MR-Lymphography: Technique, Indications and Results

Introduction: The purpose of this study is to show our experience and result and also to describe the technique of contrast enhanced MR- lymphography for the management and diagnosis of lower and upper limbs lymphedema and lymphorrea.

Methodology and Material: From July 2012 to February 2014, 22 female patients (age range 19-57 years) were admitted in our unit under the diagnosis of primary lymphedema (2 patients), secondary lymphedema (upper or lower limbs, 18 patients) and lymphorrea (2 patients). MR-lymphography was performed in all patients. All studies were performed in a 3T equipment (Magnetom VERIO, Siemens Medical Solutions) using T1-3DGRE (FLASH) sequences and intradermal injection of a gadolinium based contrast media/local anestesia mixture (gadodiamide 0.5mmol/ml and mepivacaine 1%) in each interdigital space (1 ml in each space). Images obtained were processed into MIP and VR. Lymphatics observed were referred according to an established reference system skin marks.

Results: MR lympography allowed the study lympathic system in all patients and also to carry out an evaluation and planning of lymphaticovenous anastomosis as a surgical definitive treatment of the lymphemedema (both primary and secondary). In those patients with lymphorrea, injured lymphatic vessel was determined. An exact intraoperative correlation with imaging findings was observed.

Conclusions: MR- Lymphography in a reliable, accurate, reproducible and secure technique for the diagnosis, management and surgical planning of the lymphedema and lymphorrea.