Purpose or Case Report: To report on our initial experience with the use of mesenteric dynamic contrast MR lymphangiography (DCMRL) for evaluation of the lymphatics in patients with concern for mesenteric lymphatic flow disorders and compare these findings to intranodal (IN) DCMRL and intrahepatic (IH) DCMRL.
Methods & Materials: A retrospective review of the imaging and clinical findings in children undergoing mesenteric DCMRL was performed. The technique involves injection of a gadolinium contrast agent into the mesenteric lymphatic ducts followed by dynamic time-resolved imaging of the abdomen and chest. Comparison was made to IN-DCMRL and IH-DCMRL which was performed concurrently. Imaging was reviewed by two readers in consensus for lymphatic perfusion of the duodenum and leaks into the duodenal lumen and peritoneum on mesenteric DCMRL, IN-DCMRL, and IH-DCMRL. Visualization of the thoracic duct (TD) was also evaluated.
Results: 15 consecutive patients (10 male, mean age 6.9 years, range 2 months-17 years) with mesenteric DCMRL who presented for evaluation of either protein losing enteropathy (PLE) and/or ascites were evaluated. Mesenteric DCMRL was technically successful in 14/15 patients (93%). The TD was not visualized in 4 patients, 3 of which did not have a patent TD. All patients had also IN-DCMRL and IH-DCMRL. There was no difference in TD visualization between the modalities (p=0.711). When comparing IN-DCMRL to IM-DCMRL, there was improved visualization of peritoneal leaks (p=0.003), duodenal perfusion (p=0.003), duodenal leak (p=0.014). There was no statistical difference on these findings when comparing mesenteric DCMRL to IH-DCRML. Mesenteric DCMRL demonstrated a peritoneal leak in 7 patients whereas IH-DCMRL demonstrated leak in 3 patients. Duodenal intraluminal leaks were seen by IH-DCMRL in 9 patients versus 5 with IM-DCMRL. No peritoneal or duodenal intraluminal leaks were seen with IN-DCMRL. In one patient with congenital PLE the three modalities showed different disconnected flow patterns with duodenal leak only seen by mesenteric DCMRL. There were no short-term complications from the procedures.
Conclusions: Mesenteric DCMRL is feasible and potentially safe. Mesenteric DCMRL might be the imaging modality of choice for patients with mesenteric flow abnormalities such as certain forms of ascites and PLE. Further studies should be conducted to determine when and how to utilize this new lymphatic imaging modality.