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MR Lymphography of Abdominal and Retroperitoneal Lymphatic Vessels

¹ All authors: Department of Radiology, Hôpital St.-Antoine, 184 rue du Faubourg Saint-Antoine, Paris 75012, France.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —50-year-old woman who underwent MRI for cholestasis. Coronal maximum-intensity-projection image shows prominent lumbar trunks (arrows) on both right and left paravertebral areas. Abdominal confluence of lymphatic vessels is shown as complex plexus with no saccular formation.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —25-year-old man who underwent MRI for back pain. Axial CT image obtained after IV contrast injectionshows nonenhancing hypodense rounded structure (arrows).

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —25-year-old man who underwent MRI for back pain. Coronal maximum-intensity-projection image shows giant cisterna chyli at confluence of left and right markedly dilated retroperitoneal trunks (arrows).

View larger version (109K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Axial single-shot turbo spin-echo (HASTE) sequence in 63-year-old man who underwent MRI for cholestasis. At lower level, several intestinal trunks (arrows) are seen.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Axial single-shot turbo spin-echo (HASTE) sequence in 63-year-old man who underwent MRI for cholestasis. At intermediate levels, intestinal trunks converge to form right and left intestinal trunks (arrows).

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Axial single-shot turbo spin-echo (HASTE) sequence in 63-year-old man who underwent MRI for cholestasis. At upper level, mesenteric trunk is shown coursing from mesentery to retroperitoneal space (arrow).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —58-year-old woman who underwent MRI for cholangitis. Axial single-shot turbo spin-echo (HASTE) sequence after 8 hours of fasting shows small intestinal (arrow) and retrocrural (arrowhead) lymphatic trunks.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —58-year-old woman who underwent MRI for cholangitis. After regular meal, marked dilatation of both intestinal (arrows) and retrocrural (arrowhead) lymphatic trunks is seen.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —58-year-old woman who underwent MRI for cholangitis. Coronal thin-section source images of 3D sequence show marked dilatation of lymphatic trunks after regular meal (D) and with fasting (C).

View larger version (98K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —58-year-old woman who underwent MRI for cholangitis. Coronal thin-section source images of 3D sequence show marked dilatation of lymphatic trunks after regular meal (D) and with fasting (C).

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —58-year-old woman who underwent MRI for cholangitis. Coronal maximum-intensity-projection image shows confluence of dilated lymphatic trunks.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —19-year-old man who underwent MRI for follow-up of biliary–enteric anastomosis. Coronal maximum-intensity-projection image shows abdominal confluence of lymphatic vessels as bilateral right and left saccular dilatations (arrows) that continue in cephalic direction as thoracic duct (arrowheads).

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —54-year-old woman who underwent MRI for cholestasis. Axial single-shot turbo spin-echo (HASTE) T2-weighted image shows cisterna chyli as uniformly high-signal-intensity saccular collection (arrows) in prevertebral location.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —54-year-old woman who underwent MRI for cholestasis. Coronal maximum-intensity-projection image shows cisterna chyli (arrows) clearly.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —54-year-old woman who underwent MRI for cholestasis. Axial MR images obtained at arterial (C) and delayed (D) phases show contrast enhancement of cisterna chyli (arrows) at delayed phase after gadolinium injection.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —54-year-old woman who underwent MRI for cholestasis. Axial MR images obtained at arterial (C) and delayed (D) phases show contrast enhancement of cisterna chyli (arrows) at delayed phase after gadolinium injection.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —57-year-old man who underwent MRI for cirrhosis. Coronal true fast imaging with steady-state free precession image shows origin of thoracic duct at cisterna chyli (arrow).

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —57-year-old man who underwent MRI for cirrhosis. Tortuous course of thoracic duct at right side of aorta (arrows) is well shown.

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —57-year-old man who underwent MRI for cirrhosis. Tortuous course of thoracic duct at right side of aorta (arrows) is well shown.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —25-year-old man who underwent MRI for pancreatitis. Coronal maximum-intensity-projection image shows right and left proximal thoracic trunks (arrows) that join to form distal thoracic duct (arrowhead).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9A —61-year-old man who underwent MRI after surgery for gastric cancer. Axial contrast-enhanced CT scan shows nonenhancing round structure (arrows) with low attenuation.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9B —61-year-old man who underwent MRI after surgery for gastric cancer. Axial single-shot turbo spin-echo (HASTE) (B) and coronal maximum-intensity-projection (C) images show marked dilatation of cisterna chyli after surgical ligation of thoracic duct.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9C —61-year-old man who underwent MRI after surgery for gastric cancer. Axial single-shot turbo spin-echo (HASTE) (B) and coronal maximum-intensity-projection (C) images show marked dilatation of cisterna chyli after surgical ligation of thoracic duct.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —41-year-old man with intestinal lymphangiectasis and history of chylous ascites. Axial single-shot turbo spin-echo (HASTE) images show dilatation (arrows) of both right (A) and left (B) intestinal lymphatic vessels.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —41-year-old man with intestinal lymphangiectasis and history of chylous ascites. Axial single-shot turbo spin-echo (HASTE) images show dilatation (arrows) of both right (A) and left (B) intestinal lymphatic vessels.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10C —41-year-old man with intestinal lymphangiectasis and history of chylous ascites. At upper level, marked dilatation of main intestinal trunk is shown during its course from mesentery to retrocrural space.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10D —41-year-old man with intestinal lymphangiectasis and history of chylous ascites. Coronal maximum-intensity-projection image clearly shows marked dilatation of lymphatic trunks.

View larger version (143K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —37-year-old woman with lymphangioleiomyomatosis. Axial contrast-enhanced CT scan shows several round hypodense structures (arrows) around iliac vessels.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —37-year-old woman with lymphangioleiomyomatosis. Coronal true fast imaging with steady-state free precession (B) and coronal thin-section source image of 3D sequence (C) show marked dilatation (arrows) of both iliac lymphatic trunks (B) (so-called lymphangioleiomyomas) and retroperitoneal lymphatic trunks (C). B = bladder.

View larger version (91K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —37-year-old woman with lymphangioleiomyomatosis. Coronal true fast imaging with steady-state free precession (B) and coronal thin-section source image of 3D sequence (C) show marked dilatation (arrows) of both iliac lymphatic trunks (B) (so-called lymphangioleiomyomas) and retroperitoneal lymphatic trunks (C). B = bladder.

View larger version (167K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12A —43-year-old man who underwent MRI for chylous ascites after cephalic pancreaticoduodenectomy for chronic pancreatitis. Coronal true fast imaging with steady-state free precession (FISP) image shows chylous ascites (asterisks) and retroperitoneal chylous collection (arrows).

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12B —43-year-old man who underwent MRI for chylous ascites after cephalic pancreaticoduodenectomy for chronic pancreatitis. Axial true FISP images show small leak (arrows) from retrocrural lymphatic trunk that pierces diaphragmatic crus (B) between inferior vena cava and aorta and diffuses in peritoneal cavity (C).

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12C —43-year-old man who underwent MRI for chylous ascites after cephalic pancreaticoduodenectomy for chronic pancreatitis. Axial true FISP images show small leak (arrows) from retrocrural lymphatic trunk that pierces diaphragmatic crus (B) between inferior vena cava and aorta and diffuses in peritoneal cavity (C).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 12D —43-year-old man who underwent MRI for chylous ascites after cephalic pancreaticoduodenectomy for chronic pancreatitis. Coronal thin-section source image of 3D sequence shows small leak (arrows) from retroperitoneal lymphatic trunk (arrowhead).

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