Purpose or Case Report: Evolution of MR Lymphangiography has expedited diagnosis and advanced potential implications for treatment in lymphatic disorders. In particular, evaluation of the central conducting lymphatic channels with dynamic contrast enhanced MR provides better spatial resolution, while sparing ionizing radiation inherent in lymphangio-scintigraphy and catheter lymphangiography.

We will review indications, technique with pearls and pitfalls, and overall success rates after MR lymphangiography at our institution. To discuss post-imaging clinical outcomes and implications for treatment. To illustrate imaging findings of various lymphatic pathology diagnosed on MR.
Methods & Materials: Institutional IRB approval was obtained for the retrospective review and analysis of pediatric patients evaluated with MRI lymphangiography since 2015 with varied indications. mPower (Nuance) search engine was used to identify patients using key words; all patients who underwent MRI lymphangiography were included.
Results: We identified 32 patients (17 male, 15 female) with median age at 5yrs. The most common indications for imaging included chylothorax (14/32), plastic bronchitis (7/32), and intestinal lymphangiectasia (4/32). Other interesting indications included a single case of chyluria, chylous pericardial effusion, and recurrent abdominal lymphatic malformation with subsequent confirmation on imaging. Overall success rate was 94% (30/32) and the most common findings included lymphatic leak (11/32), central conductive lymphatic anomaly (6/32), intestinal lymphangiectasia (4/32), and generalized lymphatic anomaly (2/32). Normal lymphatic channels were demonstrated in less than one third of cases (9/32). Post-imaging findings were proceeded by medical management in more than half of cases (19/32), however minimally invasive treatment with embolization by interventional radiology occurred in almost one third of cases (9/32) and surgical ligation in less than 13% of cases (4/32).
Conclusions: Dynamic contrast enhanced MR lymphangiography is a valuable advanced imaging modality in diagnosing lymphatic disorders with high success rates within our pediatric network. It requires a team based approach with collaboration amongst diagnostic radiology, IR colleagues for intranodal access and injection, anesthesia assistance, and MR technologists for implementing protocols. Future directions including advancements in lower extremity MR lymphangiography have exciting potential in diagnosing etiologies of lower extremity lymphedema.