Purpose or Case Report: The recent advances of the lymphatic intervention, has prompted progress in imaging of the lymphatic system. We would describe the clinical usefulness of the dynamic contrast-enhanced (DCE) magnetic resonance (MR) lymphangiography for imaging of the lymphatic system in pediatric patients.
Methods & Materials: A retrospectively evaluation of experience with DCE MR lymphangiography in four patients (Mean age 11.3 ± 5.5 years) was performed. The access needle was placed in the central part of both inguinal lymph nodes (LNs) under ultrasound guidance. CT contrast agent was injected into the LNs to confirm proper access under fluoroscopic guidance. After moving patients into the MR imaging room, MR contrast material was injected into the inguinal LNs for DCE MR imaging by using T1-weighted 3D gradient sequence with VIBE in the coronal plane that can be acquired in 15-30 seconds was repeated every other minute to study lymphatic transit into the cisterna chyli and thoracic duct and ultimately into the confluence of the left internal jugular vein and subclavian vein.
Results: Three patients were suspected to have protein-losing enteropathy. Two of these patients had a history of Fontan operation and liver transplantation, and one patient had no underlying disease. Another one patient was suspected to have chylothorax with unknown cause. The DCE MR lymphangiographic findings confirmed the presence of relatively normal thoracic duct in one patient, and abnormal thoracic duct dilatation in three patients. We could identify the retroperitoneal lymph system through DCE MR, though it did not provide evidence of the direct lymphatic leak to the retroperitoneal space associated with the symptoms in all patients. However, DCE MR showed an abnormal lymphatic leakage draining into the pleural space in one patient having chylothorax. The DCE MR lymphangiographic finding led to a help in management in all patients, continuation of conservative treatment in two patients, and intervention treatment in two patients. Image quality for visualizing the lymphatic system was considered good by both radiologists in all cases. There were no known adverse effects related to the DCE MR lymphangiography.
Conclusions: DCE MR lymphangiography is a recently developed technology, and its clinical application is feasible in pediatric patients. The application of DCE MR lymphangiography would significantly increase in pediatric patients as the lymph-based understanding of many diseases increases.