Sheena Pimpalwar1, Ponraj Chinnadurai2, Alex Chau3, Mercedes Pereyra4, Daniel Ashton5, Prakash Masand6, Rajesh Krishnamurthy7, Siddharth Jadhav8. 1. Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: pimpalwars@health.missouri.edu. 2. Advanced Therapies, Siemens Medical Solutions USA Inc., Hoffman Estates, IL, USA. Electronic address: ponraj.chinnadurai@siemens.com. 3. Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: axchau@texaschildrens.org. 4. Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: mmpereyr@texaschildrens.org. 5. Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: djashton@texaschildrens.org. 6. Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: pmmasand@texaschildrens.org. 7. Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA. Electronic address: rajesh.krishnamurthy@nationwidechildrens.org. 8. Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA. Electronic address: spjadhav@texaschildrens.org.
Abstract
OBJECTIVE: To review the technical aspects and categorize the imaging findings of dynamic contrast enhanced magnetic resonance lymphangiography (DCMRL) and correlate the findings with patient management options. MATERIALS AND METHODS: A retrospective review of patients who underwent DCMRL between June 2012 and August 2017 at a tertiary care paediatric hospital was performed. Twenty-five DCMRL studies were performed in 23 patients (9 males, 13 females, 1 ambiguous gender) with a median age of 4 years (range: 1 month-29 years). DCMRL imaging findings were reviewed, categorized and the impact on patient management was studied. RESULTS: DCMRL was technically successful in 23/25 (92%) studies. DCMRL findings were categorized based on the status of central conducting lymphatics (CCL) and alternate lymphatic pathways as follows: Type 1 - normal CCL with no alternate lymphatic pathways, Type 2 - partial (2a) or complete (2b) non-visualization of CCL with reflux of contrast into alternate pathways and Type 3 - normal CCL with additional filling of alternate pathways. Type 1 DCMRL patients (n = 5) were reassured and conservative management was continued, Type 2 patients (n = 10) had evidence of CCL obstruction hence thoracic duct ligation or embolization was avoided and other options such as lymphatic fluid diversion using Denver® shunt or lympho-venous anastomosis were used, and Type 3 patients (n = 8) were evaluated for elevated central venous pressure as a cause of lymphatic backflow in addition to Denver® shunt, lympho-venous anastomosis, thoracic duct ligation or embolization. CONCLUSION: DCMRL is an evolving imaging technique for understanding abnormalities of the central conducting lymphatics. Categorization of imaging findings may be helpful in guiding selection of management options.
OBJECTIVE: To review the technical aspects and categorize the imaging findings of dynamic contrast enhanced magnetic resonance lymphangiography (DCMRL) and correlate the findings with patient management options. MATERIALS AND METHODS: A retrospective review of patients who underwent DCMRL between June 2012 and August 2017 at a tertiary care paediatric hospital was performed. Twenty-five DCMRL studies were performed in 23 patients (9 males, 13 females, 1 ambiguous gender) with a median age of 4 years (range: 1 month-29 years). DCMRL imaging findings were reviewed, categorized and the impact on patient management was studied. RESULTS:DCMRL was technically successful in 23/25 (92%) studies. DCMRL findings were categorized based on the status of central conducting lymphatics (CCL) and alternate lymphatic pathways as follows: Type 1 - normal CCL with no alternate lymphatic pathways, Type 2 - partial (2a) or complete (2b) non-visualization of CCL with reflux of contrast into alternate pathways and Type 3 - normal CCL with additional filling of alternate pathways. Type 1 DCMRLpatients (n = 5) were reassured and conservative management was continued, Type 2 patients (n = 10) had evidence of CCL obstruction hence thoracic duct ligation or embolization was avoided and other options such as lymphatic fluid diversion using Denver® shunt or lympho-venous anastomosis were used, and Type 3 patients (n = 8) were evaluated for elevated central venous pressure as a cause of lymphatic backflow in addition to Denver® shunt, lympho-venous anastomosis, thoracic duct ligation or embolization. CONCLUSION:DCMRL is an evolving imaging technique for understanding abnormalities of the central conducting lymphatics. Categorization of imaging findings may be helpful in guiding selection of management options.
Authors: Veronica Bordonaro; Paolo Ciancarella; Paolo Ciliberti; Davide Curione; Carmela Napolitano; Teresa Pia Santangelo; Gian Luigi Natali; Massimo Rollo; Paolo Guccione; Luciano Pasquini; Aurelio Secinaro Journal: Radiol Med Date: 2021-01-04 Impact factor: 3.469
Authors: Jefferson N Brownell; David M Biko; Petar Mamula; Ganesh Krishnamurthy; Fernando Escobar; Abhay Srinivasan; Pablo Laje; David A Piccoli; Erin Pinto; Christopher L Smith; Yoav Dori Journal: J Pediatr Gastroenterol Nutr Date: 2022-01-01 Impact factor: 3.288