Magnetic resonance lymphangiography: Establishing normal

Mike Mills; Greta Brezgyte; Bernard Ho; Julian Pearce; Kristiana Gordon; Peter S Mortimer; Pia Ostergaard; Franklyn A Howe

doi:10.1016/j.jvsv.2024.101870

Magnetic resonance lymphangiography: Establishing normal

J Vasc Surg Venous Lymphat Disord. 2024 Mar 20:101870. doi: 10.1016/j.jvsv.2024.101870. Online ahead of print.

Authors

Mike Mills¹, Greta Brezgyte², Bernard Ho³, Julian Pearce³, Kristiana Gordon⁴, Peter S Mortimer⁴, Pia Ostergaard², Franklyn A Howe⁵

Affiliations

¹ Neurosciencs and Cell Biology Research Institute, St. George's University of London, London, UK. Electronic address: mmills@sgul.ac.uk.
² Cardiovascular and Genomics Research Institute, St. George's University of London, London, UK.
³ Dermatology and Lymphovascular Medicine, St. George's University Hospitals NHS Foundation Trust, London, UK.
⁴ Cardiovascular and Genomics Research Institute, St. George's University of London, London, UK; Dermatology and Lymphovascular Medicine, St. George's University Hospitals NHS Foundation Trust, London, UK.
⁵ Neurosciencs and Cell Biology Research Institute, St. George's University of London, London, UK.

PMID: 38513796
DOI: 10.1016/j.jvsv.2024.101870

Abstract

Background: Despite an increased interest in visualizing the lymphatic vessels with magnetic resonance lymphangiography (MRL), little literature is available describing their appearance in nonlymphedematous individuals. To determine lymphatic abnormalities, an understanding of how healthy lymphatic vessels appear and behave needs to be established. Therefore, in this study, MRL of individuals without a history of lymphatic disease was performed.

Methods: A total of 25 individuals (15 women) underwent MRL of their lower limbs using a 3.0 T Philips magnetic resonance imaging scanner (Philips Medical Systems). The first nine participants were recruited to establish the concentration of gadolinium-based contrast agent (GBCA) to administer, with the remainder imaged before and after interdigital forefoot GBCA injections at the optimized dose. Outcomes, including lymphatic vessel diameter, tortuosity, and frequency of drainage via particular drainage routes, were recorded.

Results: Healthy lymphatic vessels following the anteromedial pathway were routinely observed in post-contrast T1-weighted images (average tortuosity, 1.09 ± 0.03), with an average of 2.16 ± 0.93 lymphatic vessels with a diameter of 2.47 ± 0.50 mm crossing the anterior ankle. In six limbs, vessels following the anterolateral pathways were observed. No vessels traversing the posterior of the legs were seen. In a subset of 10 vessels, the lymphatic signal, measured at the ankle, peaked 29 minutes, 50 seconds ± 9 minutes, 29 seconds after GBCA administration. No lymphatic vessels were observed in T2-weighted images.

Conclusions: Contrast-enhanced MRL reliably depicts the lymphatic vessels in the legs of healthy controls. Following interdigital contrast injection, anteromedial drainage appears dominant. Quantitative measures related to lymphatic vessel size, tortuosity, and drainage rate are readily obtainable and could be beneficial for detecting even subtle lymphatic impairment.

Keywords: Lower extremity; Lymphatic vessels; Lymphography; Magnetic resonance imaging.