Diagnostic and interventional imaging of lymphatic disorders

During the past several years, technological innovations in nuclear diagnostics and computer imaging have rekindled enthusiasm for visualising the lymphatic system in peripheral lymphoedema and related disorders of lymph flow. Isotope lymphography or lymphangioscintigraphy has now largely replaced conventional (direct) oil-contrast lymphography for evaluating lymphatic dysplasia as it is much simpler, safe, repeatable, and provides both structural and functional detail of the lymphatic system. Magnetic resonance imaging (MRI), alone or in combination with superparamagnetic contrast agents (lymphangiomagnetograms) or fat subtraction (suppression) has the potential to yield further dividends in understanding a variety of enigmatic oedematous states including lymphoedema. Other imaging techniques of promise include ultrasonography (primarily for filariasis), fluorescent microangiolymphography, and intradermal brominated fluorocarbon (primarily for lymph nodes). Not only can these readily non-invasive imaging techniques be used to monitor and document the efficacy of treatments designed to remedy defective lymph transport and function, but in certain conditions (e.g., chylous reflux syndrome), they can be employed to obliterate incompetent lymphangiectatic/lymphangiomatous truncal elements through sclerosis using percutaneous computer-guided catheters.