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Advances in Imaging of Lymph Flow Disorders¹

¹ From the Departments of Surgery (C.L.W., M.H.W., M.J.B., A.M.S.) and Radiology (E.C.U., W.H.W., G.C.M.), University of Arizona College of Medicine, 1501 N Campbell Ave, Rm 4406, PO Box 245063, Tucson, AZ 85724-5063. Received May 19, 1999; revision requested May 25 and received July 21; accepted July 23. Supported in part by a grant from Beiersdorf-Jobst, Inc. Address correspondence to C.L.W. (e-mail: lymph@u.arizona.edu).

Conventional oil-contrast lymphography has long been the mainstay for lymphatic imaging. However, the emergence of computed tomography (CT) and magnetic resonance (MR) imaging has severely curtailed its use. Because of recent improvements and refinements, lymphangioscintigraphy now permits high-resolution imaging of peripheral lymphatic vessels and provides insight into lymph flow dynamics. It is indispensable for patients with known or suspected lymphatic circulatory disorders in confirming the diagnosis and delineating the pathogenesis and evolution of lymphedema. In addition, lymphangioscintigraphy helps evaluate lymphatic truncal anatomy and radiotracer transport. It can also be used to evaluate the efficacy of various treatment options designed to facilitate lymph flow or reduce lymph formation. The procedure is essentially noninvasive, can easily be repeated, and does not adversely affect the lymphatic vascular endothelium. MR imaging complements lymphangioscintigraphy in the monitoring and treatment of more complex lymphatic circulatory disorders, whereas CT facilitates catheter-guided percutaneous sclerosis or obliteration of specific lymphangiectasia or lymphangioma syndromes. Ultrasonography has proved useful in the setting of filariasis. Patients with a provisional diagnosis of peripheral lymphatic dysfunction or idiopathic edema should undergo diagnostic lymphangioscintigraphy and, in some cases, MR imaging to verify diagnostic accuracy, pinpoint the specific abnormality, and help guide subsequent therapy.

Index Terms: Lymphatic system, abnormalities, 99.15 • Lymphatic system, CT, 99.1291 • Lymphatic system, diseases, 99.851, 99.852 • Lymphatic system, flow dynamics, 99.92 • Lymphatic system, MR, 99.12941 • Lymphatic system, radionuclide studies, 99.12974 • Lymphatic system, US, 99.1298

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