Over the last 60 years, the primary imaging of the central lymphatic ducts was performed using a test called a pedal lymphangiogram. A contrast agent was injected and x-rays were taken to enable interventional radiologists to see all the structures of the lymphatic system. This traditional imaging procedure worked but was time-consuming and challenging for hospitals to manage equipment. Recent developments in imaging technology have made it easier to see inside the lymphatic system. A procedure called intranodal lymphangiogram uses ultrasound technology to access the lymphatic system and has almost completely replaced the traditional pedal lymphangiogram due to its simplicity and high rate of success.
Diagnostic Imaging
Intranodal (traditional) lymphangiogram
During the intranodal lymphangiogram, The lymph node in the groin is directly accessed using ultrasound guidance. An oil-based contrast agent called Lipiodol is injected so that the the lymphatic vessels can be observed under fluoroscopy (X-ray guidance).
Dynamic Contrast Enhanced MR Lymphangiography (DCMRL)
Similar to intranodal lymphangiogram, but the patient is positioned in a MR (magnetic resonance or MRI) scanner where a gadolinium-based contrast agent is injected into the lymph nodes. This technique provides superior imaging of the central lymphatic system. It provides both the anatomical and physiological/dynamic imaging of the central lymphatic system.
Intervention
Lymphatic embolization
Lymphatic embolization is recommended when abnormal lymphatic flow patterns develop or exist and create “leaks” or accumulation of fluid.
Lymphatic embolization is a two-part procedure. First, diagnostic imaging is performed to allow the surgeon to view the lymphatic system where the issues have been found. The surgeon will then access of the area of concern using x-rays to guide needles and possibly inject surgical glue, coils or plugs, or a combination of agents to help stop diagnosed leakage.