Dynamic contrast-enhanced magnetic resonance lymphangiography in pediatric patients with central lymphatic system disorders.
Veronica BordonaroPaolo CiancarellaPaolo CilibertiDavide CurioneCarmela NapolitanoTeresa Pia SantangeloGian Luigi NataliMassimo RolloPaolo GuccioneLuciano PasquiniAurelio SecinaroPublished in: La Radiologia medica (2021)
Central conducting lymphatics (CCLs) disorders represent a broad spectrum of clinical entities ranging from self-limiting traumatic leaks treated by conservative strategies, to complex lymphatic circulation abnormalities that are progressive and unresponsive to currently available treatments. Dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) performed by intranodal injection of gadolinium-based contrast material is a recently developed technique which allows a minimally invasive evaluation of the CCL abnormalities providing a dynamic assessment of lymph flow and its pathways. In our institution, DCMRL is performed after bilateral cannulation of inguinal lymph nodes, using a MR protocol which includes volumetric 3D T2-SPACE (sampling perfection with application-optimized contrasts using different flip-angle evolution) and free-breathing respiratory navigated sequence and TWIST (time-resolved angiography with Interleaved stochastic trajectories) MR angiography sequence, during intranodal injection of paramagnetic contrast medium. Although DCMRL applications in clinical practice are still improving, a minimally invasive assessment of lymphatic pathways is particularly important both in pediatric patients with primitive lymphatic system disorders and in children with complex congenital heart disease associated with CCL impairment.
Keyphrases
- magnetic resonance
- lymph node
- contrast enhanced
- minimally invasive
- congenital heart disease
- computed tomography
- optical coherence tomography
- clinical practice
- ultrasound guided
- neoadjuvant chemotherapy
- magnetic resonance imaging
- sentinel lymph node
- randomized controlled trial
- multiple sclerosis
- liver fibrosis
- liver injury
- depressive symptoms
- epithelial mesenchymal transition
- young adults
- robot assisted
- early stage
- signaling pathway
- rectal cancer