Imaging features of 99Tc m-dextran lymphoscitigraphy in thoracic duct exports obstruction / 中华核医学与分子影像杂志

Objective:To compare the 99Tc m-dextran(DX) lymphoscitigraphy and direct lymphography (DLG), in order to investigate the imaging features and clinical significance of 99Tc m-DX lymphoscitigraphy in patients with thoracic duct exports (TDE)obstruction. Methods:A total of 304 patients (140 males, 164 females, median age: 32 years) with TDE obstruction confirmed by thoracic duct exploration between 2017-01-01 and 2019-01-01 in Beijing Shijitan Hospital were retrospectively analyzed. Based on the different imaging characteristics of TDE, the reluts of 99Tc m-DX lymphoscitigraphy were divided into five groups (Ⅰ: no TDE presenting; Ⅱ: TDE presenting temporarily; Ⅲ: TDE presenting constantly or extensively; Ⅳ: abnormal reflux of imaging agents; Ⅴ: bilateral venous angle presenting). Ⅰ/Ⅱ groups were regarded as negative and Ⅲ-Ⅴ groups as positive. The consistency of 99Tc m-DX lymphoscitigraphy with DLG was evaluated with Kappa test, and the positive rates of the two methods were compared by McNemar test. Results:In the detection of TDE, the positive rate of 99Tc m-DX lymphoscintigraphy was 70.1% (213/304), which was significantly lower than that of DLG (97.4%, 296/304; χ2=4.16, P<0.001). The group Ⅲ has the largest number of cases (54.9%, 167/304), and there was a low consistency with DLG ( Kappa=0.08, P=0.005). However, there was a higher consistency between 99Tc m-DX lymphoscintigraphy results and the corresponding DLG results in the groups Ⅳ/Ⅴ ( Kappa values: 0.48, 0.86, both P<0.001). Furthermore, the diagnostic accordance rates of lower extremity lymphedema and chylous effusion were 96.1%(98/102) and 83.6%(127/152), respectively, compared with the clinical diagnosis. Conclusions:TDE obstruction of 99Tc m-DX lymphoscitigraphy presents in the majority with Ⅲ type. 99Tc m-DX lymphoscitigraphy results in patients with type Ⅳ and Ⅴ have a better consistency with those of DLG. 99Tc m-DX lymphoscitigraphy can be used as a screening tool of TDE obstruction, and play a role in the diagnosis of lower limb lymphedema and chylous effusion caused by TDE obstruction.

Percutaneous balloon plasty for thoracic duct obstruction in a patient with chyluria / 中华泌尿外科杂志

Chyluria is characterized by the presence of chyle in the urine. The most common cause of non-parasitic chyluria is the upstream obstruction of the thoracic duct and reflux of the chyle into the renal collecting system. Traditional treatments include dietary modifications and surgery. The recently developed new interventional technique to treat chyluria. Here, we firstly reported one case of chyluria caused by thoracic duct obstruction in China, which was successful treated with intranodal lymphangiography combined by percutaneous balloon plasty. The symptoms of chyluria were completely relieved after our operation, which provides a minimally invasive, safe and effective method for patients with ineffective chyluria after conservative treatment or surgery.

Tratamiento supermicroquirúrgico del linfocele inguinal con linfedema intercurrente: restauración de la fisiología linfática / Supermicrosurgical approach to inguinal lymphocele with lymphedema: restoring the lymphatic physiology

Resumen Introducción: El linfocele es una patología que puede ocurrir por la disrupción linfática durante una cirugía, siendo frecuente luego de una linfadenectomía inguinal. Existen diversos enfrentamientos para prevenirlo o minimizarlo, sin embargo, los resultados son inconsistentes. Caso clínico: Reportamos el caso de una mujer, con linfocele recurrente en zona inguinal derecha y linfedema distal de la extremidad secundario a una biopsia ganglionar, tratado exitosamente mediante supermicrocirugía para restaurar el drenaje linfático. La extremidad inferior tenía un exceso de volumen de 7,03%. Se realizaron estudios preoperatorios con linfografía por resonancia magnética y linfografía con verde de indocianina para identificar los vasos linfáticos y realizar anastomosis linfático-venosas (ALV). Se identificaron tres vasos linfáticos aferentes y se realizó una capsulectomía total. Se realizaron tres ALV término-terminales supermicroquirúrgicas en zona inguinal y una ALV distal en pierna. Durante seguimiento no hubo recidiva del linfocele, evidenciándose una reducción del exceso de volumen de la extremidad afectada de un 105,26%. El linfocele inguinal y linfedema pueden ser tratados exitosamente mediante supermicrocirugía, restaurando el flujo linfático de manera fisiológica, evitando la recurrencia de linfocele y mejorando los síntomas del linfedema.

Introduction: Lymphocele may occur after the disruption of lymphatic channels during a surgical procedure. After inguinal lymphadenectomy are very common, and many different approaches have been tried to prevent or minimize the formation of lymphoceles with inconsistent results. Clinical Case: We report a case of a female patient who presented with right recurrent inguinal lymphocele and lower limb lymphedema after lymph-node biopsy that was successfully treated with lymphatic supermicrosurgery restoring the lymph flow. Lower extremity had an excess volume of 7,03% compared to the healthy contralateral limb. Preoperative study with magnetic resonance lymphangiography and indocyanine green lymphography were done to identify intraoperatively lymphocele afferent and distal lymphatic vessels to perform lymphovenous anastomosis (LVA). Three different afferent lymphatics were identified and total capsulectomy was performed. Three end-to- end supermicrosurgical LVA in the groin and one distal LVA on the leg were performed. The surgery was uneventful, and there were no postoperative complications. In the follow-up, no lymphocele was noticed and lymphedema had visibly reduced with a reduction of excess volume of 105.26%. Inguinal lymphocele and lymphedema can be successfully treated with supermicrosurgery since it is a physiological approach to restore the lymphatic flow, in order to avoid lymphocele recurrence and to improve lymphedema symptoms.

99Tcm-SC SPECT and CT lymphography fusion imaging for detecting axillary sentinel lymph node of VX2 breast cancer rabbit models / 中国医学影像技术

Objective: To explore the value of 99Tcm-sulfur colloid (99Tcm-SC) SPECT and CT lymphography (CT-LG) fusion imaging for detecting axillary sentinel lymph node (SLN) of VX2 breast cancer rabbit models. Methods: Totally 20 purebred female New Zealand white rabbits were used to establish models of VX2 rabbit breast cancer. CT-LG and 99Tcm-SC SPECT and CT-LG fusion imaging examinations were performed, and the outcomes were compared with the Results: of SLN biopsy (SLNB) and axillary lymphadenectomy. Results: The success rate of model establishment was 95.00% (19/20). Nineteen bearing cancer rabbits completed examinations of CT-LG, 99Tcm-SC SPECT and CT-LG fusion imaging, and the percentage of rabbits with both SLN and lymph ducts mapping on CT-LG and the fusion imaging was 78.95% (15/19) and 73.68% (14/19), respectively (P>0.05). There were 16 SLN and 7 non-SLN (n-SLN) on CT-LG, 20 SLN and 12 n-SLN on fusion imaging, while 21 SLN and 17 n-SLN were detected with SLNB. There was no statistical difference among three examination Methods: for detecting axillary SLN (χ2=1.497, P=0.454). Conclusion: Using fusion imaging of 99Tcm-SC SPECT and CT-LG can detect and locate axillary SLN of VX2 breast cancer rabbit models, which could offer a new method for accurate identification and localization of SLN.

Unenhanced MR lymphography and CT after direct lymphangiography for locating lympho-urinary fistula and thoracic duct abnormalities in patients with chyluria / 中国医学影像技术

Objective: To explore the value of unenhanced MR lymphography (MRL) and CT after direct lymphangiography (DLG) in diagnosis of lympho-urinary fistula location and thoracic duct abnormalities in patients with chyluria. Methods: Data of 24 patients with chyluria were reviewed. The position of lympho-urinary fistula and signs related to obstruction of thoracic duct (TD) were analyzed. Dilated renal lymphatics and other retroperitoneal lymphatics, dilatation of TD, multiple tortuous dilated lymphatics around TD were evaluated with MRL, while contrast media reflux of renal lymphatic and urinary system, lymphatics in the outlet area of iliac trunk and thoracic duct were observed with CT after DLG. Results: MRL depicted lympho-urinary fistula in 19 cases (79.17%), including 2 cases in bilateral kidneys, 6 in left and 10 in right kidney, and 1 case in bladder. CT after DLG showed the level of lympho-urinary fistula, including 6 cases in bilateral kidneys, 7 in left and 10 in right kidney, also 1 case in bladder. The consistency between MRL and DLG plus CT was moderate (Kappa=0.601, P<0.001). There was significant difference of unilateral renal level lympho-urinary fistula between MRL and CT after DLG (χ2=22.463, P<0.001),the sensitivity and specificity of MRL was 68.97% and 100%, respectively. No contrast medium distribution at cervical section of TD was found neither with DLG nor CT after DLG, but was observed in one of them with MRL. MRL detected unilateral double renal pelvis and ureter in 2 cases misdiagnosed with CT after DLG. Conclusion: MRL can be used as a noninvasive preliminary examination for lympho-urinary fistula in patients with chyluria, combining with CT after DLG can provide comprehensive assessment of TD and lympho-urinary fistula.

Treatment of cervical chylous fistula under the guidance of lymphangiography / 中华普通外科杂志

Objective To investigate the clinical value of lymphangiography in the diagnosis and treatment of cervical chylous fistula.Methods The clinical data of 7 patients with chylous fistula at Department of Lymph Surgery,Capital Medical University Affiliated Beijing Shijitan Hospital from Jul 2010 to Aug 2015 was retrospectively analyzed.Lymphangiography was performed to investigate the site of fistula and condition of thoracic duct.Results There were 1 male and 6 female patients aging from 22 to 59 years.All patients underwent lymphangiography successfully with dynamic imaging clearly,which accurately showed the location of the leakage and the anatomy of the thoracic duct.There was compensatory branch or trunk drainage in 2 cases which underwent successful conservative treatment,the other 5 cases with leak ＞ 500 ml a day without clear compensatory branch underwent surgical treatment and were cured with no major complications.Conclusion Lymphangiography not only clearly locates the leakage and anatomical relationship of the thoracic duct,but also guides the choice of treatment and precise surgery,avoiding the secondary injury.

Lymphangiographic Interventions to Manage Postoperative Chylothorax / 대한흉부외과학회지

BACKGROUND: Postoperative chylothorax may be caused by iatrogenic injury of the collateral lymphatic ducts after thoracic surgery. Although traditional treatment could be considered in most cases, resolution may be slow. Radiological interventions have recently been developed to manage postoperative chylothorax. This study aimed to compare radiological interventions and conservative management in patients with postoperative chylothorax.METHODS: We retrospectively reviewed periprocedural drainage time, length of hospital stay, and nil per os (NPO) duration in 7 patients who received radiological interventions (intervention group [IG]) and in 9 patients who received conservative management (non-intervention group [NG]).RESULTS: The baseline characteristics of the patients in the IG and NG were comparable; however, the median drainage time and median length of hospital stay after detection of chylothorax were significantly shorter in the IG than in the NG (6 vs. 10 days, p=0.036 and 10 vs. 20 days, p=0.025, respectively). NPO duration after chylothorax detection and total drainage duration were somewhat shorter in the IG than in the NG (5 vs. 7 days and 8 vs. 14 days, respectively).CONCLUSION: This study showed that radiological interventions reduced the duration of drainage and the length of hospital stay, allowing an earlier return to normal life. To overcome several limitations of this study, a prospective, randomized controlled trial with a larger number of patients is recommended.

Linfedema: actualización en el diagnóstico y tratamiento quirúrgico / Lymphedema: update in diagnosis and surgical treatment

El linfedema es la acumulación de fluido rico en proteínas en el intersticio, secundario a anomalías en el sistema de transporte linfático. En países desarrollados se relaciona más frecuentemente al tratamiento quirúrgico del cáncer. El diagnóstico clínico y a través de técnicas de imágenes es fundamental para evaluar el estado funcional del sistema linfático. Los objetivos principales en el manejo del linfedema son limitar la morbilidad del paciente, mejorar la funcionalidad y la calidad de vida. El tratamiento quirúrgico es una alternativa cuando las medidas conservadoras ya no son suficientes. Existen procedimientos que buscan prevenir el desarrollo del linfedema y técnicas que incluye procedimientos fisiológicos (reconstructivos) y resectivos que se utilizan cuando el linfedema ya está establecido. El éxito depende de una buena elección de los pacientes y la realización de un tratamiento individualizado. A continuación se presenta una revisión en cuanto a las últimas estrategias diagnósticas y actualización en las técnicas quirúrgicas con énfasis en el tratamiento microquirúrgico.

Lymphedema is the accumulation of protein-rich fluid in the interstitium, secondary to abnormalities in the lymphatic transport system. In developed countries it is more often related to surgical treatment of cancer. The clinical diagnosis and through imaging techniques is fundamental to evaluate the functional status of the lymphatic system. The main objectives in managing lymphedema are to limit patient morbidity, improve functionality and quality of life. Surgical treatment is an option when conservative measures are no longer sufficient. There are procedures that seek to prevent the development of lymphedema, and techniques that include physiological (reconstructive) and resective procedures that are used when lymphedema is already established. Success depends on a good selection of patients and the completion of an individualized treatment. The following is a review article of the latest diagnostic strategies and update in surgical techniques with emphasis on microsurgical treatment.

Diagnosis of primary lymphedema with indocyanine green lymphography / 中华整形外科杂志

Objective@#To evaluate the diagnostic value of indocyanine green(ICG)lymphography in primary lymphedema of extremities.@*Methods@#61 patients with limb lymphedema were enrolled in the study. The contralateral healthy limbs were used as controls. After intradermal injection of Indocyanine Green, dynamic observation of lymphatic vessels and lymph flow was performed using PDE near-infrared fluorescent instrument. The frequency of lymphatic contraction was calculated.@*Results@#Lymphatic vessel images were clearly visualized in healthy limbs. Inguinal or axillary lymph nodes can be visualized when examined 30 minutes after injection. Lymphatic contraction frequency was 1(0.33-5.00)time per minute. 94.8% lymphedematous limb demonstrated delayed lymphatic vessel or lymph nodes. "Dermal backflow" and diffused shadow pattern can be observed in all affected limbs. Abnormal lymphatic vasculature and contraction can be visualized. The frequency of lymphatic contraction in the affected limb was higher compared to controls: 2.5(0.5-7.0) times per minute.@*Conclusions@#ICG lymphography possess high sensitivity for lymphedema diagnosis. ICG lymphography furthers our understanding of pathophysiological alterations of lymphatic disorders.

The treatment of peripheral lymphedema / 中华整形外科杂志

The treatment of lymphedema has been difficult due to the lack of understanding of the etiology and pathophysiology of the disease, as well as the embryology and physiology of the lymphatic system. The previous surgical treatment mostly has the blindness. Complete decongestion therapy (CDT) is the most popular treatment currently. The ultimate goal of lymphedema is the targeted and individualized treatment. New technology of multimodality lymphatic imaging emerged in the recent years largely improves the diagnosis of lymphatic circulation disorders. The treatment of peripheral lymphedema is expected to have new achievement. The key points that should be noticed in peripheral lymphedema treatment are ① to distinguish between primary and secondary lymphedema as the function and structure of the lymphatic system are substantially different. The lymphatic vessel regeneration and self-repair has not be proved in primary lymphedema. ② lymphatic vessel (possibly lymph node too) undergo a series pathological and degenerative changes in the affected limb. ③ the pathological changes of lymphoedema tissue Including chronic inflammation, tissue fibrosis and fatty deposition, should be included in the treatment target. To decrease the expression and prevent the function of the key inflammatory factor may be a new way for the treat of lymphedema.

The role of lymphography in diagnosis and treatment of chyluria / 中华泌尿外科杂志

Objective To evaluate the use of unilateral pedicle lymphography (PLG) in preoperative localization and treatment of chyluria.Methods From October 2010 to March 2017,25 cases with severe chyluria and undergoing cystoscopy and unilateral PLG before renal pedicle lymphatic disconnection were reviewed.There were 11 males and 14 females,aged 44-71 years,with an average of 58.5 years.The course of the disease was 6 months to 30 years,with an average of 8.3 years.Of them,18 cases had undergone unilateral PLG and spiral CT angiography preoperatively.Surgical treatment was performed according to PLG imaging.Results Unilateral ureteral chyluria was discovered in 16 out of the 19 cases through cystoscopy,with the sensitivity of 84.2％ (16/19).In contrast,unilateral chyluria was only detected in 4 of the other 6 patients with bilateral chyluria.Albiduria were found in the remaining 5 cases in bladder,without ureteral excreted chyle.The sensitivity for chyluria positioning by cystoscopy was 64.5％ (20/31).The location of lesion in 19 patients with unilateral chyuria and 6 patients with bilateral chyluria could be correctly displayed by PLG and the sensitivity was 100％ (31/31).There was no significant difference in location between cystoscopy and PLG in 19 patients with unilateral chyluria (P =0.2482).But in total lesion location,the sensitivity of PLG was higher than cystoscopy(P =0.0026).Eighteen patients who had undergone PLG combined with spiral CT angiography,could not only locate the chylous fistula,but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels.Chyluria had disappeared immediately after unilateral renal pedicle lymphatic exfoliation in 23 patients.However,it still presented in the other 2 patients who were confirmed contralateral pyeloymphatic fistulas by PLG 3 months after surgery and cured by reoperation.Chyluria recurred in 6 cases during follow-up of 6 to 58 months,and 4 were confirmed bilateral pyelolymphatic fistulas by PLG.Two of these 4 cases were cured by laparoscopic surgery or open surgery,respectively.The other 2 patients were cured by conservative treatment.Moreover,2 patients with unilateral chyluria recurred in situ after the first laparoscopic surgery,which was confirmed by PLG.Notably,all these patients were cured by ESWL finally.Conclusions This study suggested that PLG displays remarkable advantage in terms of localization sensitivity.PLG combined with spiral CT angiography preoperatively can not only locate the chylous fistula,but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels.Depending on PLG and spiral CT angiography,renal pedicle lymphatic disconnection can effectively protect renal vessel.In addition,it can avoid the omission of ligation for perivascular lymphatic vessels.Furthermore,PLG plays a key role in temporarily obstructing the leakage of pyelolymphatic fistulas to some extent.

MR lymphography in detecting internal mammary sentinel lymph node for rabbit models of VX2 breast cancer / 中国医学影像技术

Objective To explore the feasibility of MR lymphography (MR-LG) in detecting internal mammary sentinel lymph node (SLN) for rabbit models of VX2 breast cancer.Methods Totally 75 New Zealand white rabbits were randomly divided into 2 groups to establish VX2 breast cancer (tumor group) and inflammation models (inflammation group),respectively.MR-LG examinations and lymph node dissection were performed in all the rabbits.The results of internal mammary SLN and lymphatic vessels mapping were recorded,and the influence factors were analyzed.Results The success rate of model establishment was 97.33％ (73/75).The detection rate of internal mammary SLN and lymphatic vessels was 15.94％ (11/69) and 75.36％ (52/69),respectively,there was no statistical difference between the two groups (both P＞0.05).The rabbit's weight,time of tumor growth,tumor size,number,size and status of axillary SLN,as well as presence or not of internal mammary lymph vessels detection showed no statistical difference between detection and non-detection of internal mammary SLN (all P＞0.05),while the tumor size and axillary lymph node number showed statistically significant differences between detection and not detection of internal lymphatic vessels (both P＜0.05).The accuracy,sensitivity,specificity,false negative and false positive rate of internal mammary SLN detection with MR-LG was 76.81％ (53/69),39.13％(9/23),95.65％(44/46),60.86％(14/23) and 4.35％(2/46),respectively.Conclusion MR-LG can effectively detect internal mammary SLN and lymphatic vessels for rabbit models of VX2 breast cancer.

Lymphatic vessel mapping in the upper extremities of a healthy Korean population

BACKGROUND: Intraoperative indocyanine green (ICG) lymphography can effectively detect functioning lymph vessels in edematous limbs. However, it is sometimes difficult to clearly identify their course in later-stage edematous limbs. For this reason, many surgeons rely on experience when they decide where to make the skin incision to locate the lymphatic vessels. The purpose of this study was to elucidate lymphatic vessel flow patterns in healthy upper extremities in a Korean population and to use these findings as a reference for lymphedema treatment. METHODS: ICG fluorescence lymphography was performed by injecting 1 mL of ICG into the second web space of the hand. After 4 hours, fluorescence images of lymphatic vessels were obtained with a near-infrared camera, and the lymphatic vessels were marked. Three landmarks were designated: the radial styloid process, the mid-portion of the cubital fossa, and the lower border of the deltopectoral groove. A straight line connecting the points was drawn, and the distance between the connected lines and the marked lymphatic vessels was measured at 8 points. RESULTS: There were 30 healthy upper extremities (15 right and 15 left). The average course of the main lymph vessels passed 26.0±11.6 mm dorsal to the styloid process, 5.7±40.7 mm medial to the mid-cubital fossa, and 31.3±26.1 mm medial to the three-quarters point of the upper landmark line. CONCLUSIONS: The main functioning lymphatic vessel follows the course of the cephalic vein at the forearm level, crosses the mid-cubital point, and travels medially toward the mid-axilla.

A Case of Cutaneous Lymphatic Rupture on Calf Secondary to Punch Biopsy / 대한피부과학회지

No abstract available.

Comparative analysis of paravertebral lymphatic trunk by MR lymphangiography between intradermal and subcutaneous injection of Gadodiamide in rabbits / 中国医学影像技术

Objective To investigate intradermal injection and subcutaneous injection of Gadodiamide MR lymphangiography (MRL) in evaluation on the central conducting lymphatics in rabbits.Methods T1 weighted three-dimendional fast low angle shot (fl3d) sequence was used before and after administration of Gadodiamide to undertake MRL.Gadodiamide was administed intrademally in the left and right footpad in 8 rabbits,and then undertake MRL in 1.5T MRI system (intradermal injection group).Three days later,Gadodiamide was administered subcutaneously in the left and right footpad in 8 rabbits,and MRL were underdone with the same sequence (subcutaneous injection group).The degree of contrast enhancement within the lumbar lymphatic trunk and thoracic duct were evaluated using a 3-point scoring system.Results Intradermal injection group showed the popliteal lymph nodes,sacral lymph node and inferior aortic lymph node enhanced obviously in all 8 rabbits,and the enhancement duration time was about 30 90 mini the lumbar lymphatic trunk and cisterna chyli were detected in 6 rabbits,and part of the thoracic duct were detected in 5 rabbits.Subcutaneous injection group showed the popliteal lymph nodes enhanced obviously in all 8 rabbits,but the lumbar lymphatic trunk and the thoracic duct were not detected.The score of contrast enhancement within the lymphatic system of intradermal injection group and subcutaneous injection group had statistical difference (t=100.00,P=0.0002).Conclusion MRL with intradermal injection Gadodiamide are better than subcutaneous injection in evaluation of the lumbar lymphatic trunk.

Preliminary study of magnetic resonance lymphography to identify the sentinel lymph node of breast cancer / 实用放射学杂志

Objective To evaluate the value of interstitial magnetic resonance lymphography (MRL) to identify the sentinel lymph node (SLN) of breast cancer.Methods Totally 58 patients with invasive breast cancer were consecutive collected.15 mL of Gd-DTPA and 2 mL of mepivacain hydrochloride 2% were mixed and 0.5 mL of them was injected into the outside of the subareolar breast tissue.MRI was performed with Siemens 3.0 T Magnetom Trio MRI instrument using volumetric interpolated breath-hold examination sequence.Axillary lymph flow was tracked on maximum intensity projection (MIP) and sentinel lymph nodes were identified by interstitial MRL as M-SLN.All M-SLN were marked by a method of surface capsule localization.During surgery, methylene blue was used as tracer and SLNs stained by it were detected and excised by following the blue lymphatic vessels,these were designated as D-SLN.The numbers of SLNs detected by interstitial MRL and stained by methylene blue during operation were compared by paired samples rank-sum test and the correlation was analyzed by Spearman rank correlation test.Assessing the sensitivity, specificity and accuracy of interstitial MRL for diagnosing M-SLN.Results A total of 75 M-SLNs (average 1.60 ± 0.52) were identified by interstitial MRL.During operation, all M-SLNs were easily resected under the guidance of skin marker.91 D-SLNs (average 1.94±0.63) were stained by methylene blue, which was significant more than those of the M-SLNs.There was a strong correlation (Spearman's rank correlation coefficient 0.69,P<0.001) between the SLNs identified by these two methods.Interstitial MRL in diagnosing D-SLN metastasis of breast cancer had a sensitivity of 95.8%,specificity of 88.9%,and accuracy of 93.3%.Conclusion Interstitial MRL can accurately identify the axillary sentinel lymph node and guide the biopsy.It may have great clinical value in the future.

Experimental study on CT lymphography in evaluating axillary sentinel lymph nodes of rabbit's breast cancer using 3D and curved planar reformation / 实用放射学杂志

Objective To study the value of CT lymphography (CT-LG) in evaluating axillary sentinel lymph nodes (SLN) of rabbit with breast cancer using 3D and curved planar reformation (CPR).Methods CT-LG examinations were completed on the VX2 rabbit models bearing breast cancer established by tumor tissue mass suspension injection.All raw data were transferred to a postprocessing workstation, then the 3D and CPR were used to show lymphatic vessel and lymph nodes.On the CT-LG images, one or several lymph nodes displayed firstly in the lymphatic drainage pathway was defined as the SLN which was then confirmed by the biopsy.Results (1) 20 rabbits bearing tumor underwnet CT-LG examinations, and both SLNs and draining lymphatic vessels were detected using 3D and CPR techniques.70% (14/20) of experimental rabbits had fine images, and 16 SLNs and 7 non-SLNs were demonstrated on 14 rabbits on CT-LG images with good quality.(2) 8 continuous lymphatic vessels displayed well, exhibiting a homogeneous and continuous tube with uniform contrast-medium filling on CPR images.Most lymphatic vessels demonstrated well, and the 14 vessels with local interrupt or fuzzy on 3D images showed continuous tubular contrast-filling with heterogeneous high-density on the CPR images from the injection sites to axillary SLN.Among 6 rabbits with poor images, 3 rabbits showed the SLN but without lymphatic vessels on 3D images, 2 showed only initial segment of lymphatic vessel,and 1 had no lymphatic vessel and SLN.(3) A total 24 SLNs were obtained by SLNB,including 18 metastatic SLNs and 6 negative ones.On CT-LG images, there were statistical differences between the metastatic and negative SLNs in the maximum diameter and filling defect (P=0.041 and P=0.001, respectively).However, the short diameter, shape and margin of SLNs had no statistical differences between the two groups (all P>0.05).Conclusion On CT-LG examinations, 3D and CPR images may show axillary SLNs and lymphatic vessels effectively,and CPR can demonstrate more details than 3D.The maximum diameter and fillingdefect of SLN are helpful for distinguishing metastatic and negative SLNs.

Value of CT lymphangiography combined with direct lymphangiography in diagnosing primary intestinal lymphangiectasia / 中华放射学杂志

Objective To investigate the clinical value of CT lymphangiography (CTL) combined with direct lymphangiography (DLG) in primary intestinal lymphangiectasia (PIL). Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings (12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions), abdominal lymph nodes (6 cases), lymphangiectasia and abnormal distributions (14 cases), fistulas (lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases), lymphangiomatosis (3 cases), and thoracic duct outlet dysfunction and reflux (14 cases).The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.

Risk factor analysis for massive lymphatic ascites after laparoscopic retroperitonal lymphadenectomy in gynecologic cancers and treatment using intranodal lymphangiography with glue embolization / 부인종양

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.