Transcript Benign lymph node in prostate CA

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PAST, PRESENT AND FUTURE OF
LYMPHANGIOGRAPHY
ALI AKBAR AMERI-MD
JALAL JALAL SHOKOUHI-MD
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• 5th century B.C
Hippocrates mentioned lymphatic system
• 1563 Eustachi described thoracic duct in horses
(Vena-alba thoracis)
• Rud beck 1630-1702: discovered vessels in the liver
containing no blood (clear fluid) with valve and drains
into thoracic duct
• Thomas Bartholin mentioned: all body have this vessels
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Introduction:
Primary
Lymph edema
Secondary
Lymphoscintigraphy:
Direct lymphography:
High resolution MR lymphography:
Diagnosis of lymph-edema is important but today
no imaging procedure has fulfilled these criteria.
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Imaging:
X-ray Lymphangiography (patent blue, Lipiodel ultrafluid)
For tumor staging (testis, lymphoma) and lymphoedema,
post traumatic, lymph obstruction, chilothorax
Lymphocele in post surgery and congenital lymph
anomalies.
Nowadays staging is possible by U.S, X-ray CT, MRI
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High resolution MR lymphangiography:
contrast administration:
1. Gadodiamide ,Extra cellular, Water soluble
paramagnetic contrast agent
Concentration of GD (0.5 mmol) – 0.1 mmol per/ kg of
body weight equivalent to 0.2 ml/ kg
Excluding patients with: Renal insufficiency allergy to
GD
2. Needle 24 gauge
3. 2ML mepivacaine hydrochloride 1%
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Micro-magnetic resonance Lymphangiography
with GD-labeled dendrimer nanoparticle T1w
3D, fast spoiled GRE T2, T1 w 3D fast imaging
employing steady-state (3D-FIESTA - C)
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Lymphoscintigraphy is primary imaging technique
but:
Ionizing radiation
Poor spatial and temporal resolution
Limited value for accurate assessment of lymphatic
anatomy and function
Direct lymphography:
Provide highest accumulation of contrast agent.
Long time examination- radiation-pulmonary embolism-infection
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Injection method:
All divided to (10 portions)
4 portions injected cutaneously to dorsal aspect of each
foot at four inter digital webs.
One portion is injected medial to both first proximal
phalanges
Max: 1.8 ml per portion with massage for 60 seconds
(pain)
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MR examinations:
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Foot and lower leg (dedicated peripheral surface coil)
Upper leg and knee
Pelvis and proximal upper leg (phased-array body coil)
Heavily T2W 3D turbo spin echo (TR/TE 2000/694) +
MIP
Strongest enhancement available at 45 to 55 minutes for
inguinal and external iliac 35 minutes for lymphatic
pathways (do not forget massage)
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Complementary for MR-Lymphangiography:
1. CT
2. PET-CT (c-choline pet)
for prostate is more accurate than MRI
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Water imaging:
• STIR
• Myelogram can show lymphatic channels using no dye
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Lymph duct. stenting
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Benign lymph node in prostate CA (CT)
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Right benign node, left malignant node bladder CA
(shape analysis)
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Ferumoxtran: enhances (darkness)right side benign node in bladder
CA (MRI T2* + Ferumoxtran), left side is malignant (Signal analysis)
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Malignant nodes in 3D MR by Ferumoxtran-10 prostate CA
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Lecture notes for new way
• Interstitial MR-Lymphangiography for detection of
sentinel lymph node
• To assess morphology of the pre- and post-operatively
cases for microsurgery reconstruction for the lumphatic
vessels and stenting.
• Validation study of MR-Lymphangiography using SPIO
(super para magnetic nanoparticle) contrast in bladder
cancer, GU cancer and prostate CA
Thank you for your attention