Abstract
Simple SummaryThe lymphatic system is an essential component of the human circulatory system that plays a critical role in antigen presentation, mounting immune reactions, gastrointestinal tract lipid absorption, and maintenance of interstitial homeostasis. This complex network of specially adapted vessels and lymphoid organs also represents major pathway for cancer spread. Knowledge of lymphatic anatomy, physiology, and expected imaging appearances is crucial in understanding the pattern of cancer spread, with great implications for treatment and management. In this review article, we discuss lymphatic anatomy, physiology, imaging techniques, and radiographic appearances of cancer spread with relevant illustrative cases.The lymphatic system is an anatomically complex vascular network that is responsible for interstitial fluid homeostasis, transport of large interstitial particles and cells, immunity, and lipid absorption in the gastrointestinal tract. This network of specially adapted vessels and lymphoid tissue provides a major pathway for metastatic spread. Many malignancies produce vascular endothelial factors that induce tumoral and peritumoral lymphangiogenesis, increasing the likelihood for lymphatic spread. Radiologic evaluation for disease staging is the cornerstone of oncologic patient treatment and management. Multiple imaging modalities are available to access both local and distant metastasis. In this manuscript, we review the anatomy, physiology, and imaging of the lymphatic system.
Highlights
The lymphatic system is an anatomically complex vascular system that is involved in mounting immune reactions, maintaining interstitial fluid homeostasis, and transporting large interstitial particles and cells, as well as in gastrointestinal tract lipid absorption [1,2,3]
The lymphatic system is composed of lymphatic organs that are interconnected with lymphatic vessels
magnetic resonance lymphangiography (MRL) is a novel imaging technique that is used mainly to evaluate the lymphatic vessels in patients with lymphedema, which is commonly encountered in postsurgical lymph node dissection
Summary
The lymphatic system is an anatomically complex vascular system that is involved in mounting immune reactions, maintaining interstitial fluid homeostasis, and transporting large interstitial particles and cells, as well as in gastrointestinal tract lipid absorption [1,2,3]. Lymphatic organs include organs such as lymph nodes, spleen, thymus, and bone marrow [1]. This network of specially adapted vessels and lymphoid tissue provides a major pathway for cancer spread. Many tumors express vascular endothelial factors that induce neoangiogenesis and lymphangiogenesis. These processes induce increased growth of blood and lymphatic vessels to the tumor and surrounding regions, providing additional nutrients for tumor growth and more pathways for spread. Multiple imaging modalities are utilized to accurately stage disease including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), positron emission tomography–computed tomography (PET-CT), conventional lymphangiography (CL), magnetic resonance lymphangiography (MRL), and sentinel lymph node (SNL) imaging [8,9,10]. We briefly illustrate the structure, anatomy, and the most commonly used imaging modalities for evaluation of the lymphatic system
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