Preoperative evaluation of metastasis to internal iliac lymph nodes are very important in the designing of the patient's therapeutic plan and the predicting the prognosis of carcinoma of the uterine cervix. Until now no study has reported on the subject of selective visualization of the internal iliac lymph nodes. Indirect lymphangiography is a simple method for evaluating local lymphatic system. The internal iliac lymph nodes can be visualized by combining indirect lymphangiography of the upper one-third area of the vagina and thin section CT scan. We applied this method to 25 cases of FIGO B and A stage of the carcinoma of the uterine cervix, and correlated our findings with results of radical abdominal hysterectomy, We were able to visualize the internal iliac lymph nodes in 24 cases out of 25, and their size range was 3-15 mm. No nodal metastasis were found in all the patients and these were varified by subsequent pathologic examination from radically dissected lymph nodes.
Cervix Uteri* ; Female ; Humans ; Hysterectomy ; Lymph Nodes* ; Lymphatic System ; Lymphography ; Methods* ; Neoplasm Metastasis ; Prognosis ; Tomography, X-Ray Computed* ; Vagina

OBJECTIVETo evaluate anatomical and functional images of contrast MR lymphangiography in the diagnosis of limb lymphatic circulation disorders.

METHODS30 patients with limb lymphedema were enrolled in the study. There were 27 patients of primary lymphedema and 3 of secondary lymphedema. Contrast enhanced lymphangiography was performed with 3.0 T MR Unit after intracutaneous injection of gadobenate dimeglumine into the interdigital webs of the dorsal foot and hand. The kinetics of enhanced lymph flow within the lymphatics were calculated using the formula: Speed (cm) = total length of visualized lymph vessel (cm)/ inspection time (minutes) and by comparing dynamic nodal enhancement and time-signal intensity curves between edematous and contralateral limbs. Morphological abnormalities of the lymphatic system were also evaluated.

RESULTSFollowing injection of the contrast agent enhanced lymphatic channels were consistently visualized in all clinical lymphedematous limbs and five contralateral limbs of unilateral lymphedema cases. The speed of enhanced flow within the lymphatics of lymphedematous limbs ranged from 0.30 to 1.48 cm/min. The contrast enhancement in inguinal nodes of edematous limbs was significantly lower than that of contralateral limbs (P < 0.01). Dynamic measurement of contrast enhancement showed a remarkable lowering of peak time (P < 0.01) and peak enhancement (P < 0.01) and a delay in outflow in inguinal nodes of affected limbs compared with that of control limbs. Post-contrast MR imaging also depicted varied distribution patterns of lymphatics and abnormal lymph flow pathways within lymph nodes in the limbs with lymphatic circulation disorders.

CONCLUSIONSContrast MR lymphangiography with gadobenate dimeglumine was able to visualize the precise anatomy of lymphatic vessels and lymph nodes in lymphedematous limbs. It also provided comprehensive information about the functional status of lymph flow transportation in lymphatics and lymph nodes.

Adolescent ; Adult ; Child ; Humans ; Lymph Nodes ; pathology ; Lymphatic Vessels ; pathology ; Lymphedema ; diagnostic imaging ; pathology ; Lymphography ; methods ; Middle Aged ; Young Adult

OBJECTIVETo compare the role of radionuclide lymphoscintigraphy and dynamic magnetic resonance lymphangiography (MRL) for the diagnosis of extremity lymphedema.

METHODSSixteen patients with primary extremity lymphedema and two with Klippel-Trenaunay syndrome combined with lymphedema were examined by lymphoscintigraphy using the tracer 99Tc-labelled dextran, and also by MRL using gadobenate dimeglumine as contrast agent. The results of morphological abnormalities and functional state of the lymphatic system at affected limbs from the two imaging methods were compared.

RESULTSLymphatic vessels were imaged in 14 of 18 limbs with lymphedema using MRL, compared with one of 18 using lymphoscintigraphy. MRL detected the inguinal nodes in 16 of 17 patients, whereas lymphoscintigraphy revealed inguinal nodes in only nine cases. MRL revealed more precise information about structural and functional abnormalities of lymph vessels and nodes than lymphoscintigraphy by real-time measurement of lymph flow in vessels and nodes.

CONCLUSIONSDynamic MRL is more sensitive and accurate than lymphoscintigraphy in the detection of anatomical and functional abnormalities in the lymphatic system in patients with extremity lymphedema.

Adolescent ; Adult ; Aged ; Child ; Extremities ; Female ; Humans ; Lymphedema ; diagnostic imaging ; Lymphography ; methods ; Lymphoscintigraphy ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Young Adult

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.
Adult ; Aged ; Ascites/*etiology/therapy ; Embolization, Therapeutic/*methods ; Female ; Genital Neoplasms, Female/*surgery ; Humans ; Lymph Node Excision/*adverse effects ; *Lymphography ; Middle Aged ; Postoperative Complications/*etiology ; Retrospective Studies

OBJECTIVE: To evaluate risk factors for massive lymphatic ascites after laparoscopic retroperitoneal lymphadenectomy in gynecologic cancer and the feasibility of treatments using intranodal lymphangiography (INLAG) with glue embolization. METHODS: A retrospective analysis of 234 patients with gynecologic cancer who received laparoscopic retroperitonal lymphadenectomy between April 2006 and November 2015 was done. In June 2014, INLAG with glue embolization was initiated to manage massive lymphatic ascites. All possible clinicopathologic factors related to massive lymphatic ascites were determined in the pre-INLAG group (n=163). Clinical courses between pre-INLAG group and post-INLAG group (n=71) were compared. RESULTS: In the pre-INLAG group (n=163), four patients (2.5%) developed massive lymphatic ascites postoperatively. Postoperative lymphatic ascites was associated with liver cirrhosis (three cirrhotic patients, p<0.001). In the post-INLAG group, one patient with massive lymphatic ascites had a congestive heart failure and first received INLAG with glue embolization. She had pelvic drain removed within 7 days after INLAG. The mean duration of pelvic drain and hospital stay decreased after the introduction of INLAG (13.2 days vs. 10.9 days, p=0.001; 15.2 days vs. 12.6 days, p=0.001). There was no evidence of recurrence after this procedure. CONCLUSION: Underlying medical conditions related to the reduced effective circulating volume, such as liver cirrhosis and heart failure, may be associated with massive lymphatic ascites after retroperitoneal lymphadenectomy. INLAG with glue embolization can be an alternative treatment options to treat leaking lymphatic channels in patients with massive lymphatic leakage.
Adult ; Aged ; Ascites/*etiology/therapy ; Embolization, Therapeutic/*methods ; Female ; Genital Neoplasms, Female/*surgery ; Humans ; Lymph Node Excision/*adverse effects ; *Lymphography ; Middle Aged ; Postoperative Complications/*etiology ; Retrospective Studies

OBJECTIVETo assess the feasibility of interstitial magnetic resonance lymphangiography (IMRL) with intracutaneous injection of gadobenate dimeglumine--a commercially available, non-ionic, extracellular paramagnetic contrast agent.

METHODSWe studied 10 patients with lower extremity lymphedema. A mixture of 7.5 ml gadobenate dimeglumine and 0.5 ml 2% lidocaine were evenly subdivided into 8 portions and injected intracutaneously into each web space of both feet. For IMRL, a 3D fast spoiled gradient-recalled echo T1-weighted images with a fat saturation technique (T1 high resolution isotropic volume excitation, THRIVE) was performed.

RESULTSThe beaded appearance of lymphatic vessels extending from the injection site were detected in 11 of 12 lower legs and the best delineation of lymphatic vessels was present at 15-30 minutes after injection. In 6 of 12 affected thighs, lymphatic vessels could be also visualized with the strongest enhancement at 45 minutes.

CONCLUSIONIMRL is a safe and technically feasible new method which can effectively visualize the pathological lymphatic vessels in lower extremity lymphedema.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Lower Extremity ; Lymphedema ; diagnostic imaging ; Lymphography ; methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Young Adult

OBJECTIVETo compare the effects of two contrast agents, Gd-DTPA and HSA-Gd-DTPA, in magnetic resonance (MR) lymphography.

METHODSTwelve New-Zealand rabbits were randomized into Gd-DTPA and HSA-Gd-DTPA groups with subcutaneous (interdigital skin fold) injection of the two contrast agents (0.2 ml of 0.5 mmol/L Gd(3+)) for MR lymphography of the popliteal lymph nodes examined in the axial and sagital orientation. T(1)-weighted, T1-weighted fat suppressed, and T(2)-weighted spin-echo (SE) images of the lymph nodes were obtained in plain scans. The post-contrast scanning started at 30 min, 1 h and 3 h after Gd-DTPA administration and at 10 min, 30 min and 60 min after HSA-Gd-DTPA injection to obtain T(1)-weighted images with identical imaging parameters. The signal intensity of popliteal lymph node was measured and the enhancement rate calculated.

RESULTSAfter subcutaneous injection, Gd-DTPA quickly entered blood circulation to result in obvious enhancement of the anterior-tibial vein and the urine and also in heterogeneous enhancement of the popliteal lymph nodes. HSA-Gd-DTPA did not enter the blood, causing obvious homogeneous enhancement of the lymphatic vessels and lymph nodes. HSA-Gd-DTPA resulted in higher enhancement rate than Gd-DTPA, and the enhancement rate in Gd-DTPA group decreased with time as opposed to that of the HSA-Gd-DTPA group.

CONCLUSIONHSA-Gd-DTPA has better performance than Gd-DTPA in MR lymphography after subcutaneous administration.

Animals ; Contrast Media ; administration & dosage ; pharmacokinetics ; Gadolinium DTPA ; administration & dosage ; pharmacokinetics ; Humans ; Lymph Nodes ; diagnostic imaging ; Lymphography ; instrumentation ; methods ; Rabbits ; Random Allocation ; Serum Albumin ; administration & dosage ; pharmacokinetics

OBJECTIVE: To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. MATERIALS AND METHODS: This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. RESULTS: All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean +/- standard deviation, 1.7 +/- 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. CONCLUSION: Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.
Animals ; Carcinoma/pathology/*radiography/secondary ; Contrast Media/*diagnostic use ; Ethiodized Oil/*diagnostic use ; Feasibility Studies ; Female ; Injections ; Lymph Node Excision/methods ; Lymph Nodes/pathology/*radiography ; Lymphatic Metastasis/radiography ; Lymphography/*methods ; Rabbits ; Thigh ; Tomography, X-Ray Computed/*methods

PURPOSE: Preoperative identification of the sentinel lymph node (SLN) in gastric cancer (GC) patients may have great advantages for the minimally invasive treatment. This study was performed to evaluate the possibility of preoperative SLN detection using CT lymphography. MATERIALS AND METHODS: Fourteen patients with early GC were enrolled. CT images were obtained before and at 1, 3, and 5 minutes after endoscopic submucosal peritumoral injection of 2 mL iopamidol. For patients with clearly identified SLNs, to make comparisons with the CT lymphography results, intraoperative SLN detection was performed using subserosally injected Indocyanine green (ICG) lymphography and ex vivo ICG and iopamidol lymphography using mammography was also performed. RESULTS: CT lymphography clearly visualized draining lymphatics and SLNs in 4 (28.6%) out of 14 patients. All clearly visualized SLNs (one to three SLNs per patient) under preoperative imaging were detected in the same location by intraoperative ICG lymphography and ex vivo ICG and iopamidol lymphography using mammography. All preoperative SLN detections were observed with the primary tumors in the lower third of the stomach. CONCLUSION: Although our study demonstrated a SLN detection rate of less than 30%, CT lymphography with radio-contrast showed potential as a method of preoperative SLN detection for GC.
Adult ; Aged ; Female ; Humans ; Iopamidol/diagnostic use ; Lymph Nodes/pathology/*radiography ; Lymphography/*methods ; Male ; Middle Aged ; Models, Biological ; Preoperative Care ; Sentinel Lymph Node Biopsy ; Stomach Neoplasms/pathology/*radiography ; Tomography, X-Ray Computed/*methods