Changes in the Lymphatic System on the MR Lymphangiography (MRL) In Patients with Liver Cirrhosis

Our group routinely uses MR Lymphangiography (MRL) in a clinical setting to image the lymphatic system in patients with plastic bronchitis, chylothorax and lymphangiomatosis ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1148/rg.2017170014", "ISSN" : "0271-5333", "PMID" : "29019760", "abstract" : "The lymphatic system, an important component of the circulatory system with essential physiologic functions, can be affected by various disease processes. There has been a delay in the development of effective imaging methods for the lymphatic system due to its small size, which limits visualization as well as introduction of contrast material. Traditionally, the lymphatic system has been imaged by injecting contrast material or radiotracers into the feet or hands. This is not sufficient for assessment of the central conducting lymphatics (CCLs) (such as the thoracic duct or the cisterna chyli). Fluoroscopic intranodal lymphangiography with injection of oil-based contrast material into groin lymph nodes improves visualization of CCLs but is limited in practice owing to the use of radiation and the potential risk for paradoxical embolization in children with left-to-right shunt. Dynamic contrast material-enhanced (DCE) magnetic resonance (MR) lymphangiography, which is performed by injecting gadolinium-based contrast material into groin lymph nodes, overcomes these limitations. T2-weighted imaging plays a complementary role to DCE MR lymphangiography in the assessment of CCLs. DCE MR lymphangiography demonstrates preserved integrity or any abnormality of the CCLs (including blockage or leak). The technique has recently been used in evaluating pulmonary lymphatic perfusion syndrome in children with plastic bronchitis, neonatal lymphatic flow disorders, and nontraumatic chylothorax. It is useful in identification of the source of chylous ascites and contributes to understanding of the anatomy of lymphatic malformations. It is successfully used for planning of embolization of aberrant lymphatic channels in a variety of lymphatic flow disorders. This review discusses the anatomy and function of the lymphatic system, the evolution of imaging of the lymphatic system, and DCE MR lymphangiography technique and its applications in children. \u00a9RSNA, 2017.", "author" : [ { "dropping-particle" : "", "family" : "Chavhan", "given" : "Govind B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Amaral", "given" : "Joao G.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Temple", "given" : "Michael", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Itkin", "given" : "Maxim", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "RadioGraphics", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2017" ] ] }, "page" : "1775-1790", "title" : "MR Lymphangiography in Children: Technique and Potential Applications", "type" : "article-journal", "volume" : "37" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=8fe51700-de03-44ba-a878-30fa7f534123" ] } ], "mendeley" : { "formattedCitation" : "(13)", "plainTextFormattedCitation" : "(13)", "previouslyFormattedCitation" : "(13)" }, "properties" : {  }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }(13). This new technique allowed imaging and physiological evaluation of the central lymphatic system that includes cisterna chyli and the thoracic duct.  MRL not only allowed for understanding of the pathophysiology of these disorders, but also provided an excellent tool in planning of the interventional procedure.

 

The goal of this study is to compare the changes in the central lymphatic system in liver cirrhosis patients with and without the ascites.

 

We believe that the application of MRL in patient with liver cirrhosis will be an effective means to assess flow velocity and volume in the thoracic duct. It can further provide valuable insight into the pathophysiology of changes in the lymphatic flow in the central lymphatic system in patient with liver cirrhosis and ascites. We hope that our study will shed light on pathophysiology of the ascites in liver cirrhosis.