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Giant cisterna chyli: MRI depiction with gadolinium-DTPA enhancement
K C Lee1, V N Cassar-Pullicino
1Department of Radiology, Robert Jones & Agnes Hunt Orthopaedic & District Hospital, Oswestry, Shropshire, SY10 7AG, UK.
Aim:
To demonstrate the use of MRI with Gadolinium-DTPA enhancement in the diagnosis of giant cisterna chyli.
Materials And Methods:
The study consisted of contrast enhanced MRI with ultrasound and CT correlation in three patients with a giant cisterna chyli. An analysis of the morphology, location and post-contrast MR signal characteristics in relation to time was performed.
Results:
Cisterna chyli has a characteristic lobulated morphology and location but the unenhanced MRI appearances are not specific. The post-Gadolinium-DTPA MRI appearances are critically dependent on the time elapsed after injection of contrast medium. Within the first 5 min, there is no enhancement at all, but by 10 min there is early layering of contrast medium evident, which by 30 min produces a clear fluid-fluid level. Delayed images at 4-5 h demonstrate a uniform enhancement of the cisternal contents producing a homogeneous intermediate signal. All of these features are best visualized on T1 fast saturation sequences.
Conclusion:
MRI with Gadolinium-DTPA enhancement is valuable in confirming the nature of the lymphatic ducts in the retroperitoneal space and helps to differentiate these normal structures from alternative lesions such as lymphadenopathy and tumour recurrence.