Breast cancer and melanoma have high incidence in Australia. In both cases there is propensity for metastatic spread via the lymphatic system and nodal involvement alters long term prognosis. Sentinel Lymph Node(s) Sentinel node(s) receive lymphatic afferents directly from the tumour bed and drain to non-sentinel nodes along the drainage pathways. Histological assessment of sentinel nodes provides high sensitivity and specificity for detection of lymphatic metastasis. Sentinel node biopsy has been introduced an intermediate step in oncologic management to assist with staging, prognostication and...

A variety of techniques for MR lymphangiography and sentinel lymph node localisation have been described in the literature.5-12 These can be broadly grouped into positive contrast and negative contrast techniques. Positive contrast A water soluble linear or macrocyclic paramagnetic contrast agent containing gadolinium with concentration between 0.5 mmol and 1.0 mmol is mixed with a local anaesthetic such as 1% lignocaine hydrochloride for peri-tumoral injection.5-9 Imaging consists of pre-contrast T2, diffusion weighted imaging and dynamic post contrast T1 spoiled gradient echo sequences. Additional T1 imaging...

Lymphatic channels and sentinel lymph nodes may be mapped with MRI. The technique represents a potential option to compliment or supplement lymphoscintigraphy. MRI guided intervention and biopsy is becoming more prevalent and there is a potential future role for MRI guided sentinel lymph node localisation and sampling particularly in guiding decision making on the use of neoadjuvant therapy.

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