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

ABSTRACT

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.