Gadoteridol for MR imaging of lymphatic vessels in lymphoedematous patients: initial experience after intracutaneous injection

Abstract

The aim of this study was to evaluate the feasibility of gadoteridol in visualizing lymphatic vessels of lymphoedematous patients after intracutaneous injection. 20 lower extremities in 10 lymphoedematous patients were examined. Gadoteridol (9 ml) was subdivided into five portions and injected intracutaneously into the dorsal aspect of each foot. For MRI, a three-dimensional spoiled gradient echo sequence was performed. No complications were observed during or after intracutaneous injection of gadoteridol. The lymphoedema was bilateral in seven and unilateral in three of the examined patients. Contrast enhancement of gadoteridol was detected in lymphatic vessels at the level of the lower leg in 17 lower extremities (85%). Enhancing lymphatic vessels of the upper leg were observed in 11 lower extremities (55%). Furthermore, gadoteridol enhanced 10 out of 20 inguinal lymph node groups (50%). No external iliac lymph nodes were observed in any of the patients. Regions of dermal backflow, indicating proximal lymphatic obstruction, were seen in 13 lower extremities (65%). As soon as 15 min after gadoteridol injection, accompanying venous enhancement was detected in all lower extremities (100%). MRI of lymphatic vessels in lymphoedematous patients is safe and feasible after intracutaneous injection of gadoteridol if the diagnosis of lymphoedema necessitates a better definition for optimal therapeutic planning or an objective, diagnostic baseline is required. The proposed technique represents a minimally invasive imaging method of identifying anatomical and physiological derangements in lymphatic vessels.