MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View

Figure 6

MRL (1,5 T, GE) in a 43-year-old man with congenital primary lymphedema. 3D frontal spoiled gradient-echo MIP after 5 (a) and 20 (b) minutes show a progressive delineation and enhancement of lymphatic vessels (white solid arrows) with an extensive area of dermal backflow (interstitial dispersion of the contrast medium in soft tissue due to proximal obstruction of lymph drainage) in the left foot (arrow head in (b)); please note the beaded appearance of lymphatics comparing to the substantially more rectilinear shape of veins (open arrows). The possibility of visualizing a precontrast venogram through a 3D steady-state free precession (SSFP) balanced sequence makes the distinction between veins and lymphatic vessels easier. The optimal depiction of the high-intensity epifascial lymphedema (c) and inguinal lymph nodes (d) is also evident.

(a)

(b)

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