Magnetic Resonance Lymphangiography in Lower Limb Lymphedema

Background: Magnetic Resonance Lymphangiography (MRL) represents a pivotal advancement in the diagnostic imaging of lower limb lymphedema, offering detailed insights into lymphatic system abnormalities. Aim: To evaluate the feasibility and efficacy of high-resolution MRL using gadodiamide in patients with primary and secondary lower extremity lymphedema. Methods: This prospective study Conducted at Al-Azhar University Hospitals examined 20 patients who underwent MRL, adhering to strict inclusion and exclusion criteria to ensure the validity of findings. The imaging protocol entailed a meticulous approach, using a 1.5-Tesla MRI unit and a contrast-enhanced technique to visualize lymphatic and vascular structures optimally. This method facilitated classifying lymphatic drainage patterns into five distinct types, providing crucial information for surgical planning and therapeutic strategies. Results: We found that the prevalence of primary lymphedema was 45% of cases, with secondary causes mainly attributed to surgical interventions and trauma. A notable finding was the identification of dermal backflow in the distal leg (Pattern I) in 35% of cases, indicating advanced lymphatic dysfunction. Moreover, the study highlighted MRL's technical feasibility and safety, emphasizing its minimal invasiveness and potential as a superior diagnostic tool for lymphedema assessment. The mean time for detecting dilated lymphatic vessels was approximately 24 minutes, with a mean maximum diameter of 3.53 mm, underscoring the technique's efficacy in delineating lymphatic pathology. Conclusion: This study validates the utility of MR lymphangiography as a morphologically and functionally superior, minimally invasive imaging modality. It underscores its significance in mapping the lymphatic system and staging lymphedema, paving the way for targeted therapeutic interventions. MRL emerges as a promising diagnostic tool, offering significant benefits over traditional methods regarding safety, accuracy, and comprehensive assessment capabilities.