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High-resolution MR lymphangiography for planning lymphaticovenous anastomosis treatment: a single-centre experience

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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.

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Authors and Affiliations

  1. Department of Medical, Surgical and Neuro Sciences, Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy

    Maria Antonietta Mazzei, Francesco Gentili & Luca Volterrani

  2. Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy

    Francesco Giuseppe Mazzei, Duccio Guerrieri & Alfonso Fausto

  3. Department of Medical Biotechnology, Unit of Maxillofacial Surgery, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy

    Paolo Gennaro & Guido Gabriele

  4. University of Siena, Siena, Italy

    Andrea Nigri

  5. Department of Molecular and Developmental Medicine, Unit of Anatomy, University of Siena, Siena, Italy

    Elisabetta Weber

  6. Department of Medical, Surgical and Neuro Sciences, Unit of Phlebology, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy

    Giuseppe Botta

Authors
  1. Maria Antonietta Mazzei
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  2. Francesco Gentili
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  3. Francesco Giuseppe Mazzei
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  4. Paolo Gennaro
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  6. Andrea Nigri
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  7. Guido Gabriele
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  8. Elisabetta Weber
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  9. Alfonso Fausto
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  10. Giuseppe Botta
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  11. Luca Volterrani
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Contributions

Author contributions

Mazzei FG, Gennaro P, Weber E, Botta G., Mazzei MA, Volterrani L: conception, design and critical revision of this article; Gentili F, Guerrieri D, Nigri A, Weber E, Fausto A: analysis and interpretation of data and drafting of the article; all the authors: final approval of the version to be published.

Corresponding author

Correspondence to Francesco Gentili.

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The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in this study involving human participants were undertaken in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Patients were fully informed of the procedure to obtain their complete collaboration and informed consent was obtained from all individual participants included in the study.

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Mazzei, M.A., Gentili, F., Mazzei, F.G. et al. High-resolution MR lymphangiography for planning lymphaticovenous anastomosis treatment: a single-centre experience. Radiol med 122, 918–927 (2017). https://doi.org/10.1007/s11547-017-0795-x

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  • DOI: https://doi.org/10.1007/s11547-017-0795-x

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