Non-contrast MR lymphography of the lymphatic system of the liver

  • Lionel ArrivéEmail author
  • Laurence Monnier-Cholley
  • Nora Cazzagon
  • Dominique Wendum
  • Edouard Chambenois
  • Sanaâ El Mouhadi
Magnetic Resonance


This review shows the images obtained with non-contrast MR lymphography in different pathologic conditions affecting the liver. Non-contrast MR lymphography is obtained with a free-breathing 3D high spatial resolution fast-recovery fast spin-echo sequence similar to that used for 3D MR cholangiopancreatography. The liver is the largest lymph-producing organ generating approximately half of the body’s lymphatic fluid and is the most important part of the lymphatic system from a functional point of view. Therefore, understanding the anatomy, physiology, and physiopathology of the lymphatics of the liver is important. However, its anatomy and pathology are relatively unknown because of the absence of commonly used imaging techniques. We describe the anatomy, the physiology, and the pathophysiology of the lymphatic system of the liver and the possibility of identifying dilated lymphatic vessels in various liver diseases and conditions. Disruption of normal lymphatic structure and function is observed in various disease conditions. Liver lymph flow is directly correlated with portal venous pressure. Therefore, a dilatation of liver lymphatics is observed in portal hypertension as well as in increased pressure in hepatic veins. After liver transplantation, ligation of lymphatic vessels at the hilum reduces chylous ascites and results in lymphatic dilatation which is easily observed. In severe long-standing biliary stenosis, dilated lymphatic vessels are commonly demonstrated with non-contrast MR lymphography. In hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and some metastases, lymphatic vessels are abundant in the immediate vicinity of the tumour. These various lymphatic abnormalities can be demonstrated with non-contrast MR lymphography.

Key Points

• Anatomy and pathology of the lymphatics of the liver are relatively unknown, partly because of lack of current imaging technique.

• Non-contrast MR lymphography is obtained with a free-breathing 3D high spatial resolution fast spin-echo sequence similar to that used for 3D MR cholangiopancreatography.

• Non-contrast MR lymphography may participate to the understanding of several abnormal liver conditions including portal hypertension, biliary diseases, and malignant hepatic tumours.


Lymphatic system Liver Abnormalities, lymphatic Magnetic resonance 



Hepatocellular carcinoma


Intrahepatic cholangiocarcinoma


Vascular Endothelial Growth Factor



All the radiology technologists of our department for their unique expertise, Pascale Dono for editorial assistance, and Julien Bouvier for technical assistance.


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

Compliance with ethical standards


The scientific guarantor of this publication is Lionel Arrivé M.D.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Statistical expertise was not mandatory for this review.

Informed consent

Written informed consent was not mandatory for this review.

Ethical approval

Institutional Review Board approval was not mandatory for this review.


• retrospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Faculté de Médecine Pierre et Marie Curie and Department of Radiology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de ParisSorbonne UniversitéParisFrance
  2. 2.Hepatology Department, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, French Network for Rare Liver Diseases in Adults and Children (FILFOIE), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris (APHP), INSERM, UMR_S 938, CDR Saint-AntoineUPMC Univ Paris 06ParisFrance
  3. 3.Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPadovaItaly
  4. 4.Faculté de Médecine Pierre et Marie Curie and Department of Pathology, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de ParisSorbonne UniversitéParisFrance

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