Abstract
The lymphatic system is anatomically complex and difficult to image. Lymph ducts are responsible for the drainage of part of the body’s interstitial fluid. Lymph nodes account for the enrichment of lymph fluid, and can be involved in a large variety of diseases, especially cancer. For a long time, lymphatic imaging was limited to the sole use of conventional lymphography involving invasive procedures and patient discomfort. New contrast agents and techniques in ultrasound, nuclear medicine, and MR imaging are now available for imaging of both the lymphatic vessels and the lymph nodes. The objective of this review is to discuss the different imaging modalities of the lymphatic system, with a special focus on the new possibilities of lymphatic imaging including enhanced MR lymphography, sentinel node and positron emission tomography imaging, and contrast-enhanced ultrasound.
Similar content being viewed by others
References
Witte CL, Witte MH, Unger EC et al (2000) Advances in imaging of lymph flow disorders. Radiographics 20:1697–1719
Picard J-D (1995) Lymphatic circulation. S.I.A., Lavaur, France
Merrigan BA, Winter DC, O’Sullivan GC (1997) Chylothorax. Br J Surg 84:15–20
Moghimi SM, Bonnemain B (1999) Subcutaneous and intravenous delivery of diagnostic agents to the lymphatic system: applications in lymphoscintigraphy and indirect lymphography. Adv Drug Deliv Rev 37:295–312
Weissleder H, Weissleder R (1988) Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology 167:729–735
Witte CL, Witte MH (1999) Diagnostic and interventional imaging of lymphatic disorders. Int Angiol 18:25–30
Weissleder R, Elizondo G, Josephson L et al (1989) Experimental lymph node metastases: enhanced detection with MR lymphography. Radiology 171:835–839
Weissleder R, Elizondo G, Wittenberg J, Rabito CA, Bengele HH, Josephson L (1990) Ultrasmall superparamagnetic iron oxide: characterization of a new class of contrast agents for MR imaging. Radiology 175:489–493
Jung CW (1995) Surface properties of superparamagnetic iron oxide MR contrast agents: ferumoxides, ferumoxtran, ferumoxsil. Magn Reson Imaging 13:675–691
Jung CW, Jacobs P (1995) Physical and chemical properties of superparamagnetic iron oxide MR contrast agents: ferumoxides, ferumoxtran, ferumoxsil. Magn Reson Imaging 13:661–674
Weissleder R, Elizondo G, Wittenberg J, Lee AS, Josephson L, Brady TJ (1990) Ultrasmall superparamagnetic iron oxide: an intravenous contrast agent for assessing lymph nodes with MR imaging. Radiology 175:494–498
Clement O, Rety F, Cuenod CA et al (1998) MR lymphography: evidence of extravasation of superparamagnetic nanoparticles into the lymph. Acad Radiol 5:S170–S172 (discussion S183–S174)
Rety F, Clement O, Siauve N et al (2000) MR lymphography using iron oxide nanoparticles in rats: pharmacokinetics in the lymphatic system after intravenous injection. J Magn Reson Imaging 12:734–739
Vassallo P, Matei C, Heston WD, McLachlan SJ, Koutcher JA, Castellino RA (1994) AMI-227-enhanced MR lymphography: usefulness for differentiating reactive from tumor-bearing lymph nodes. Radiology 193:501–506
Guimaraes R, Clement O, Bittoun J, Carnot F, Frija G (1994) MR lymphography with superparamagnetic iron nanoparticles in rats: pathologic basis for contrast enhancement. Am J Roentgenol 162:201–207
Hayashi S, Miyazaki M (1999) Thoracic duct: visualization at nonenhanced MR lymphography—initial experience. Radiology 212:598–600
Harika L, Weissleder R, Poss K, Zimmer C, Papisov MI, Brady TJ (1995) MR lymphography with a lymphotropic T1-type MR contrast agent: Gd-DTPA-PGM. Magn Reson Med 33:88–92
Staatz G, Nolte-Ernsting CC, Adam GB et al (2001) Interstitial T1-weighted MR lymphography: lipophilic perfluorinated gadolinium chelates in pigs. Radiology 220:129–134
Misselwitz B, Schmitt-Willich H, Michaelis M, Oellinger JJ (2002) Interstitial magnetic resonance lymphography using a polymeric t1 contrast agent: initial experience with Gadomer-17. Invest Radiol 37:146–151
Ruehm SG, Corot C, Debatin JF (2001) Interstitial MR lymphography with a conventional extracellular gadolinium-based agent: assessment in rabbits. Radiology 218:664–669
Bellin MF, Vasile M, Morel-Precetti S (2003) Currently used non-specific extracellular MR contrast media. Eur Radiol 12:2688–2698
Ruehm SG, Schroeder T, Debatin JF (2001) Interstitial MR lymphography with gadoterate meglumine: initial experience in humans. Radiology 220:816–821
Moskovic E, Fernando I, Blake P, Parsons C (1991) Lymphography—current role in oncology. Br J Radiol 64:422–427
Cserni G (1999) Metastases in axillary sentinel lymph nodes in breast cancer as detected by intensive histopathological work up. J Clin Pathol 52:922–924
Dowlatshahi K, Fan M, Snider HC, HabibFA (1997) Lymph node micrometastases from breast carcinoma: reviewing the dilemma. Cancer 80:1188–1197
Uematsu T, Sano M, Homma K (2001) In vitro high-resolution helical CT of small axillary lymph nodes in patients with breast cancer: correlation of CT and histology. Am J Roentgenol 176:1069–1074
Mumtaz H, Hall-Craggs MA, Davidson T et al (1997) Staging of symptomatic primary breast cancer with MR imaging. Am J Roentgenol 169:417–424
Konyer NB, Ramsay EA, Bronskill MJ, Plewes DB (2002) Comparison of MR imaging breast coils. Radiology 222:830–834
Luciani A, Dao TH, Lapeyre M et al (2004) Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results. Am J Roentgenol (in press)
Morton DL, Wen DR, Wong JH et al (1992) Technical details of intraoperative lymphatic mapping for early stage melanoma. Arch Surg 127:392–399
Krag DN (1999) The sentinel node for staging breast cancer: current review. Breast Cancer 6:233–236
Whitworth P, McMasters KM, Tafra L, Edwards MJ (2000) State-of-the-art lymph node staging for breast cancer in the year 2000. Am J Surg 180:262–267
Wisner ER, Katzberg RW, Koblik PD et al (1995) Indirect computed tomography lymphography of subdiaphragmatic lymph nodes using iodinated nanoparticles in normal dogs. Acad Radiol 2:405–412
McIntire GL, Bacon ER, Illig KJ et al (2000) Time course of nodal enhancement with CT X-ray nanoparticle contrast agents: effect of particle size and chemical structure. Invest Radiol 35:91–96
Bellin MF, Roy C, Kinkel K et al (1998) Lymph node metastases: safety and effectiveness of MR imaging with ultrasmall superparamagnetic iron oxide particles—initial clinical experience. Radiology 207:799–808
Sigal R, Vogl T, Casselman J et al (2002) Lymph node metastases from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sinerem MR)—results of a phase-III multicenter clinical trial. Eur Radiol 12:1104–1113
Harisinghani MG, Barentsz J, Hahn PF et al (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348:2491–2499
Michel SC, Keller TM, Frohlich JM et al (2002) Preoperative breast cancer staging: MR imaging of the axilla with ultrasmall superparamagnetic iron oxide enhancement. Radiology 225:527–536
Harisinghani MG, Saini S, Slater GJ, Schnall MD, Rifkin MD (1997) MR imaging of pelvic lymph nodes in primary pelvic carcinoma with ultrasmall superparamagnetic iron oxide (Combidex): preliminary observations. J Magn Reson Imaging 7:161–163
Williams AD, Cousins C, Soutter WP et al (2001) Detection of pelvic lymph node metastases in gynecologic malignancy: a comparison of CT, MR imaging, and positron emission tomography. Am J Roentgenol 177:343–348
Hong SP, Hahn JS, Lee JD, Bae SW, Youn MJ (2003) 18F-Fluorodeoxyglucose-positron emission tomography in the staging of malignant lymphoma compared with CT and 67 Ga Scan. Yonsei Med J 44:779–786
Friedberg JW, Chengazi V (2003) PET scans in the staging of lymphoma: current status. Oncologist 8:438–447
Barranger E, Grahek D, Antoine M, Montravers F, Talbot JN, Uzan S (2003) Evaluation of fluorodeoxyglucose positron emission tomography in the detection of axillary lymph node metastases in patients with early-stage breast cancer. Ann Surg Oncol 10:622–627
Eubank WB, Mankoff DA, Takasugi J et al (2001) 18fluorodeoxyglucose positron emission tomography to detect mediastinal or internal mammary metastases in breast cancer. J Clin Oncol 19:3516–3523
Lin WC, Hung YC, Yeh LS, Kao CH, Yen RF, Shen YY (2003) Usefulness of (18)F-fluorodeoxyglucose positron emission tomography to detect para-aortic lymph nodal metastasis in advanced cervical cancer with negative computed tomography findings. Gynecol Oncol 89:73–76
Antoch G, Stattaus J, Nemat AT et al (2003) Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 229:526–533
Picchio M, Messa C, Landoni C et al (2003) Value of [11C]choline-positron emission tomography for re-staging prostate cancer: a comparison with [18F]fluorodeoxyglucose-positron emission tomography. J Urol 169:1337–1340
Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220
Tregnaghi A, De Candia A, Calderone M et al (1997) Ultrasonographic evaluation of superficial lymph node metastases in melanoma. Eur J Radiol 24:216–221
Steinkamp HJ, Wissgott C, Rademaker J, Felix R (2002) Current status of power Doppler and color Doppler sonography in the differential diagnosis of lymph node lesions. Eur Radiol 12:1785–1793
Moritz JD, Ludwig A, Oestmann JW (2000) Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. Am J Roentgenol 174:1279–1284
Yang WT, Metreweli C, Lam PK, Chang J (2001) Benign and malignant breast masses and axillary nodes: evaluation with echo-enhanced color power Doppler US. Radiology 220:795–802
Schmid-Wendtner MH, Partscht K, Korting HC, Volkenandt M (2002) Improved differentiation of benign and malignant lymphadenopathy in patients with cutaneous melanoma by contrast-enhanced color Doppler sonography. Arch Dermatol 138:491–497
Wisner ER, Ferrara KW, Short RE, Ottoboni TB, Gabe JD, Patel D (2003) Sentinel node detection using contrast-enhanced power Doppler ultrasound lymphography. Invest Radiol 38:358–365
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Clément, O., Luciani, A. Imaging the lymphatic system: possibilities and clinical applications. Eur Radiol 14, 1498–1507 (2004). https://doi.org/10.1007/s00330-004-2265-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-004-2265-9