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Salcedo Miranda D, Galvis JR, Téllez Rodríguez LJ, Garzón Ramírez JC, Ariza Traslaviña J. Diffuse pulmonary lymphangiomatosis as a differential diagnosis of anterior mediastinal mass. J Surg Case Rep 2024; 2024:rjae577. [PMID: 39280023 PMCID: PMC11393567 DOI: 10.1093/jscr/rjae577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/23/2024] [Indexed: 09/18/2024] Open
Abstract
Diffuse pulmonary lymphangiomatosis (DLP) is an extremely rare silent disease, characterized by proliferation and thickening of abnormal pulmonary, pleural, and mediastinal soft tissue lymphatic channels. Its clinical presentation is nonspecific symptoms such as cough, dyspnea, and hemoptysis. Tomographic findings for DLP include thickening of the interlobular septa and peribronchovascular interstitium and ground glass opacities. Nevertheless, the anterior mediastinal mass, associated with thickening of interlobular septa and peribronchovascular interstitial, ground glass opacities, pleural effusion, diffuse infiltration of the mediastinum and pleural thickening in a patient with lymphangiomas, DLP should be suspected as a differential diagnosis.
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Affiliation(s)
- Diego Salcedo Miranda
- Thoracic Surgery, National Cancer Institute - El Bosque University, Bogotá, 111511, Colombia
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Salehi BP, Sibley RC, Friedman R, Kim G, Singhal D, Loening AM, Tsai LL. MRI of Lymphedema. J Magn Reson Imaging 2023; 57:977-991. [PMID: 36271779 PMCID: PMC10006319 DOI: 10.1002/jmri.28496] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022] Open
Abstract
Lymphedema is a devastating disease that has no cure. Management of lymphedema has evolved rapidly over the past two decades with the advent of surgeries that can ameliorate symptoms. MRI has played an increasingly important role in the diagnosis and evaluation of lymphedema, as it provides high spatial resolution of the distribution and severity of soft tissue edema, characterizes diseased lymphatic channels, and assesses secondary effects such as fat hypertrophy. Many different MR techniques have been developed for the evaluation of lymphedema, and the modality can be tailored to suit the needs of a lymphatic clinic. In this review article we provide an overview of lymphedema, current management options, and the current role of MRI in lymphedema diagnosis and management. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Betsa Parsai Salehi
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Rosie Friedman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Dhruv Singhal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Leo L Tsai
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Lymph Node Metastases Detection Using Gd 2O 3@PCD as Novel Multifunctional Contrast Imaging Agent in Metabolic Magnetic Resonance Molecular Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5425851. [PMID: 36304774 PMCID: PMC9581618 DOI: 10.1155/2022/5425851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 01/26/2023]
Abstract
Axillary lymph node detection is crucial to staging and prognosis of the lymph node metastatic spread in breast cancer. Currently, lymphoscintigraphy and blue dye, as the conventional methods to localize sentinel lymph nodes (SLNs), are invasive and can only be performed during surgery. This study has had a novel hybrid gadolinium oxide nanoparticle coating with Cyclodextrin-based polyester as a high-relaxivity T1 magnetic resonance molecular imaging (MRMI) contrast agent (CA). Twelve female BALB/c mice were randomly divided into three groups of four mice; each group was injected with 4T1 cells to obtain metastasis lymph nodes and diagnosed by using the 3D T1W (VIBE) MRI (Siemens 3T, Prisma). The synthesized Gd2O3@PCD nanoparticles with a suitable particle size range of 20-40 nm have had much higher longitudinal relaxivity (r 1) for Gd2O3@PCD and Gd-DOTA (Dotarem) with the values of 3.98 mM-1·s-1 ± 0.003 and 2.71 mM-1·s-1 ± 0.005, respectively. Identical MR images in coronal views were subsequently obtained to create time-intensity curves of the right axillary lymph nodes and to measure the contrast ratio (CR). The peak CR and qualitative assessment of axillary lymph nodes at five-time points were evaluated. After subcutaneous injection, the contrast ratio of axillary lymph node and tumor in mice exhibited CR peak of Gd2O3@PCD and Dotarem with the values of 2.21 ± 0.06 and 0.40 ± 0.004 for lymph node and 2.54 ± 0.04 and 1.21 ± 0.007 for the tumor, respectively. Furthermore, the lumbar-aortic lymph node is weakly visible in the original coronal image. In conclusion, the use of Gd2O3@PCD nanoparticles as novel MRMI CAs enables high resolution for the detection of lymph node metastasis in mice with the potential capability for breast cancer diagnostic imaging.
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Uhlenbruch M, Keymel S, Krüger S. [Lymphangiomatosis: Rare Cause of Pleural Effusion]. Pneumologie 2020; 75:138-141. [PMID: 32707589 DOI: 10.1055/a-1207-1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 33-year-old man presented to us with slowly progressive dyspnea. At the physical examination we found pleural effusion on the right side, lymph edema of the left lower limb and foot and blotchy map-like skin changes. The pleural puncture revealed a chylous effusion. In whole body MRI we saw the pleural effusion on the right, an increase in lymph vessels in the pelvis and paraaortic, and prominent chylous vessels. There was no bone involvement. The abdominal thoracic duct was enlarged by up to 3 mm. We diagnosed a general lymphatic anomaly (GLA) - lymphangiomatosis. GLA is a rare disease of unknown origin with dysplasia of the lymphatic system. The thoracic manifestation is often the development of chylous pleural effusions. However, many other organs can also be involved. Therapy includes in most cases symptomatic relief and the attempt to slow the progression of the disease.
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Affiliation(s)
- M Uhlenbruch
- Klinik für Pneumologie, Kardiologie und internistische Intensivmedizin, Florence Nightingale Krankenhaus, Kaiserswerther Diakonie, Düsseldorf
| | - S Keymel
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf
| | - S Krüger
- Klinik für Pneumologie, Kardiologie und internistische Intensivmedizin, Florence Nightingale Krankenhaus, Kaiserswerther Diakonie, Düsseldorf.,Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf
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Nicolas G, Shebli A, Minari AM, Sleimen AEH, Jaoude FA, Terro JJ, Zeidan M, Khairallah M, Hashem M. Propranolol Alleviating the Challenging Clinical Course of Birth Onset Generalized Lymphangiomatosis. A Case Report. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.05.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Cystic hygromas, interchangeably named Lymphangiomas, are rare, congenital, benign lesions due to an abnormal lymphatic system development that tend to occur mostly in the head, neck, and oral cavity.
Case Presentation: This is a case of 18 year old male patient Syrian, smoker, with a history of multiple cystic hygromas since birth along with a generous surgical history of multiple laparotomies for intrabadominal cystic excisions, splenectomy herniorrhaphies (bilateral inguinal hernias and 2 incisional hernias due to laparotomies) left orchieopexy then testiculectomy, scrotal skin graft , multiple abdominal radioguided cystic drainage and sclerotherapy; presented to our care center for fever, dry cough, pleuretic chest pain, and mild abdominal pain with watery diarrhea.
Conclusion: Cystic Hygroma is still being considered as a rare entity and can virtually occur in the whole body sites mostly at head and neck regions as explained above. Challenges in this disease is by finding cases where the presence of such cystic lesions is in extremely rare and unusual sites as well as different treatment modalities and prognostics depending on the site and size of the detected cystic formations.
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Luisi F, Torre O, Harari S. Thoracic involvement in generalised lymphatic anomaly (or lymphangiomatosis). Eur Respir Rev 2017; 25:170-7. [PMID: 27246594 PMCID: PMC9487238 DOI: 10.1183/16000617.0018-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/21/2016] [Indexed: 01/05/2023] Open
Abstract
Generalised lymphatic anomaly (GLA), also known as lymphangiomatosis, is a rare disease caused by congenital abnormalities of lymphatic development. It usually presents in childhood but can also be diagnosed in adults. GLA encompasses a wide spectrum of clinical manifestations ranging from single-organ involvement to generalised disease. Given the rarity of the disease, most of the information regarding it comes from case reports. To date, no clinical trials concerning treatment are available. This review focuses on thoracic GLA and summarises possible diagnostic and therapeutic approaches. Possible diagnostic and therapeutic approaches to generalised lymphatic anomaly (lymphangiomatosis)http://ow.ly/4n4pgU
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Affiliation(s)
- Francesca Luisi
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
| | - Olga Torre
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
| | - Sergio Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe, Multimedica IRCCS, Milan, Italy
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Chen CP, Wang KG, Huang HK, Peng CR, Chern SR, Wu PS, Chen YN, Chen SW, Lee CC, Wang W. Detection of mosaic 15q11.1-q11.2 deletion encompassing NBEAP1 and POTEB in a fetus with diffuse lymphangiomatosis. Taiwan J Obstet Gynecol 2017; 56:230-233. [DOI: 10.1016/j.tjog.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 10/19/2022] Open
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MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2598358. [PMID: 28367439 PMCID: PMC5359436 DOI: 10.1155/2017/2598358] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/19/2017] [Indexed: 11/30/2022]
Abstract
We propose a practical approach for performing high-resolution MR lymphangiography (MRL). We shall discuss and illustrate the technical approach for the visualization of lymphatic vessels in patients suffering from lymphedema, how to distinguish lymphatic vessels from veins, and MRL role in supermicrosurgery treatment planning. A brief review of literature, from a technical point of view, is also reported.
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Mitsumori LM. Response: Magnetic resonance lymphangiography: How to prove it? J Magn Reson Imaging 2016; 44:1368-1369. [DOI: 10.1002/jmri.25313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 04/28/2016] [Indexed: 11/10/2022] Open
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Mitsumori LM, McDonald ES, Neligan PC, Maki JH. Peripheral Magnetic Resonance Lymphangiography: Techniques and Applications. Tech Vasc Interv Radiol 2016; 19:262-272. [PMID: 27993321 DOI: 10.1053/j.tvir.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral lymphedema is a chronic progressive and debilitating disorder that results from abnormal lymphatic drainage. Advances in microsurgical techniques have led to the development of new treatment options for lymphedema that benefit from preoperative imaging to select the most appropriate surgical repair. Magnetic resonance (MR) lymphangiography is a noninvasive imaging modality capable of providing high-resolution 3D images of the lower extremities to define the severity and extent of lymphedema and depict individual lymphatic channels. The MR examination consists of 2 primary sequences. The first is a 3D heavily T2-weighted sequence to depict the severity and extent of the lymphedema. The second is a fat-suppressed 3D spoiled gradient-echo sequence performed after the intracutaneous injection of an extracellular gadolinium-based MR contrast agent. As venous enhancement almost always occurs, one of the interpretative challenges is differentiating enhancing lymphatic channels from superficial veins. MR techniques that can help with venous contamination include the addition of a contrast-enhanced MR venogram to the examination protocol, or the use of an iron-based blood-pool contrast agent to selectively suppress venous enhancement.
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Affiliation(s)
- Lee M Mitsumori
- Department of Radiology, Straub Clinic and Hospital, Honolulu, HI
| | | | - Peter C Neligan
- Department of Surgery, University of Washington, Seattle, WA
| | - Jeffrey H Maki
- Department of Radiology, University of Washington, Seattle, WA.
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Kim EY, Hwang HS, Lee HY, Cho JH, Kim HK, Lee KS, Shim YM, Zo J. Anatomic and Functional Evaluation of Central Lymphatics With Noninvasive Magnetic Resonance Lymphangiography. Medicine (Baltimore) 2016; 95:e3109. [PMID: 27015184 PMCID: PMC4998379 DOI: 10.1097/md.0000000000003109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Accurate assessment of the lymphatic system has been limited due to the lack of optimal diagnostic methods. Recently, we adopted noncontrast magnetic resonance (MR) lymphangiography to evaluate the central lymphatic channel. We aimed to investigate the feasibility and the clinical usefulness of noninvasive MR lymphangiography for determining lymphatic disease.Ten patients (age range 42-72 years) with suspected chylothorax (n = 7) or lymphangioma (n = 3) who underwent MR lymphangiography were included in this prospective study. The thoracic duct was evaluated using coronal and axial images of heavily T2-weighted sequences, and reconstructed maximum intensity projection. Two radiologists documented visualization of the thoracic duct from the level of the diaphragm to the thoracic duct outlet, and also an area of dispersion around the chyloma or direct continuity between the thoracic duct and mediastinal cystic mass.The entire thoracic duct was successfully delineated in all patients. Lymphangiographic findings played a critical role in identifying leakage sites in cases of postoperative chylothorax, and contributed to differential diagnosis and confirmation of continuity with the thoracic duct in cases of lymphangioma, and also in diagnosing Gorham disease, which is a rare disorder. In patients who underwent surgery, intraoperative findings were matched with lymphangiographic imaging findings.Nonenhanced MR lymphangiography is a safe and effective method for imaging the central lymphatic system, and can contribute to differential diagnosis and appropriate preoperative evaluation of pathologic lymphatic problems.
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Affiliation(s)
- Eun Young Kim
- From the Department of Radiology and Center for Imaging Science (EYK, HSH, HYL, KSL); Department of Thoracic and Cardiovascular Surgery (JHC, HKK, YMS, JZ), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Radiology (EYK), Ajou University School of Medicine, Suwon, Korea
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12
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Herruela-Suffee C, Warin M, Castier-Amouyel M, Dallery F, Bonnaire B, Constans JM. Whole-body MRI in generalized cystic lymphangiomatosis in the pediatric population: diagnosis, differential diagnoses, and follow-up. Skeletal Radiol 2016; 45:177-85. [PMID: 26545884 DOI: 10.1007/s00256-015-2280-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/18/2015] [Accepted: 10/26/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Generalized cystic lymphangiomatosis is a particularly rare disease with variable involvement of skeletal and extraskeletal sites. The key role of imaging in the diagnosis of this disease is no longer in doubt. The aim of our study was to demonstrate the contribution of whole-body magnetic resonance imaging (WB-MRI) at the diagnostic stage and during the follow-up in the pediatric population. SUBJECTS AND METHODS Three children were included from 2008. The inclusion criteria were radiological images (conventional radiographs, computed tomography, and MRI) compatible with histological confirmation. Each child included received WB-MRI at the diagnosis stage and during follow-up. RESULTS WB-MRI detected multiple hypointense T1 and hyperintense T2-STIR cystic bony lesions. One unnoticed mass in the retroperitoneum on computed tomography was easily detected by MRI. Mediastinal involvement was observed in one asymptomatic case. Histology was contributory in all cases. Preventive intramedullary nailings was done in one case. Follow-up WB-MRI detected new asymptomatic lesions in all cases. One child presented a third episode of lymphangitis of the right thigh during follow-up. CONCLUSIONS Due to its high sensitivity to diagnose, ability to eliminate differential diagnoses and make exhaustive lesions assessment, and its non-radiating character for long-term follow-up, WB-MRI is highly recommended for generalized cystic lymphangiomatosis in the pediatric population.
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Affiliation(s)
| | - Mathilde Warin
- Service de Radiologie, CHU Amiens-Picardie, 80054, Amiens Cedex 1, France
| | | | - Florine Dallery
- Service de Radiologie, CHU Amiens-Picardie, 80054, Amiens Cedex 1, France
| | - Bruno Bonnaire
- Service de Radiologie, CHU Amiens-Picardie, 80054, Amiens Cedex 1, France
| | - Jean-Marc Constans
- Service de Radiologie, CHU Amiens-Picardie, 80054, Amiens Cedex 1, France
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Mitsumori LM, McDonald ES, Wilson GJ, Neligan PC, Minoshima S, Maki JH. Mr lymphangiography: How i do it. J Magn Reson Imaging 2015; 42:1465-77. [DOI: 10.1002/jmri.24887] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/21/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- Lee M. Mitsumori
- Department of Radiology; Straub Clinic and Hospital; Honolulu Hawaii USA
| | | | - Gregory J. Wilson
- Department of Radiology; University of Washington; Seattle Washington USA
| | - Peter C. Neligan
- Department of Plastic Surgery; University of Washington; Seattle Washington USA
| | - Satoshi Minoshima
- Department of Radiology; University of Washington; Seattle Washington USA
| | - Jeffrey H. Maki
- Department of Radiology; University of Washington; Seattle Washington USA
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Munn LL, Padera TP. Imaging the lymphatic system. Microvasc Res 2014; 96:55-63. [PMID: 24956510 DOI: 10.1016/j.mvr.2014.06.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/12/2014] [Indexed: 02/07/2023]
Abstract
Visualization of the lymphatic system is clinically necessary during diagnosis or treatment of many conditions and diseases; it is used for identifying and monitoring lymphedema, for detecting metastatic lesions during cancer staging and for locating lymphatic structures so they can be spared during surgical procedures. Imaging lymphatic anatomy and function also plays an important role in experimental studies of lymphatic development and function, where spatial resolution and accessibility are better. Here, we review technologies for visualizing and imaging the lymphatic system for clinical applications. We then describe the use of lymphatic imaging in experimental systems as well as some of the emerging technologies for improving these methodologies.
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Affiliation(s)
- Lance L Munn
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - Timothy P Padera
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
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Lu Q, Hua J, Kassir MM, Delproposto Z, Dai Y, Sun J, Haacke M, Hu J. Imaging lymphatic system in breast cancer patients with magnetic resonance lymphangiography. PLoS One 2013; 8:e69701. [PMID: 23861979 PMCID: PMC3702586 DOI: 10.1371/journal.pone.0069701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 06/17/2013] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the feasibility of gadolinium (Gd) contrast-enhanced magnetic resonance lymphangiography (MRL) in breast cancer patients within a typical clinical setting, and to establish a Gd-MRL protocol and identify potential MRL biomarkers for differentiating metastatic from non-metastatic lymph nodes. Materials and Methods 32 patients with unilateral breast cancer were enrolled and divided into 4 groups of 8 patients. Groups I, II, and III received 1.0, 0.5, and 0.3 ml of intradermal contrast; group IV received two 0.5 ml doses of intradermal contrast. MRL images were acquired on a 3.0 T system and evaluated independently by two radiologists for the number and size of enhancing lymph nodes, lymph node contrast uptake kinetics, lymph vessel size, and contrast enhancement patterns within lymph nodes. Results Group III patients had a statistically significant decrease in the total number of enhancing axillary lymph nodes and lymphatic vessels compared to all other groups. While group IV patients had a statistically significant faster time to reach the maximum peak enhancement over group I and II (by 3 minutes), there was no other statistically significant difference between imaging results between groups I, II, and IV. 27 out of 128 lymphatic vessels (21%) showed dilatation, and all patients with dilated lymphatic vessels were pathologically proven to have metastases. Using the pattern of enhancement defects as the sole criterion for identifying metastatic lymph nodes during Gd-MRL interpretation, and using histopathology as the gold standard, the sensitivity and specificity were estimated to be 86% and 95%, respectively. Conclusion Gd-MRL can adequately depict the lymphatic system, can define sentinel lymph nodes, and has the potential to differentiate between metastatic and non-metastatic lymph nodes in breast cancer patients.
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Affiliation(s)
- Qing Lu
- Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Hua
- Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- * E-mail: (J. Hua); (J. Hu)
| | - Mohammad M. Kassir
- Department of Radiology, Wayne State University; Michigan, United States of America
| | - Zachary Delproposto
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Yongming Dai
- MR Business, Greater China, Philips Healthcare, Shanghai, China
| | - Jingyi Sun
- Department of Radiology, Wayne State University; Michigan, United States of America
| | - Mark Haacke
- Department of Radiology, Wayne State University; Michigan, United States of America
| | - Jiani Hu
- Department of Radiology, Wayne State University; Michigan, United States of America
- * E-mail: (J. Hua); (J. Hu)
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Hashimoto's Thyroiditis and Kikuchi's Disease: Presentation of a Case and Review of the Literature. Case Rep Otolaryngol 2012; 2012:267595. [PMID: 23227401 PMCID: PMC3514797 DOI: 10.1155/2012/267595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 19-year-old woman with a history of Hashimoto's thyroiditis who presented with tender right anterior cervical lymphadenopathy and fever. Workup for infectious, autoimmune, and malignant causes was unremarkable. Surgical removal of cervical lymph nodes after detailed magnetic resonance (MR) imaging disclosed necrotizing lymphadenitis, also known as Kikuchi's disease (KD). The patient was treated with a short-term course of steroids, due to the onset of pancytopenia and borderline antiphospholipid antibodies combined with increased anti-thyroglobulin (anti-TG) titers. Despite being a diagnosis of exclusion, KD should be included in the differential of such patients, particularly in cases of previous or concurrent autoimmune diseases such as Hashimoto's thyroiditis, which necessitate a long-term follow-up.
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