First-in-Human Safety and Feasibility of Nodal and Pedal MR Lymphangiography with Gadopiclenol

Purpose To evaluate the preliminary technical development, safety, and feasibility of dynamic contrast-enhanced MR lymphangiography (DCE-MRL) performed with nodal and/or dermal injection of gadopiclenol. Materials and Methods This institutional review board-approved retrospective study included consecutive patients referred to the complex lymphatic disorders clinic who underwent DCE-MRL at 1.5 T with gadopiclenol administered via inguinal nodal and/or interstitial transpedal injection. Technical performance, safety, and feasibility for imaging peripheral and central conducting lymphatic anatomy, flow, and drainage were assessed. Results A total of 23 patients (12 female) underwent DCE-MRL with gadopiclenol. Contrast material was administered via inguinal lymph nodes in all patients (23 of 23, 100%) and via interstitial transpedal injection in one patient (one of 23, 4.3%). No serious or nonserious adverse events were observed (0 of 23). Evaluation of central conducting lymphatic anatomy, flow, and drainage into the central venous system was feasible in all patients (23 of 23), and evaluation of lower extremity superficial lymphatic anatomy was feasible in one patient. Signal contrast increased with flip angle up to approximately 35° at 1.5 T, supporting protocol optimization. Preliminary results suggest a near-optimal flip angle of 35° at 1.5 T, a higher flip angle than when using other gadolinium-based contrast agents. Conclusion Dynamic gadopiclenol-enhanced nodal and pedal MR lymphangiography was safe and feasible for imaging peripheral and central conducting lymphatic anatomy. Keywords: Lymphangiography, MR-Angiography, Lymphatic, MR-Dynamic Contrast Enhanced, MR-Contrast Agent Supplemental material is available for this article. © RSNA, 2026.