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Nuklearmedizin 2014; 53(05): 190-196
DOI: 10.3413/Nukmed-0649-14-03
Original article
Schattauer GmbH

Magnetic resonance imaging versus lymphoscintigraphy for the assessment of focal lymphatic transport disorders of the lower limb

First experiencesKernspintomographie versus Lymphszintigraphie zur Beurteilung fokaler Lymphtransportstörungen der unteren ExtremitätenErste Erfahrungen
M. Weiss
1   Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Germany
,
C. Burgard
2   Department of Clinical Radiology , Ludwig-Maximilians-University of Munich, Germany
,
R. Baumeister
3   Department of Micro-, Hand- and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Germany
,
F. Strobl
2   Department of Clinical Radiology , Ludwig-Maximilians-University of Munich, Germany
,
A. Rominger
1   Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Germany
,
P. Bartenstein
1   Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Germany
,
J. Wallmichrath
3   Department of Micro-, Hand- and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Germany
,
A. Frick
3   Department of Micro-, Hand- and Reconstructive Surgery, Ludwig-Maximilians-University of Munich, Germany
,
M. Notohamiprodjo
2   Department of Clinical Radiology , Ludwig-Maximilians-University of Munich, Germany
› Author Affiliations
Further Information

Publication History

received: 12 March 2014

accepted in revised form: 13 June 2014

Publication Date:
02 January 2018 (online)

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Summary

Purpose: To compare the diagnostic accuracy of magnetic resonance imaging (MR-lym- phangiography) and lymphoscintigraphy for assessment of focal lesions of the peripheral lymphatic system. Patients with focal lymphatic transport disorders might benefit from surgi-cal interventions. Patients, methods: We examined by lymphoscintigraphy and MR- lymphangiography a total of 85 lower limbs in 46 consecutive patients (33 women; mean age 41 years; range 9-79 years) presenting with uni- or bilateral lymphedema. MR-lym- phangiographies were obtained at isotropic sub-millimeter resolution with a 3.0 Tesla magnet after injection of gadolinium contrast medium. MR-lymphangiography was reviewed by radiologists, whereas lymp- hoscintigraphy was reviewed by nuclear medicine physicians. The images were examined for localization and distribution of any focal lesions of the lymphatic vessel system. Diagnostic accuracy of the MR-approach was calculated relative to the lymphoscintigraphy gold standard. Results: There was substantial correlation of results by the two modalities (κ = 0.62). MR-lymphangiography had sensitivity of 68%, specificity of 91%, positive predictive value of 82%, and negative predictive value of 83%. Conclusions: Imaging findings of both lymphoscintigraphy and MR-lymph- angiography showed good diagnostic accuracy. MR-lymphangiography proved more information about anatomic location of focal lesions of the lymphatic vessels, but use of MR-lymphangiography is currently constrained due to the requirement for off-label subcutaneous injection of gadolinium che- lates. Consequently, and due to its superior sensitivity lymphoscintigraphy remains the most common imaging method to assess functional lymphatic disorders of the lower limb.

Zusammenfassung

Ziel war es die diagnostische Genauigkeit der Kernspintomographie (MR-Lymphangiogra- phie) und Lymphszintigraphie zur Einschätzung fokaler Läsionen des peripheren Lymphsystems zu vergleichen. Patienten mit fokalen lymphatischen Transportstörungen können von chirurgischen Interventionen profitieren. Patienten, Methoden: Wir untersuchten insgesamt 85 untere Extremitäten bei 46 konsekutiven Patienten (33 Frauen, Durchschnittsalter 41 Jahre, Range 9-79 Jahre) mit uni- oder bilateralem Lymphödem mittels Lymphszintigraphie und MR-Lymphangiogra- phie. Die MR-Lymphangiographien wurden mittels isotroper submillimeter-Auflösung an einem 3,0-Tesla-Magneten nach Applikation von Gadolinium-Kontrastmittel durchgeführt. Die MR-Lymphangiographien wurde von Radiologen beurteilt, die Lymphszintigraphien von Nuklearmedizinern. Die Aufnahmen wurden nach Lokalisation und Verteilung umschriebener Läsionen des Lymphgefäßsystems beurteilt. Die Genauigkeit der MR-Un- tersuchung wurde dabei relativ zur Lymph- szintigraphie als Goldstandard berechnet. Ergebnisse: Es bestand eine gute Korrelation der Ergebnisse beider Modalitäten (κ = 0,62). Die MR-Lymphangiographie zeigte eine Sen- sitivität von 68%, eine Spezifität von 91%, einen positiven Vorhersagewert von 82% und einen negativen Vorhersagewert von 83%. Schlussfolgerungen: Die Ergebnisse beider Methoden, Lymphszintigraphie und MR-Lymphangiographie, zeigten eine gute diagnostische Genauigkeit. Die MR-Lymph- angiographie zeigte mehr Information über die anatomische Lokalisation der umschriebenen Läsionen des Lymphgefäßsystems, wobei der Einsatz der MR-Lymphangio- graphie aufgrund der fehlenden Zulassung für die subkutane Applikation des Gadolinium-Kontrastmittels eingeschränkt ist. Konsequenterweise und aufgrund ihrer höheren Sensitivität bleibt die Lymphszintigraphie die bevorzugte Methode zur Untersuchung funktioneller Lymphtransportstörungen der unteren Extremitäten.

Keywords

Lymphoscintigraphy - MR-lymphangiography - magnet resonance imaging - lymphoedema - lymphatic disorders

Schlüsselwörter

Lymphszintigraphie - MR-Lymphangiographie - Kernspintomographie - Lymphödem - Lymphtransportstörung
 

  • References

  • 1 Bourgeois P. Scintigraphic investigations of the lymphatic system: The influence of injected volume and quantity of labeled colloidal tracer. J Nucl Med 2007; 48: 693-695.
    CrossrefPubMedGoogle Scholar
  • 2 Cohan RH, Leder RA, Herzberg AJ. et al. Extravascular toxicity of two magnetic resonance contrast agents. Preliminary experience in the rat. Invest Radiol 1991; 26: 224-226.
    CrossrefPubMedGoogle Scholar
  • 3 Fink C, Bock M, Kiessling F, Delorme S. Interstitial magnetic resonance lymphography with gadobutrol in rats: evaluation of contrast kinetics. Invest Radiol 2002; 37: 655-662.
    CrossrefPubMedGoogle Scholar
  • 4 Hong Y, Xiang L, Hu Y. et al. Interstitial magnetic resonance lymphography is an effective diagnostic tool for the detection of lymph node metastases in patients with cervical cancer. BMC Cancer 2012; 12: 360.
    CrossrefPubMedGoogle Scholar
  • 5 International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology 2003; 36: 84-91.
    PubMedGoogle Scholar
  • 6 Kandeel AA, Ahmed Younes J, Mohamed Zaher A. Significance of popliteal lymph nodes visualization during radionuclide lymphoscintigraphy for lower limb lymphedema. Indian J Nucl Med 2013; 28: 134-137.
    CrossrefPubMedGoogle Scholar
  • 7 Liu NF, Lu Q, Jiang ZH, Wang CG, Zhou JG. Anatomic and functional evaluation of the lymphatics and lymph nodes in diagnosis of lymphatic circulation disorders with contrast magnetic resonance lymphangiography. J Vasc Surg 2009; 49: 980-987.
    CrossrefPubMedGoogle Scholar
  • 8 Lohrmann C, Felmerer G, Foeldi E. et al. MR lymphangiography for the assessment of the lymphatic system in patients undergoing microsurgical reconstructions of lymphatic vessels. Microvasc Res 2008; 76: 42-45.
    CrossrefPubMedGoogle Scholar
  • 9 Lohrmann C, Felmerer G, Speck O. et al. Postoperative lymphoceles: detection with high-resolution MR lymphangiography. J Vasc Interv Radiol 2006; 17: 1057-1062.
    CrossrefPubMedGoogle Scholar
  • 10 Lu Q, Bui D, Liu NF. et al. Magnetic resonance lymphography at 3T: a promising noninvasive approach to characterise inguinal lymphatic vessel leakage. Eur J Vasc Endovasc Surg 2012; 43: 106-111.
    CrossrefPubMedGoogle Scholar
  • 11 Meijer HJ. et al. Geographical distribution of lymph node metastases on MR lymphography in prostate cancer patients. Radiother Oncol 2013; 106: 59-63.
    CrossrefPubMedGoogle Scholar
  • 12 Notohamiprodjo M, Baumeister RG, Jakobs TF. et al. MR-lymphangiography at 3.0 T – a feasibility study. Eur Radiol 2009; 19: 2771-2778.
    CrossrefPubMedGoogle Scholar
  • 13 Notohamiprodjo M, Weiss M, Baumeister RG. et al. MR lymphangiography at 3.0 T: correlation with lymphoscintigraphy. Radiology 2012; 264: 78-87.
    CrossrefPubMedGoogle Scholar
  • 14 Runge VM, Dickey KM, Williams NM, Peng X. Local tissue toxicity in response to extravascular extravasation of magnetic resonance contrast media. Invest Radiol 2002; 37: 393-398.
    CrossrefPubMedGoogle Scholar
  • 15 Strobl FF, Weiss M, Wallmichrath J. et al. MR lymphangiography for assessment of focal dermal backflow for presurgical work-up in patients with peripheral lymphoedema. Handchir Mikrochir Plast Chir 2012; 44: 329-333.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Weiss M, Baumeister RG, Hahn K. Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study. Eur J Nucl Med Mol Imaging. 2003; 30: 202-206.
    CrossrefPubMedGoogle Scholar
  • 17 Weiss M, Gildehaus FJ, Brinkbäumer K. et al. Lymph kinetics with technetium-99m labeled radiopharmaceuticals – Animal studies. Nuklearmedizin 2005; 44: 156-165.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Weiss M, Landrock S, Wallmichrath J. et al. The clinical yield of SPECT/CT for the assessment of lymphatic transport disorders. First experiences. Nuklearmedizin 2013; 52: 235-243.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology 1988; 167: 729-735.
    CrossrefPubMedGoogle Scholar