MR lymphangiography is valuable in primary lymphatic disorders (congenital lymphedema, lymphatic malformations) and post-surgical lymphedema, often in the setting of complex congenital heart diseases. Symptoms include chylothorax, plastic bronchitis, chylous ascites, and protein losing enteropathy.
We have implemented custom protocols that include direct injection of contrast into groin and mesenteric lymph nodes and also dermal injections.
Protocol: MR Lymphangiography
Example: Lymphedema in a child after an injury. MRI with dermal gadolinium injection is combined with an intravenous ferumoxytol black blood technique shows dermal backflow in the lower calf from disrupted superficial lymphatics and intact deep lymphatics up to the inguinal lymph nodes.
Example: MR lymphangiogram with dynamic imaging after direct intranodal injection reveals lymphatic leak into the left pleural space, leading to a chylous effusion