Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Lymphatic Intervention, the Frontline of Modern Lymphatic Medicine: Part I. History, Anatomy, Physiology, and Diagnostic Imaging of the Lymphatic System

  • Saebeom Hur (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jinoo Kim (Department of Radiology, Ajou University Hospital) ;
  • Lakshmi Ratnam (Department of Radiology, St George's University Hospitals NHS Foundation Trust) ;
  • Maxim Itkin (Department of Radiology, Hospital of the University of Pennsylvania)
  • Received : 2022.09.13
  • Accepted : 2022.11.14
  • Published : 2023.02.01
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Abstract

Recent advances in lymphatic imaging have provided novel insights into the lymphatic system. Interventional radiology has played a significant role in the development of lymphatic imaging techniques and modalities. Radiologists should be familiar with the basic physiology and anatomy of the lymphatic system to understand the imaging features of lymphatic disorders, which reflect their pathophysiology. This study comprehensively reviews the physiological and anatomical aspects of the human lymphatic system as well as the latest lymphatic imaging techniques.

Keywords

Acknowledgement

This article was supported by grant no. 03-2022-0030 from the SNUH Research Fund.

References

  1. Kinmonth JB. Lymphangiography in man; a method of outlining lymphatic trunks at operation. Clin Sci 1952;11:13-20 
  2. Alitalo K. The lymphatic vasculature in disease. Nat Med 2011;17:1371-1380 
  3. Mortimer PS, Rockson SG. New developments in clinical aspects of lymphatic disease. J Clin Invest 2014;124:915-921 
  4. Levick JR, Michel CC. Microvascular fluid exchange and the revised Starling principle. Cardiovasc Res 2010;87:198-210 
  5. Goswami AK, Khaja MS, Downing T, Kokabi N, Saad WE, Majdalany BS. Lymphatic anatomy and physiology. Semin Intervent Radiol 2020;37:227-236 
  6. Hur S. Lymphatic Intervention. In: Korean Society of Interventional Radiology, ed. Interventional radiology, 3rd ed. Seoul: Ilchokak, 2022:541-559 
  7. Willard-Mack CL. Normal structure, function, and histology of lymph nodes. Toxicol Pathol 2006;34:409-424 
  8. Moore JE Jr, Bertram CD. Lymphatic system flows. Annu Rev Fluid Mech 2018;50:459-482 
  9. Frank BW, Kern F Jr. Intestinal and liver lymph and lymphatics. Gastroenterology 1968;55:408-422 
  10. Itkin M, Rabinowitz D, Hur S. Liver lymphatic imaging and interventions: resurrection of the forgotten knowledge. Semin Intervent Radiol 2020;37:318-323 
  11. Hur S, Jun H, Jeong YS. Novel interventional radiological management for lymphatic leakages after gynecologic surgery: lymphangiography and embolization. Gland Surg 2021;10:1260-1267 
  12. Havard AC, Collins DJ, Guy RL, Husband JE. Magnetic resonance behaviour of lipiodol. Clin Radiol 1992;45:198-200 
  13. Pamarthi V, Pabon-Ramos WM, Marnell V, Hurwitz LM. MRI of the central lymphatic system: indications, imaging technique, and pre-procedural planning. Top Magn Reson Imaging 2017;26:175-180 
  14. Schwartz FR, James O, Kuo PH, Witte MH, Koweek LM, Pabon-Ramos WM. Lymphatic imaging: current noninvasive and invasive techniques. Semin Intervent Radiol 2020;37:237-249 
  15. Kinmonth JB, Taylor GW, Harper RK. Lymphangiography; a technique for its clinical use in the lower limb. Br Med J 1955;1:940-942 
  16. Rajebi MR, Chaudry G, Padua HM, Dillon B, Yilmaz S, Arnold RW, et al. Intranodal lymphangiography: feasibility and preliminary experience in children. J Vasc Interv Radiol 2011;22:1300-1305 
  17. Bruun S, Engeset A. Lymphadenography. Acta Radiol 1956;45:389-395 
  18. Shanbrom E, Zheutlin N. Radiographic studies of the lymphatic system. Arch Intern Med 1959;104:589-593 
  19. Alejandre-Lafont E, Krompiec C, Rau WS, Krombach GA. Effectiveness of therapeutic lymphography on lymphatic leakage. Acta Radiol 2011;52:305-311 
  20. Campioni N. Lymphography in clinical practice. Policlinico Prat 1967;74:1349-1367 
  21. Lee EW, Shin JH, Ko HK, Park J, Kim SH, Sung KB. Lymphangiography to treat postoperative lymphatic leakage: a technical review. Korean J Radiol 2014;15:724-732 
  22. Kawasaki R, Sugimoto K, Fujii M, Miyamoto N, Okada T, Yamaguchi M, et al. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment. AJR Am J Roentgenol 2013;201:659-666 
  23. Kortes N, Radeleff B, Sommer CM, Bellemann N, Ott K, Richter GM, et al. Therapeutic lymphangiography and CT-guided sclerotherapy for the treatment of refractory lymphatic leakage. J Vasc Interv Radiol 2014;25:127-132 
  24. Ghysels MP, Le Moine O, Deviere J. Hepatic lymphography: another trick for portal vein location during transjugular intrahepatic portosystemic shunts. AJR Am J Roentgenol 1996;166:467-468 
  25. Sezai S, Sakurabayashi S, Yamamoto Y, Hirano M, Kamisaka K, Oka H. Percutaneous transhepatic lymphography (PTL) for visualizing metastasized lesions from hepatocellular carcinoma. International Hepatology Communications 1994;2:1-5 
  26. Matsumoto S, Mori H, Tada I. Successful demonstration of post-operative lymphatic fistula by percutaneous transhepatic lymphography. Clin Radiol 2000;55:485-486 
  27. Smith CL, Liu M, Saravanan M, Dewitt AG, Biko DM, Pinto EM, et al. Liver lymphatic anatomy and role in systemic lymphatic disease. Eur Radiol 2022;32:112-121 
  28. Biko DM, Smith CL, Otero HJ, Saul D, White AM, DeWitt A, et al. Intrahepatic dynamic contrast MR lymphangiography: initial experience with a new technique for the assessment of liver lymphatics. Eur Radiol 2019;29:5190-5196 
  29. Lee H, Kim SJ, Hur S, Kim HS, Min SI, Lee JH, et al. The feasibility of mesenteric intranodal lymphangiography: its clinical application for refractory postoperative chylous ascites. J Vasc Interv Radiol 2018;29:1290-1292 
  30. Kinmonth JB, Cox SJ. Protein-losing enteropathy in primary lymphoedema: mesenteric lymphography and gut resection. Br J Surg 1974;61:589-593 
  31. Dori Y, Zviman MM, Itkin M. Dynamic contrast-enhanced MR lymphangiography: feasibility study in swine. Radiology 2014;273:410-416 
  32. Krishnamurthy R, Hernandez A, Kavuk S, Annam A, Pimpalwar S. Imaging the central conducting lymphatics: initial experience with dynamic MR lymphangiography. Radiology 2015;274:871-878 
  33. Nadolski GJ, Ponce-Dorrego MD, Darge K, Biko DM, Itkin M. Validation of the position of injection needles with contrast-enhanced ultrasound for dynamic contract-enhanced MR lymphangiography. J Vasc Interv Radiol 2018;29:1028-1030 
  34. Chavhan GB, Amaral JG, Temple M, Itkin M. MR lymphangiography in children: technique and potential applications. Radiographics 2017;37:1775-1790 
  35. Itkin M. Magnetic resonance lymphangiography and lymphatic embolization in the treatment of pulmonary complication of lymphatic malformation. Semin Intervent Radiol 2017;34:294-300 
  36. Pimpalwar S, Chinnadurai P, Chau A, Pereyra M, Ashton D, Masand P, et al. Dynamic contrast enhanced magnetic resonance lymphangiography: categorization of imaging findings and correlation with patient management. Eur J Radiol 2018;101:129-135 
  37. Shaikh R, Biko DM, Lee EY. MR imaging evaluation of pediatric lymphatics: overview of techniques and imaging findings. Magn Reson Imaging Clin N Am 2019;27:373-385 
  38. Hong Y, Xiang L, Hu Y, Zhou Z, Yu H, Zhu B. Interstitial magnetic resonance lymphography is an effective diagnostic tool for the detection of lymph node metastases in patients with cervical cancer. BMC Cancer 2012;12:360 
  39. Lohrmann C, Pache G, Felmerer G, Foeldi E, Schaefer O, Langer M. Posttraumatic edema of the lower extremities: evaluation of the lymphatic vessels with magnetic resonance lymphangiography. J Vasc Surg 2009;49:417-423 
  40. Pieper CC, Feisst A, Schild HH. Contrast-enhanced interstitial transpedal MR lymphangiography for thoracic chylous effusions. Radiology 2020;295:458-466 
  41. Eggers H, Brendel B, Duijndam A, Herigault G. Dual-echo Dixon imaging with flexible choice of echo times. Magn Reson Med 2011;65:96-107 
  42. Johnson OW, Chick JF, Chauhan NR, Fairchild AH, Fan CM, Stecker MS, et al. The thoracic duct: clinical importance, anatomic variation, imaging, and embolization. Eur Radiol 2016;26:2482-2493 
  43. Hong JY, Han K, Jung JH, Kim JS. Association of exposure to diagnostic low-dose ionizing radiation with risk of cancer among youths in South Korea. JAMA Netw Open 2019;2:e1910584 
  44. Dong J, Xin J, Shen W, Wen T, Chen X, Sun Y, et al. CT lymphangiography (CTL) in primary intestinal lymphangiectasia (PIL): a comparative study with intraoperative enteroscopy (IOE). Acad Radiol 2018;26:275-281 
  45. Jin D, Sun X, Shen W, Zhao Q, Wang R. Diagnosis of lymphangiomatosis: a study based on CT lymphangiography. Acad Radiol 2020;27:219-226 
  46. Safar K, Aouaifia A, Oudjit A, Le Pimpec-Barthes F, Riquet M, Legmann P. Value of CT lymphangiography in the detection of lymphatic leakage: a report of nine cases. J Radiol 2011;92:25-31 
  47. Zhang C, Chen X, Wen T, Zhang Q, Huo M, Dong J, et al. Computed tomography lymphangiography findings in 27 cases of lymphangioleiomyomatosis. Acta Radiol 2016;58:1342-1348 
  48. Patel S, Hur S, Khaddash T, Simpson S, Itkin M. Intranodal CT lymphangiography with water-soluble iodinated contrast medium for imaging of the central lymphatic system. Radiology 2022;302:228-233