Purpose or Case Report: The purpose of this submission is to educate technologists in performing magnetic resonance (MR) lymphangiography in conjunction with intranodal gadolium contrast injection in the pediatric patient. MR lymphangiography is a new procedure in the pediatric population. The lymphatic system plays the important role of transporting fluid from tissue back into the venous system via lymphovenous connections. Despite this key role, there has been a poor understanding of lymphatic flow physiology. The recent development of dynamic contrast intranodal MR lymphangiography, which provides quick and reliable access to the central lymphatic system, has provided insight into understanding the pathophysiology of several lymphatic flow disorders and provides guidance for interventional procedures. It also makes it possible to see central lymphatic anatomy with high spatial and temporal resolution. This allows clinicians to map the anatomy of the lymphatic system to determine the location of lymphatic leaks. MR lymphangiography may reduce the need for conventional IR lymphangiogram and spare patient’s radiation exposure.
Methods & Materials: Multiplanar multisequence MR is performed with and without the administration of intranodal gadolinium. Precontrast sequences include coronal T2 “Sampling Perfection with Application Optimized Contrasts using Different Flip Angle Evolution” (SPACE), axial coronal and sagittal with “True Fast Imaging with Steady State Free Precession” (TRUFI) and precontrast coronal T1 “Volumetric Interpolated Breathhold Examination” (VIBE). Subsequently, under ultrasound guidance, 22-gauge spinal needles are inserted into bilateral inguinal lymph nodes and gadolinium followed by saline is injected into the lymph nodes timed over a duration of 15 minutes. TWIST sequences are acquired as well as delayed postcontrast sequences.
Results: MR lymphangiography was performed in several patients who received conventional IR lymphangiogram contemporaneously. Qualitative evaluation of these cases indicates that MR lymphangiography may be diagnostically adequate for evaluation of lymphatic disorders.
Conclusions: MR lymphangiography requires complex coordination between anesthesia, interventional radiology (IR) and the MR divisions. Despite these challenges, our recently developed MR lymphangiography protocol has been successfully performed in several patients and early validation looks promising.