Abstract

Background Primary lymphatic anomalies are often complicated by central lymphatic abnormalities. Intranodal dynamic contrast enhanced MR lymphangiography (DCMRL) is a relatively new technique for imaging the central lymphatic system. Historically, the only method of imaging the central lymphatics well was with pedal lymphangiography, which is technically challenging, time consuming, involves the use of ionising radiation and has risks associated with the use of lipiodol. The treatment options for primary lymphatic disorders have also been limited to symptomatic management. Purpose To describe the technique of DCMRL to identify central lymphatic abnormalities in patients with primary lymphatic anomalies and discuss utility of the findings. Materials and Methods 28 patients with primary lymphatic abnormalities underwent dynamic MR imaging following injection of gadolinium directly into inguinal lymph nodes at a tertiary lymphovascular referral centre. Results Technical success was achieved in 23 patients (82.1%). Pathological imaging findings included obstructed, hypoplastic or absent lymphatic channels with collateralisation/rerouting or reflux of flow, lymphangiectasia, lymphatic pseudoaneurysms and lymph leaks. Protocol modifications for improved imaging are highlighted including technical aspects of lymph node injection, image acquisition and MRI parameters. In two patients, imaging findings warranted embolization of the abnormal lymphatic channels with subsequent symptomatic improvement. Conclusion DCMRL has been shown to be a safe, reproducible technique in patients with primary lymphatic anomalies enabling imaging of the central lymphatic system.