Two Non-gadolinium-based, Innovative Approaches to Preoperative Lymphangiography

Area of Science:

• Medical Imaging
• Lymphatic System Diagnostics
• Non-invasive Procedures

Background:

• Intravenous gadolinium-based contrast agents (GBCAs) used in MRI lymphangiography carry risks of gadolinium retention.
• Concerns exist regarding GBCA retention and toxicity from intradermal injections in patients with lymphatic obstruction.

Purpose of the Study:

• To demonstrate proof of concept for two preoperative lymphangiographic techniques that do not utilize gadolinium-based contrast agents.
• To evaluate alternative contrast agents for improved safety and efficacy in lymphatic imaging.

Main Methods:

• Contrast-enhanced ultrasound (CEUS) with microbubbles (Lumason) for left upper extremity edema.
• Magnetic resonance imaging (MRI) lymphangiography with ferumoxytol for right lower extremity edema.
• Comparison with conventional indocyanine green (ICG) injections.

Main Results:

• Both CEUS with microbubbles and ferumoxytol-enhanced MRI successfully identified candidates for lymphovenous bypass surgery.
• These candidates were not identified using standard indocyanine green injections.
• The techniques showed feasibility for preoperative lymphatic mapping.

Conclusions:

• Low-dose ferumoxytol is a viable non-GBCA alternative for MRI lymphangiography.
• Contrast-enhanced ultrasound can effectively identify suitable lymphatic vessels for surgical anastomosis.