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LETTER TO THE EDITOR  
Year : 2011  |  Volume : 21  |  Issue : 2  |  Page : 155
Interstitial MRI lymphangiography of the lower limbs


1 Department of Radiodiagnosis and Imaging, Chhatrapati Shahuji Maharaj Medical University, Chowk Lucknow, Uttar Pradesh - 226 003, India
2 Department of Dermatology, Venereology and Leprosy, Chhatrapati Shahuji Maharaj Medical University, Chowk Lucknow, Uttar Pradesh - 226 003, India
3 Department of General Surgery, Chhatrapati Shahuji Maharaj Medical University, Chowk Lucknow, Uttar Pradesh - 226 003, India

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Date of Web Publication23-Jun-2011
 

How to cite this article:
Parihar A, Suvirya S, Kumar S, Singh R. Interstitial MRI lymphangiography of the lower limbs. Indian J Radiol Imaging 2011;21:155

How to cite this URL:
Parihar A, Suvirya S, Kumar S, Singh R. Interstitial MRI lymphangiography of the lower limbs. Indian J Radiol Imaging [serial online] 2011 [cited 2019 Nov 20];21:155. Available from: http://www.ijri.org/text.asp?2011/21/2/155/82285
Dear Sir,

We read the article "Technical note: MRI lymphangiography of the lower limb in secondary lymphedema" by Kamble et al., published recently in your journal with great interest. [1] We concur with the authors that the investigation of secondary lymphedema has been enigmatic with direct lymphangiography being too invasive and lymphiscintigraphy having poor spatial and temporal resolution. The authors have rightly pointed out that indirect contrast-enhanced MRI lymphangiography offers excellent visualization of the lower limb lymphatics in secondary lymphedema. The greatest advantage of this technique is the absence of radiation exposure, the multiplanar capability of MRI allowing for precise compartmental localization (epifascial/subfascial/intramuscular) and accurate depiction of the extent of abnormality. We would like to point out that one of the major limitations of the technique is poor visualization of inguinal lymph nodes after intradermal injection of contrast in the feet. We would also like to share our experience of indirect MRI lymphangiography with a newer MRI contrast agent with high relaxivity, gadobenate dimeglumine (0.5 mmol/L MultiHance, Bracco, Milano, Italy). We have found gadobenate dimeglumine to provide more detailed depiction of the lymphatic anatomy in the small number of patients that we have done [Figure 1]A and B. Lohrmann et al. have demonstrated frequent visualization of inguinal lymph nodes after injection of gadoteridol (ProHance, Bracco-Altana, Konstanz, Germany) one of the newer contrast agents. [2] The use of newer contrast agents with higher relaxivity thus offers the possibility of simultaneous depiction of the lymphatic channels and the lymph node groups.
Figure 1: (A,B): Coronal short tau inversion recovery (STIR) image (A) shows extensive epifascial edema in the left foot of a 35-year-old female patient with secondary lymphedema (thick arrow). Coronal 3D maximum intensity projection (MIP) reconstruction image of a 3D time-of-flight (TOF) acquisition, 15 min after intradermal gadobenate dimeglumine contrast injection shows paucity of axial lymphatics in the foot and lower leg region with enlargement of the remaining channels (thin arrow) and extensive dermal back flow in the foot region (arrowhead). The right foot shows normal caliber lymphatic channels (thick arrow in B).

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   References Top

1.Kamble RB, Shetty R, Diwakar N, Madhusudan G. Technical note: MR Lymphangiography of the lower limb in secondary lymphedema. Indian J Radiol Imaging 2011;21:15-7.  Back to cited text no. 1
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2.Lohrmann C, Foeldi E, Bartholomae JP, Langer M. Gadoteridol for MR imaging of lymphatic vessels in lymphoedematous patients: Initial experience after intracutaneous injection. Br J Radiol 2007;80:569-73.  Back to cited text no. 2
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Correspondence Address:
Anit Parihar
Department of Radiodiagnosis and Imaging, Chhatrapati Shahuji Maharaj Medical University, Chowk Lucknow, Uttar Pradesh - 226 003
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.82285

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Kamble, R.B., Shetty, R.V., Diwakar, N., Madhusudan, G.
Indian Journal of Radiology and Imaging. 2011; 21(2): 155-156
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