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High-Resolution MR Lymphangiography in Patients with Primary and Secondary Lymphedema

Christian Lohrmann1, Etelka Foeldi2, Oliver Speck1 and Mathias Langer1

1 Department of Radiology, Division of Diagnostic Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany.
2 Foeldi Clinic for Lymphology, Hinterzarten, Germany.


Figure 1
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  		Fig. 1A —Four cases of lymphedema: two primary and two secondary. 33-year-old man with primary lymphedema. Frontal 3D spoiled gradient-echo high-resolution MR lymphangiography image, obtained 45 minutes after gadodiamide injection, clearly delineates slightly enlarged lymphatic vessels in right lower leg (arrows). Note concomitantly enhanced vein (arrowheads) that shows lower signal intensity.

 

Figure 2
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  		Fig. 1B —Four cases of lymphedema: two primary and two secondary. 46-year-old man with primary lymphedema. Bilateral frontal 3D spoiled gradient-echo high-resolution MR lymphangiography sequence, obtained 45 minutes after gadodiamide injection, clearly delineates several slightly enlarged lymphatic vessels in both lower legs. Note concomitantly enhanced veins (arrowheads), which show lower signal intensity.

 

Figure 3
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  		Fig. 1C —Four cases of lymphedema: two primary and two secondary. 43-year-old woman with history of cervical cancer and secondary lymphedema related to pelvic and inguinal lymph node extirpation. Frontal 3D spoiled gradient-echo high-resolution MR lymphangiography image of left lower leg, obtained 35 minutes after gadodiamide injection, reveals delayed lymphatic flow with reticular pattern of dilated lymphatic vessels indicating neovascularization related to obstruction. Furthermore, dermal backflow (arrowhead) is detected. Note concomitantly enhanced vein (arrow), which shows lower signal intensity.

 

Figure 4
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  		Fig. 1D —Four cases of lymphedema: two primary and two secondary. 79-year-old woman with history of malignant melanoma and secondary lymphedema related to inguinal lymph node extirpation and radiation. Frontal 3D spoiled gradient-echo high-resolution MR lymphangiography sequence, obtained 35 minutes after gadodiamide injection, reveals delayed lymphatic flow with extensive reticular pattern of dilated lymphatic vessels, indicating neovascularization related to obstruction.

 

Figure 5
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  		Fig. 2 —20-year-old woman with primary lymphedema. Angled 3D spoiled gradient-echo high-resolution MR lymphangiography image, obtained 55 minutes after gadodiamide injection, clearly delineates multiple large and tortuous lymphatic vessels in left upper leg.

 

Figure 6
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  		Fig. 3 —20-year-old woman with primary lymphedema (not same patient as in Fig. 2). Angled 3D spoiled gradient-echo high-resolution MR lymphangiography sequence, obtained 55 minutes after contrast material injection, clearly delineates dilated lymphatic external iliac pathway (arrowhead), originating from inguinal lymph nodes, indicating obstruction. Furthermore, dermal backflow (arrows) is detected. Note enhancement of bladder (asterisk), showing venous uptake and renal clearance of contrast medium after intracutaneous injection.

 

Figure 7
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  		Fig. 4A —Primary lymphedema. Graph shows typical time course of signal enhancement in lymphatic and venous vessels of lower leg.

 

Figure 8
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  		Fig. 4B —Primary lymphedema. MR lymphangiography images show signal enhancement in lymphatic vessels (B) and veins (C) of 49-year-old woman with primary lymphedema.

 

Figure 9
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  		Fig. 4C —Primary lymphedema. MR lymphangiography images show signal enhancement in lymphatic vessels (B) and veins (C) of 49-year-old woman with primary lymphedema.

 

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