Maria Antonietta Mazzei1, Francesco Gentili2, Francesco Giuseppe Mazzei3, Paolo Gennaro4, Duccio Guerrieri3, Andrea Nigri5, Guido Gabriele4, Elisabetta Weber6, Alfonso Fausto3, Giuseppe Botta7, Luca Volterrani1. 1. Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy. 2. Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy. francescogentili@gmail.com. 3. Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy. 4. Department of Medical Biotechnology, Unit of Maxillofacial Surgery, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy. 5. University of Siena, Siena, Italy. 6. Department of Molecular and Developmental Medicine, Unit of Anatomy, University of Siena, Siena, Italy. 7. Department of Medical, Surgical and Neuro Sciences, Unit of Phlebology, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.
Abstract
PURPOSE: This article illustrates the feasibility of MR lymphangiography (MRL) for imaging lymphatic vessels in patients with lymphedema, its accuracy in distinguishing lymphatic vessels from veins, and its utility for planning Lymphaticovenous anastomosis (LVA) treatment. MATERIALS AND METHODS: We prospectively enrolled 30 patients (24 women, range 18-70, 17 cases of lower limb lymphedema, 6 cases of primary lymphedema). All the patients underwent MRL, using a 1.5T MR unit (Signa Twin Speed Hdxt; GE), after the subcutaneous injection of gadobenate dimeglumine (Gd-BOPTA) with a little dose of lidocaine into the interdigital webs of the dorsal foot or hand. Lymphatic vessels identified for the LVA at MRL were histologically confirmed after surgery. Enhancement of lymphatic vessels and veins at different times after injection of contrast medium and their diameters were measured. RESULTS: A total of 79 lymphatic vessels were clearly identified in 29 patients at MRL; their morphology was tortuous in 22 patients and rectilinear in 7, whereas, the adjacent veins were straight with focal bulging only at the level of venous valve; the enhancement kinetic of the two different structures were different (p < 0.05) but the mean diameter of affected lymphatic vessels was similar to the adjacent veins (p > 0.05). Thirty-four out of 38 specimens of presumed lymphatic vessels at MRL, collected during surgery, resulted positive at the immunoistochemical marker d2-40, with a significant association (Chi-square = 40.421, DF = 1, p < 0.05, contingency coefficent 0.644). One patient had an early complication 1 month after treatment. CONCLUSIONS: MRL is easy and safe to use and combines extensive information on the anatomy and functionality of lymphatic vessels and veins in a single process; therefore, it could be useful in LVA treatment planning and evaluating possible super-microsurgical treatment complications in patients with lymphedema.
PURPOSE: This article illustrates the feasibility of MR lymphangiography (MRL) for imaging lymphatic vessels in patients with lymphedema, its accuracy in distinguishing lymphatic vessels from veins, and its utility for planning Lymphaticovenous anastomosis (LVA) treatment. MATERIALS AND METHODS: We prospectively enrolled 30 patients (24 women, range 18-70, 17 cases of lower limb lymphedema, 6 cases of primary lymphedema). All the patients underwent MRL, using a 1.5T MR unit (Signa Twin Speed Hdxt; GE), after the subcutaneous injection of gadobenate dimeglumine (Gd-BOPTA) with a little dose of lidocaine into the interdigital webs of the dorsal foot or hand. Lymphatic vessels identified for the LVA at MRL were histologically confirmed after surgery. Enhancement of lymphatic vessels and veins at different times after injection of contrast medium and their diameters were measured. RESULTS: A total of 79 lymphatic vessels were clearly identified in 29 patients at MRL; their morphology was tortuous in 22 patients and rectilinear in 7, whereas, the adjacent veins were straight with focal bulging only at the level of venous valve; the enhancement kinetic of the two different structures were different (p < 0.05) but the mean diameter of affected lymphatic vessels was similar to the adjacent veins (p > 0.05). Thirty-four out of 38 specimens of presumed lymphatic vessels at MRL, collected during surgery, resulted positive at the immunoistochemical marker d2-40, with a significant association (Chi-square = 40.421, DF = 1, p < 0.05, contingency coefficent 0.644). One patient had an early complication 1 month after treatment. CONCLUSIONS: MRL is easy and safe to use and combines extensive information on the anatomy and functionality of lymphatic vessels and veins in a single process; therefore, it could be useful in LVA treatment planning and evaluating possible super-microsurgical treatment complications in patients with lymphedema.
Authors: P Gennaro; A Borghini; G Chisci; F G Mazzei; E Weber; E Tedone Clemente; S Guerrini; F Gentili; G Gabriele; C Ungari; M A Mazzei Journal: Eur Rev Med Pharmacol Sci Date: 2017-02 Impact factor: 3.507
Authors: Francesco Giuseppe Mazzei; Francesco Gentili; Susanna Guerrini; Nevada Cioffi Squitieri; Duccio Guerrieri; Paolo Gennaro; Michele Scialpi; Luca Volterrani; Maria Antonietta Mazzei Journal: Biomed Res Int Date: 2017-03-07 Impact factor: 3.411
Authors: Saskia van Heumen; Jonas J M Riksen; Wichor M Bramer; Gijs van Soest; Dalibor Vasilic Journal: Ann Surg Oncol Date: 2022-09-28 Impact factor: 4.339
Authors: Maria Antonietta Mazzei; Letizia Di Giacomo; Alfonso Fausto; Francesco Gentili; Francesco Giuseppe Mazzei; Luca Volterrani Journal: Biomed Res Int Date: 2018-10-21 Impact factor: 3.411
Authors: Massimo De Filippo; Sara Puglisi; Fabiano D'Amuri; Francesco Gentili; Ilaria Paladini; Gianpaolo Carrafiello; Umberto Maestroni; Paolo Del Rio; Francesco Ziglioli; Francesco Pagnini Journal: Radiol Med Date: 2021-08-20 Impact factor: 3.469
Authors: Michael Mills; Malou van Zanten; Marco Borri; Peter S Mortimer; Kristiana Gordon; Pia Ostergaard; Franklyn A Howe Journal: J Magn Reson Imaging Date: 2021-02-24 Impact factor: 4.813