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Iodine-induced hypothyroidism and goiter following lipiodolTM lymphography.

Hypothyroid goiter is a rare but well recognized complication following long term administration of iodine containing expectorants and disinfectants in children. Only few reports exist on iodine-induced hypothyroidism after a single injection of the iodized radiopaque dye Lipiodol. A 15-year-old boy with previously normal thyroid function is described who developed hypothyroid goiter within six weeks following bipedal lymphography. Urinary iodine excretion was extremely elevated up to 18 mg/day while serum concentrations of total thyroxine were below the euthyroid range and thyrotropin levels were elevated. After oral L-thyroxine treatment the goiter disappeared. Thyroid function remained normal when treatment was discontinued after five months although iodine excretion was still 50 times higher (2.5 mg/day) than in normal age matched children. The observed alterations of the thyroid gland were caused by a long lasting Wolff-Chaikoff effect with a delayed adaptation to high iodide concentrations.

Adolescent↗

Differential permeability of lymphatic and blood vessels in determining the route of metastasis as demonstrated by indirect lymphography.

Indirect mammo-lymphography with serial radiograms was made on rats bearing three established rat mammary carcinomas (SMT-2A, TMT-50, MT-W9B), with the water-soluble contrast medium, Iotasul. In the lymphogenously metastasizing SMT-2A, fine lymphatic sprouts from the tumor were seen converging into an afferent lymph vessel that was extending toward a metastatic regional lymph node, in 15-30 min. For 45 min, the dye remained localized in the primary tumor with no other vascular structures or viscera visible until it emerged in the urinary bladder, indicating that Iotasul was absorbed slowly into the systemic circulation via lymphatics and diluted beyond recognition by lymph and blood, and then reconcentrated in urine. In contrast, in the hematogenously metastasizing TMT-50, Iotasul was rapidly diffused into the blood stream, revealing the inferior caval vein within 5 min, and by 15 min the heart, aorta, common carotid arteries, kidney and ureter were all clearly revealed. In the non-metastasizing MT-W9B host, several small vascular markings around the tumor were seen by 10 min and the outline of kidneys and urinary bladder in 15 min, suggesting that the dye was also absorbed through blood capillaries but somewhat slowly. Thus, the differential vascular permeability in rat mammary tumors revealed by Iotasul has not only helped to distinguish lymphatics from blood vessels, but also to correlate it with their metastatic potential.

Adenocarcinoma↗

Gadofluorine 8: initial experience with a new contrast medium for interstitial MR lymphography.

RATIONALE AND OBJECTIVES: Differential diagnosis of malignant and beign lymph nodes is still a problem in lymphographic imaging modalities. Plain magnetic resonance imaging (MRI) and computed tomography (CT) are inadequate for detecting metastases in normal-sized lymph nodes and for differentiating enlarged nodes. Therefore it is important to have a contrast agent that accumulates in healthy lymphatic tissue but does not accumulate in metastatic deposits. METHODS: The lymphographic contrast agent Gadofluorine 8 (Schering AG, Berlin, Germany) is a lipophilic but water-soluble gadolinium complex. Lymphographic effects were investigated in guinea pigs, dogs, and tumor-bearing rabbits after interstitial (subcutaneous or intracutaneous) injection. MR imaging was performed using T1-weighted gradient-echo sequences until 120 min after administration. RESULTS: After interstitial injection Gadofluorine 8 accumulates in regional lymph nodes, resulting in a pronounced increase in signal intensity in the lymph nodes. Differentiation between normal and metastatic lymph nodes was achieved. CONCLUSIONS: Gadofluorine 8 is an innovative contrast agent that can distinguish between normal and tumorous lymph nodes in interstitial MR lymphography.

Animals↗

Prognostic significance of lymphography in stage IIIs Hodgkin's disease (HD).

Ninety-six patients with pathological stage IIIs Hodgkin's disease, uniformly treated with six cycles of MOPP and TNI, were retrospectively analysed in an effort to determine whether the lymphographic aspect of lymph nodes influence the prognosis. Case material was grouped according to the presence of lymph nodes less than 3 cm in diameter or larger at lymphography. Five-year survival and disease-free survival were 85 and 78% for patients with small lymph node involvement, compared to 48 and 30% for patients with larger lymph nodes. The comparative analysis between the lymphographic aspect and other prognostic factors shows that large lymphographic involvement is strongly correlated with the presence of large spleen involvement (P less than 0.0000029), followed by stage III2 (P less than 0.000612), followed by greater than or equal to 5 involved sites (P less than 0.012), followed by age greater than 40 yr (P less than 0.047). Conversely, no significant correlation was found with symptoms, histology and mediastinal involvement. Modifications of current treatment for both large and small lymph node involvement are discussed.

Adult↗

Sentinel lymph node biopsy using computed tomography-lymphography in patients with breast cancer.

BACKGROUND: The sentinel lymph node biopsy (SLNB) technique is established in the treatment of breast cancer. The current technique of mapping the SLN with blue dye or radiotracers requires a learning period. Tracer and injection site selection and intraoperative pathologic examination have been discussed. METHODS: We developed a three-dimensional computed tomography lymphography (3D CT-LG) technique with commercially available iopamidol. SLNB and backup dissection were performed in 40 patients with T1 and T2 breast cancer. Feasibility and efficacy of CT-LG were examined. RESULTS: In all patients, lymph flow and the surrounding anatomical environment were visualized with 3D CT-LG. SLNB was successful because of accurate navigation by 3D CT-LG. SLN was detected in all patients, whereas dye navigation failed in seven fatty axilla and two patients with prior excisional biopsy. Backup dissection confirmed the accuracy of CT-LG-guided SLNB. A false negative result was found in only one patient. Preoperative prediction was feasible in cases of SLN metastasis. CONCLUSIONS: CT-LG allowed accurate SLN localization by quickly and adequately visualizing the direct connection between the SLN and its afferent lymphatic vessels. Detailed cross-sectional images of lymphatic anatomy during CT resulted in successful SLNB with shortening of the presurgical examination schedule.

Adult↗

Case report: the incidental lipid embolization to the brain and kidney after lymphography in a patient with malignant lymphoma: CT findings.

Lipid embolization to the brain and kidney is reported, confirmed by computed tomography (CT) following lymphography in a man with malignant lymphoma. The patient complained of headache and unstable gait and became blind and hemiplegic immediately after the examination. With supportive therapy he recovered from the complications in 5 months except for slight gait disturbance, probably explained by cerebral infarction. Mechanisms of the combined brain and renal embolization are discussed.

Antineoplastic Combined Chemotherapy Protocols↗

Abdominal lymphography in thalassaemia major.

The appearances are described of abdominal lymphography in seven patients with thalassaemia major. All were severely and chronically anaemic. An abnormal course of lymphatic channels was seen in only one case. Nodal filling defects were found in all patients, lying centrally and peripherally, in para-aortic and iliac glands. The findings correlate well with the microscopic features of lymph nodes removed at therapeutic splenectomy. These show haemosiderin deposition and foci of extramedullary erythropoeisis.

Adolescent↗

Lymphography in alveolar soft part sarcoma.

Alveolar soft part sarcoma is a rare tumour found in musculofasculofascial planes, most often in the lower limbs of young adults. The tumour shows a characteristic orderly cellular arrangement and the few mitoses belie the often rapid progress of the disease. Cytoplasmic crystals unique to this tumour may be demonstrated. The need for thorough investigation of the patient as an initial staging procedure and to provide a prognostic forecast is emphasised. Isotope scanning of the bones, brain and liver is indicated. Two cases are reported which demonstrate the value of lymphography. The nodal features found were: 1. Enlargement of a lymph node of normal interal architecture. 2. Almost complete nodal replacement by tumour. 3. Pseudolymphomatous appearances. Follow up films are required, after an interval, to show the progress of the disease or response to therapy.

Adult↗

Bipedal lymphography in the management of bladder cancer.

Bipedal lymphography was performed in 91 patients with transitional cell carcinoma of the bladder. Equivocal reports were submitted in 18 (19.8%) examinations. In this series 18 (19.8%) of the patients died within one year of first treatment by radical radiotherapy. The prognosis was poorer in patients with more locally advanced tumours, in whom there was a higher proportion of abnormal lymphograms. An abnormal lymphogram was also related to a poorer prognosis than if the lymphogram was normal. This difference was greater when associated with a poorly differentiated cancer. The implications for management are discussed.

Carcinoma, Transitional Cell↗

The current practice of lymphography: a survey in the age of computed tomography.

A postal survey has revealed a reduction in the practice of lymphography in several hospitals where body computed tomography (CT) is available. Nowhere in this country has this reduction been quite so marked as in East Anglia, where very few lymphograms are now performed. Some of the factors which may be responsible are assessed; in particular, the introduction of body CT.

England↗

Serious adverse reaction to patent blue violet at lymphography.

Allergic reactions during lymphography are uncommon, usually minor and difficult to attribute to a single agent because of the common practice of mixing patent blue dye and local anaesthetic before injection. A case is presented where injection of patent blue dye alone was followed by generalised urticaria, swelling and constriction in the throat and difficulty breathing.

Adult↗

Transabdominal fine needle aspiration of retroperitoneal lymph nodes in staging of genitourinary tract cancer (correlation with lymphography and lymph node dissection findings).

Percutaneous fine needle aspiration of retroperitoneal pelvic and abdominal lymph nodes was done in 100 patients with clinically localized bladder, prostatic, testis and penile cancer. A diagnosis of metastases to regional lymph nodes was detected by this method in 20 patients. Fine needle aspiration revealed evidence of regional lymph node involvement in 6 of 40 patients (15 per cent) with negative findings on lymphography and computerized tomography scan. Lymph node aspiration was followed by lymph node dissection in 50 patients. The correlation between aspiration and dissection was 68 per cent. The accuracy of obtaining representative material from the lymph node aspiration was 83 per cent. Negative results of lymph node aspiration cannot be used in clinical management. However, positive aspiration results provide the clinician with valuable information obtainable otherwise only by laparotomy or lymph node dissection. Positive aspiration results may spare patients with prostatic and bladder cancer an unnecessary radical operation, and may indicate early chemotherapy or surgery in patients with testis and penile cancer.

Biopsy, Needle↗

Lymphography and percutaneous lymph node biopsy in clinically localized carcinoma of the prostate.

Accurate staging of prostatic carcinoma requires determination of the status of the regional draining lymph nodes. Pelvic lymphadenectomy is the definitive examination but has certain morbidity and even mortality. Lymphography is safe but may not be sufficiently accurate. A total of 41 patients with clinically localized disease and abnormal or suspicious lymphograms underwent percutaneous lymph node biopsy. Ten of 11 patients (91 per cent) with abnormal lymphograms and 14 of 30 (47 per cent) with suspicious lymphograms had positive cytology studies. Of the suspicious defects an unopacified void in a nodal chain most frequently was positive. Of 22 potentially curable patients with stages A and B1 disease 12 had metastatic disease.

Biopsy↗

Testicular lymphography: clinical study.

Direct injection of lipiodol into the parenchyma of the human testis to study retroperitoneal lymphatics and lymph nodes is a potentially dangerous investigation. The information obtained with this study is incomplete and far inferior when compared to results obtained with standard procedures, such as pedal lymphography or cannulation of testicular lymphatics.

Adult↗

Indirect computed tomography lymphography using iodinated nanoparticles: time and dose response in normal canine lymph nodes.

RATIONALE AND OBJECTIVES: We evaluated the effect of time and dose on lymph node iodine uptake after subcutaneous or submucosal administration of iodinated nanoparticles used for computed tomography lymphography. METHODS: We injected 0.1-6 ml of a 15% wt/vol iodinated nanoparticle suspension into the distal extremities subcutaneously (n = 5) or into the buccal submucosa (n = 7) of normal dogs. Precontrast and 4, 12, 24, and 48 hr after contrast administration, CT scans of opacified lymph nodes were obtained. Iodine concentration, node volume, and total iodine uptake were estimated for each node. RESULTS: All estimated parameters increased between 4 and 12 hr postcontrast (p < .05), with no significant increase thereafter. At 24 hr postcontrast, iodine concentration ranged from 0.01 to 16.1 mg/ml (47-568 Hounsfield units). The average iodine concentration and total iodine uptake increased with contrast dose (p < .05) for all lymph node groups evaluated. Node opacification also revealed internal architectural detail. CONCLUSION: Subcutaneous and submucosal injections of iodinated nanoparticles result in a dose-dependent iodine uptake in targeted lymph nodes. In addition, architectural detail within opacified nodes can be visualized.

Animals↗

Iodinated nanoparticles for indirect computed tomography lymphography of the craniocervical and thoracic lymph nodes in normal dogs.

RATIONALE AND OBJECTIVES: We evaluated the imaging characteristics of an interstitially or intraperitoneally delivered iodinated particulate contrast agent for computed tomography (CT) lymphography of the craniocervical and thoracic lymph nodes. METHODS: We injected 2-4 ml of 15% wt/vol iodinated nanoparticle suspension subcutaneously, submucosally, or intraperitoneally in eight normal dogs. CT and plain radiographic images were obtained prior to contrast administration and 4 hr, 24 hr, and 7 days after injection. Correlation was made to detailed postmortem assessment. RESULTS: CT images showed enhancement of regional nodes draining injection sites. Mean attenuation of opacified nodes was 313 +/- 297 (mean +/- standard deviation), 536 +/- 453, and 492 +/- 372 Hounsfield units at 4 hr, 24 hr, and 7 days postinjection, respectively. Lymph node opacification on CT images correlated well with node location found at postmortem. CONCLUSION: Craniocervical and thoracic lymph nodes can be effectively opacified from interstitial or intraperitoneal delivery of this iodinated nanoparticulate contrast agent.

Animals↗

Indirect computed tomography lymphography using iodinated nanoparticles to detect cancerous lymph nodes in a cutaneous melanoma model.

RATIONALE AND OBJECTIVES: To evaluate differences in contrast uptake in normal and cancerous lymph nodes on indirect computed tomography (CT) in swine, we conducted lymphographic examinations after subcutaneous injection of a lymphotropic iodinated nanoparticle suspension. METHODS: Perilesional subcutaneous contrast injections (2 ml per lesion) of a 15% wt/vol iodinated nanoparticle suspension were made in immature Sinclair miniature swine (n = 5) with cutaneous melanomas. Average attenuation, iodine concentration, node volume, and total iodine uptake were estimated on the CT scans for each opacified lymph node 24 hr after injection. Nodes were classified as normal or cancerous microscopically, and the percentage of tumor replacement was estimated in cancerous nodes. RESULTS: Average attenuation and iodine concentration were higher in normal nodes, and total iodine uptake was higher in cancerous nodes with greater than 25% replacement (p < .05). Architectural alterations in opacified cancerous nodes included medullary filling defects, expansile cortical lesions, and disruption of corticomedullary junctions. CONCLUSION: Quantitative and qualitative differences in iodinated nanoparticle enhancement characteristics are useful in distinguishing between normal and cancerous lymph nodes on indirect CT lymphography examinations.

Animals↗