Contrast-enhanced Interstitial Transpedal MR Lymphangiography for Thoracic Chylous Effusions

Area of Science:

• Radiology
• Interventional Radiology
• Lymphatic Imaging

Background:

• Interventional radiology is increasingly used for central lymphatic system (CLS) abnormalities.
• Clinical imaging for planning lymphatic interventions remains challenging.
• Thoracic chylous effusions require effective preprocedural diagnostic tools.

Purpose of the Study:

• To assess the clinical utility of contrast-enhanced interstitial transpedal MR lymphangiography.
• To evaluate its role in the preinterventional workup for lymphatic interventions.
• To specifically examine its use in patients with thoracic chylous effusions.

Main Methods:

• Retrospective analysis of 25 patients with chylous effusions undergoing transpedal MR lymphangiography (1.5 T, T1-weighted imaging).
• Gadolinium-based contrast medium injected interstitially under local anesthesia.
• Evaluation of technical success, CLS abnormality depiction, and interventional access site identification; radiographic lymphangiography as reference standard.

Main Results:

• Transpedal MR lymphangiography demonstrated high technical success (92%) and was well-tolerated without complications.
• Excellent interrater agreement for image quality (κ = 0.96) and strong correlation between image quality and CLS visualization (ρ = 0.71).
• Accurate visualization of retroperitoneal lymphatics (92%), cisterna chyli (96%), thoracic duct (92%), and identification of abnormalities (92%) and access routes (96%).

Conclusions:

• Transpedal interstitial MR lymphangiography is a well-tolerated and effective imaging modality.
• It accurately identifies specific pathologic abnormalities causing thoracic chylous leakages.
• The technique provides clinically useful information for pre-lymphatic intervention planning.