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Intrahepatic dynamic contrast MR lymphangiography: initial experience with a new technique for the assessment of liver lymphatics

  • David M. BikoEmail author
  • Christopher L. Smith
  • Hansel J. Otero
  • David Saul
  • Ammie M. White
  • Aaron DeWitt
  • Andrew C. Glatz
  • David A. Piccoli
  • Petar Mamula
  • Jonathan J. Rome
  • Yoav Dori
Magnetic Resonance

Abstract

Objectives

To describe the technique and report on our initial experience with the use of intrahepatic dynamic contrast magnetic resonance lymphangiography (IH-DCMRL) for evaluation of the lymphatics in patients with hepatic lymphatic flow disorders.

Methods

This is a retrospective review of the imaging and clinical findings in six consecutive patients undergoing IH-DCMRL. The technique involves injection of a gadolinium contrast agent into the intrahepatic lymphatic ducts followed by imaging of the abdomen and chest with both heavily T2-weighted imaging and dynamic time-resolved imaging.

Results

In six consecutive patients, IH-DCMRL was technically successful. There were four patients with protein-losing enteropathy (PLE) and two with ascites in this study. In the four patients with PLE, IH-DCMRL demonstrated hepatoduodenal connections with leak of contrast into the duodenal lumen not seen by conventional lymphangiography. In one patient with ascites, IH-DCMRL demonstrated lymphatic leakage into the peritoneal cavity not seen by intranodal lymphangiography. In the second patient with ascites, retrograde lymphatic perfusion of mesenteric lymphatic networks and nodes was seen. Venous contamination was seen in two patients. No biliary contamination was identified. There were no short-term complications.

Conclusions

IH-DCMRL is a cross-sectional technique which successfully evaluated hepatic lymphatic flow disorders and warrants further investigation.

Key Points

• Intrahepatic dynamic contrast magnetic resonance lymphangiography (IH-DCMRL) is a new imaging technique to evaluate hepatic lymphatic flow disorders such as protein-losing enteropathy.

• In comparison to conventional liver lymphangiography, IH-DCMRL offers a 3D imaging technique and better distal lymphatic contrast distribution and does not use ionizing radiation.

Keywords

Magnetic resonance imaging Lymphatic system Protein-losing enteropathies 

Abbreviations

IH-DCMRL

Intrahepatic dynamic contrast magnetic resonance lymphangiography

PLE

Protein-losing enteropathy

TD

Thoracic duct

TWIST

Time-resolved imaging with interleaved stochastic trajectories

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Yoav Dori.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

References

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • David M. Biko
    • 1
    Email author
  • Christopher L. Smith
    • 2
  • Hansel J. Otero
    • 1
  • David Saul
    • 1
  • Ammie M. White
    • 1
  • Aaron DeWitt
    • 2
  • Andrew C. Glatz
    • 2
  • David A. Piccoli
    • 3
  • Petar Mamula
    • 3
  • Jonathan J. Rome
    • 2
  • Yoav Dori
    • 2
  1. 1.Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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