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Sang Hoon Lee1, ∗
, Joon Pio Hong2
, Joon Pio Hong2
Abstract
Currently, there has been an increase in the use of surgical modalities to treat lymphedema and MR imaging to examine lymphatic vessels. Furthermore, there have been several advancements in the field of MR imaging, from the traditional heavily T2-weighted images to three-dimension-al images. Three-dimensional images include spoiled gradient echo images, and numerous ad-vanced techniques have been implemented. Among the fat suppression techniques, mDixon technique has recently been in the spotlight.
Index terms
Magnetic Resonance Imaging, Lymphography, LymphoscintigraphyREFERENCES
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Fig. 1.
Lymphedema of both thighs. A 19-year-old woman with a leg swell-ing for 10 years and chylothorax for 2 years. T2-weighted image shows extensive subcutaneous edema, fat hy-pertrophy, and suspicious fibrosis.
Fig. 2.
A 49-year-old woman with lymphedema for 20 years having no history of surgical intervention. A. Lymphoscintigraphy shows dermal backflow of left lower leg (arrow). B. Maximum intensity projection image using T1 weighted fast field echo-mDixon technique shows three lymphatic vessels (arrows) and dermal backflow (arrowhead) at left lower leg.
Fig. 3.
Lymphedema of right lower extremity: a 63 year-old woman. A. Lymphoscintigraphy shows no lymphatic vessel on 1 minute after injection (left); 1 hour (middle) and 2 hour (right) delayed images show extensive dermal backflow (arrows) and a few lymph node uptakes at inguinal area. B, C. MIP image, 10 minutes after injection (B) shows multiple lymphatic vessels at lower leg and distal thigh, right (arrows). A more prominent dermal back flow and lymphatic vessels (arrows) 30 minutes after the injection (C). The T1FFE-mDixon technique is used in these images. D. MPR axial image shows lymphedema and dilated lymphatic vessels of right lower leg. Left leg appears to be normal. MIP images are better than axial images to differentiate between the veins and lymphatics. Dermal backflow appears as a thickening of the skin and enhancement (arrows). Our institution routinely provided 3 mm reconstructed images of whole acquired area for anatomic information. ANT = anterior, MIP = maximum intensity projection, MPR = multiplanar reformation, T1FFE = T1 weighted fast field echo
Fig. 4.
A 51-year-old man with a lymphedema that had developed two years ago, and had suffered from an episode of heart failure. A. 3D T1WI coronal image shows dilatation of lymphatic vessel (arrows). B. MIP image shows multiple lymphatic vessels of lower leg and thigh, extension to inguinal area (arrows). C. 3D intermediate-weighted FSE shows lymphatic vessel (arrows), but is faint compared with 3D T1WI. D.MIP image using 3D intermediate-weighted FSE shows multiple lymphatic vessels of lower leg and thigh (arrows), no visible proximal thigh and inguinal lymphatics. FSE = fast spin echo, MIP = maximum intensity projection, T1WI = T1 weighted image
Fig. 5.
A 62-year-old woman underwent surgical intervention 20 years ago due to an endometrial cancer, and had developed lymphedema 18 years ago. A-G. FLASH technique was applied. Each image was acquired at intervals of 8 minutes. (A) to (G)shows lymphatic vessels at right lower leg (arrows). Lymphatics are best delineated at 32 minutes after injection (D) and after that show plateau of visualization of lymphatics.
Fig. 6.
A 60-year-old woman was surgically treated 3 years ago due to a breast cancer, and subsequently developed a lymphedema in the left arm. We used the VIBE-CAIPIRINHA technique. A. The lymphatic vessels are delineated faintly at left forearm and around the elbow (arrows) 10 minutes after injection. B. The lymphatic vessels are delineated more extensively (arrows) 1 hour after injection. CAIPIRINHA = Controlled Aliasing In Parallel Imaging Results In Higher Acceleration, VIBE = volumetric interpolated breath-hold examination
Table 1.
Imaging Techniques of MR Lymphangiography
| VIBE-CAIPIRINHA | FLASH (SPGR) | 3D T1FFE mDixon | |
|---|---|---|---|
| Repetition time (ms) | 7.4 | 3.4 | 4.3 |
| Echo time (ms) | 3.8 | 1.3 | 1.4/2.5 |
| Voxel size (mm3) | 0.8 × 0.8 × 2 | 0.8 × 0.8 × 2 | 1 × 1 × 1 |
| Field of view (mm) | 320 × 320 (upper) | 320 × 320 (upper) | 450 (FH) × 300 (RL) × 200 (AP) |
| 300 × 300 (lower) | 300 × 300 (lower) | ||
| NEX | 300 × 300 (lower) 1 | 300 × 300 (lower) 1 | 1 |
| Imaging time∗ | 6 min 36 sec (upper) | 7 min 24 sec (upper) | 4 min 30 sec (upper) |
| 8 min 23 sec (lower) | 7 min 40 sec (lower) | 8 min 20 sec (lower) |
∗ Upper extremity has been divided into three parts including the axillary area, upper arm, and lower arm, while the lower extremity was divided into four parts including the pelvis, upper thigh, knee, and lower leg.
AP = anterior to posterior, CAIPIRINHA = Controlled Aliasing In Parallel Imaging Results In Higher Acceleration, FH = feet to high, FLASH = fast low angle shot, NEX = number of excitations, RL = right to left, SPGR = spoiled gradient echo, T1FFE = T1 weighted fast field echo, VIBE = volumetric interpolated breath-hold ex-amination
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