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PubMed1981

[Lymph node staging in prostatic carcinoma Lymphography, pedal and intraprostatic lymphoscintigraphy, transcutaneous fine-needle lymph node biopsy and pelvic "guided" lymphadenectomy. Considerations on a series of 20 cases (1 September 1978-31 January 1980)].

Evaluation of lymph node involvement in carcinoma of the prostate is an essential step in staging when radical management is still possible. For this purpose, lymphography, lymphoscintigraphy, thin-needle transcutaneous lymph node biopsy, and pelvic lymphadenectomy have been variously combined since 1978 in 20 new cases (T1-T2-T3/Mo). Pedal lymphography displayed a good correlation with the histological data offered by adenectomy, and proved indispensable for the execution of transcutaneous biopsy under fluoroscopic control. Pedal lymphoscintigraphy is less invasive than lymphography. It provided suggestive morphological pictures of the lymph node chains, including those outside the pelvis; these, however, were difficult to interpret and must be regarded as of great, but complementary utility. Intraprostatic lymphoscintigraphy by injecting the radionuclide into the gland capsule permitted visualisation of the periprostatic nodes and confirmed previous experimental and clinical data. Lymph node metastases were seen in 50% of cases. Their frequency was inversely proportional to the degree of histological differentiation. In all cases, the external iliac and "obturator" (internal chain of external iliac group) notes were involved. Voluminous metastases were observed in two cases of "incidental" (To) carcinoma. The lymphography contrast medium was always found in the "obturators". It is suggested that these findings underscore the need for careful lymph node examination, even in the earliest stages of prostate cancer. They also raise further queries with regard to the treatment of incidental carcinoma.

Acid Phosphatase↗
PubMed2005

[High-resolution T1-weighted MR-lymphography of inguinal lymph nodes after interstitial application of Gadomer-17 in animal experiments].

PURPOSE: To evaluate the microstructural anatomy of inguinal lymph nodes in pigs after interstitial MR-lymphography with the dendritic contrast agent Gadomer-17. MATERIAL AND METHODS: High-resolution T1-weighted MR-lymphography was performed in inguinal lymph nodes of 10 domestic pigs (39 - 46 kg) after subcutaneous injection of 10 mumol/kg body weight Gadomer-17 in the hind legs of the animals. A 1.5T MR scanner and a ring-shaped surface coil were used. Two different high-resolution gradient-echo sequences with additionally reconstructed maximum-intensity projections were evaluated in a total of 20 lymph nodes. The high-resolution MR-findings were correlated with the histologic sections of the excised inguinal lymph nodes. RESULTS: Coronal T1-weighted 3D gradient-echo images (TR = 20 msec, TE = 6.1 - 8.3 msec, FA = 20 degrees ) with a slice thickness of 1 mm, a field-of-view of 120 mm and a matrix size of 256 x 256 (reconstructed to 1024 x 1024 voxels) yielding a reconstructed in-plane resolution of 117 x 117 microm (2) were best suited for the high-resolution MR lymphography of inguinal lymph nodes and enabled the differentiation of the hyperintense lymph node sinuses and hypointense lymphoid parenchyma of each lymph node (100 %). Even dilated lymphatic vessels evident in the histologic specimen were best demonstrated on the MIP images. CONCLUSION: High-resolution interstitial MR lymphography with Gadomer-17 allows the visualization of different tissue compartments of inguinal lymph nodes. This new technique is feasible on a routine 1.5T scanner and may offer potential for the detection of micrometastases in lymph nodes of cancer patients.

Animals↗
PubMed1989

[Isotype lymphography findings in sclerotherapy, varicose exeresis and excision of autologous venous transplants for arterial reconstructions].

In an isotope lymphography study on 24 patients (38 legs), the influence of complete sclerosation therapy of trunk varicosis of the great and small saphenous veins according to Tournay is examined before and, on average, four weeks after treatment. The isotope lymphography parameter was defined as the ratio of the outflow from the foot to the influx to the groin area (quotient Q). The results showed no significant change in Q after treatment compared with the starting values. Thus, sclerosation therapy did not result in any impairment of lymphatic transport. In contrast, of the 9 patients (12 legs) treated by varicose exeresis who were referred for isotope lymphography there were 8 cases (i.e. 9 legs) of impaired lymphatic transport. However, this was a pre-selected patient group. Three further patients were examined by isotope lymphography after resection of a saphenous segment for arterial reconstruction. These revealed excessive lymphatic transport disturbances which were quantified for the first time. Vascular surgeons should include this complication in their explanatory talks with patients.

Adult↗
PubMed1976

Current status of lymphography in patients with cancer.

In the early 1960's lymphography was received enthusiastically. Expectations were high that a very accurate diagnostic method for the detection of metastases had been found. This enthusiasm subsided after it became apparent that small lesions could not be discerned and that the images demonstrated were frequently nonspecific. Better correlation was achieved with advanced stages of cancer but because the presence of metastases was usually already known, it was questionable if the lymphogram contributed much to the management of the patient. In recent years, after the examination was placed in its proper prospective, the value and status of lymphography in patients with cancer were reassessed. The radiographic findings were divided into direct, or actual demonstration of metastastases, and indirect changes--those changes resulting from replacement of lymph nodes or blockage of the vessels by metastases. Lymphography proved particularly valuable in the diagnosis and staging of patients with pelvic cancer arising from such organs as cervix, uterus, vulva, ovary, and from tumors arising from the prostate, testicles, and penis. It also proved valuable in the assessment of extension of disease in melanomas of the extremities. The value of the positive lymphogram is easy to assess. However, when one encounters a "normal" lymphogram, one must realize that this does not exclude the presence of metastatic disease; it merely demonstrates that the the time of the study no lesions were recognized in visualized lymph nodes. Therefore, the negative lymphogram should not result in any modification of treatment which would have been prescribed under the same clinical circumstances if one did not have the lymphogram at hand.

Female↗
PubMed1981

Staging lymphography with respect to lymph node histology, treatment, and follow-up in patients with mycosis fungoides.

Extracutaneous involvement in mycosis fungoides (MF) is associated with a poor prognosis. Therefore, a pretreatment staging procedure is used to determine the extent of the disease. As part of the staging procedure lymphography was performed in 36 patients with MF. The radiographic findings and the correlation of these findings with the histopathologic changes in lymph nodes and the clinical course are described. Lymphography in MF shows a variety of abnormalities. However, these abnormalities correlate in only 61% of the patients with the extent and the clinical course of the disease. It is concluded that lymphography is not a useful clinical tool in the staging of MF.

Adult↗
PubMed1978

A comparative study between direct testicular and pedal lymphography in dogs. (A preliminary report).

In 20 dogs, 12 bilateral and 8 unilateral pedal and direct testicular lymphographies were performed. Comparison between the two methods showed that pedal lymphography failed to visualize some of the regional lymph nodes of the testicle. Histological examinations of the excised testicles two months after the injection of the contrast material failed to show any significant abnormalities. The potential applications of direct testicular lymphography are discussed.

Animals↗
PubMed1984

Value of lymphography in Stage IB cancer of the uterine cervix.

In many neoplasms, lymphography is a reliable method with which lymph node metastases are demonstrated, but its accuracy in Stage IB cancer of the uterine cervix remains to be more firmly established. One hundred patients with Stage IB cancer of the uterine cervix underwent lymphography before radical hysterectomy with pelvic lymphadenectomy was contemplated. All the lymphographic findings were reviewed without knowledge of the pathologic parameters of the patients and were classified as being either positive (five cases), suspicious (15 cases), or negative (80 cases). The pathologic studies revealed lymph node metastases in 18 patients--in five with positive lymphographic findings, in three with suspicious findings, and in 10 with negative ones. The five true positive cases were compared to the 13 false negative or suspicious lymphographic results. It appears that the former have a greater number of involved lymph nodes and a greater mean size of the metastases. Thus, in Stage IB cancer of the uterine cervix, lymphography demonstrates an excellent specificity (100%) but a low sensitivity (27.8%).

Female↗
PubMed1975

A review of the role of lymphography in the management of testicular tumours.

The pedal lymphographic findings in 260 patients with testicular tumours are reviewed: 117 patients had a seminoma, 105 had a teratoma and 38 combined tumours. 26 percent of seminomas were associated with a positive lymphogram, corresponding figures being 42 percent for teratomas and 53 percent for combined tumours. The role of the lymphogram is (1) to stage the case so that the extent and form of the treatment can be logically assessed, (2) to plan accurately radiotherapy treatment fields, (3) to observe the results of treatment on serial follow-up films, (4) to detect the recurrence of tumour using "re-fill" lymphography if necessary, (5) to show possible unsuspected metastases involving supraclavicular and mediastinal glands, and (6) to give a prognosis, since a negative lymphogram suggests an excellent chance of survival. Three main types of lymphographic appearances are recognized: nodal, mass replacement and "pseudo-lymphomatous". Nodal deposits are most common. Most positive findings are in the para-aortic chain on the same side as the tumour. Iliac involvement is much less common. Seminomas in this series showed a 96 percent crude three-year survival rate. For teratomas and combined tumours the three-year survival rates were 59 percent and 61 percent respectively, but deaths are uncommon in the lymphographically negative Stage I cases. Bone deposits are rare. Only two were found in this series. We do not perform testicular lymphography, but consider there is a useful role for inferior venacavography when there is poor filling of upper para-aortic nodes at lymphography. The importance of taking follow-up films after the initial examination is stressed.

Bone Neoplasms↗
PubMed1980

Magnification lymphography.

Magnification lymphography was performed on 37 patients, 22 of whom were suffering from bladder carcinoma, and compared with non-magnification lymphograms by two observers independently. The magnification lymphograms were performed on a Siemens Microfocus Bi 125/3/50 RG tube with a 0.1 mm focal spot. In six of the 37 patients (16%) significant extra information was found on the magnification lymphograms compared to the non-magnification lymphograms. In 31 out of 37 patients (84%), the intranodal detail shown was better in the magnification radiographs. Against the additional information gained must be weighed the disadvantages of magnification lymphography which include increased radiation dose, lengthening of procedure time, increased cost and the critical nature of exposure factors. In conclusion, magnification lymphography has a place and the disadvantages seem to be outweighed by the advantages.

Adult↗
PubMed1980

Changes in lymph node size induced by lymphography.

Although the contraction of normal lymph nodes after lymphography has been measured the enlargment caused by lymphography has not. In this study the lengths and widths of 25 radiologically normal nodes were measured in five patients who had a second lymphogram carried out when these nodes were still outlined by contrast medium from the first lymphogram. If the mean length after the second lymphogram is taken as 100% then the mean length 24 h earlier measured 82%, and if the mean volume after the second lymphogram is taken as 100% then the mean volume 24 h earlier was 49%. These substantial increases are similar to the reductions which have been reported in some previous papers and are probably due to distension of lymph node sinuses by oily contrast medium. It is obviously important that changes in lymph node size which are induced by lymphography itself be taken into account when follow-up films and repeat lymphograms are used to assess the response of lymph nodes to treatment.

Adult↗
PubMed1984

Priorities for computed tomography and lymphography in the staging and initial management of Hodgkin's disease.

Thirty-five patients with Hodgkin's disease were staged with the aid of chest radiographs, bipedal lymphograms and computed tomography (CT) scans. Computed tomographic findings altered management in only two patients (6%) by indicating enlargement of their radiotherapy fields. After lymphography, five patients (14%) were changed from Stage II (clinical and CT staging) to Stage III, so altering their management. Because either technique may show more extensive disease, CT and lymphography are complementary. Computed tomography should be performed initially. If it reveals no abnormality in the lymphogram area, lymphography, too, should be undertaken. Inverted Y fields are easier to visualise and design from lymphograms than from CT sections.

Combined Modality Therapy↗
PubMed1988

Lymphography in the initial evaluation of endometrial carcinoma.

Two hundred eighty-eight patients with endometrial carcinoma underwent a bipedal lymphography. The proportion of positive lymphangiograms is related to the clinical stage, the histologic grade, and the depth of myometrial invasion. Lymphography is not a significant predictor of survival taking into account the other prognostic factors. A histological examination of the lymph nodes was carried out for 138 patients. Lymphography is not very sensitive but is highly specific, detecting only 50% of metastases with a false positive rate that is too high. It therefore is of little diagnostic and prognostic value for operable patients. It is, however, useful for the followup of lymph nodes of patients treated by radiation therapy.

Evaluation Studies as Topic↗
PubMed1985

[Acute adult respiratory distress syndrome after lymphography].

Pulmonary complications of lymphography are usually described as radiological infiltrates without clinical symptoms. However, a case is here reported of an adult respiratory distress syndrome occurring after lymphography in a 60 year old female lymphoma patient. Pulmonary oedema developed within 48 h; haemodynamic study showed a normal capillary wedge pressure. The patient died from intractable low cardiac output within 24 h. Post-mortem examination showed pulmonary lymphocytic infiltration and multiple fat emboli. The lack of lymphatic drainage was probably responsible for the intravascular passage of lipid-soluble contrast medium, this giving endothelial lesions. In such patients with preexisting lung disease or pulmonary involvement in haematological disease, lymphography has to be considered carefully.

Embolism, Fat↗
PubMed1977

The diagnostic accuracy of lymphography in Hodgkin's disease (author's transl).

Between 1972 and 1975, exploratory laparotomies were carried out on 52 otherwise untreated patients with histologically verified Hodgkin's disease in stages I, II and III following lymphography. 84% of patients with negative lymphograms had histologically normal lymph nodes. 16% of negative lymphograms were shown to have to have histologically positive lymph nodes. Two out of eight patients diagnosed as positive on lymphography (25%) proved to be false positives caused by extensive lymph node involution. The diagnostic accuracy lymphography was therefore 83%. Surgical exploration was of value only in histologically positive cases. Post-operative control by means of lymphanigiography is essential for the evaluation of the course of Hodgkin's disease.

Adolescent↗
PubMed1979

[Lymph node metastases--diagnosis by lymphography and CT (author's transl)].

The value of lymphography and CT in the diagnosis of abdominal lymph node metastases was compared in 82 patients with various types of malignant disease. In the presence of systemic disease or testicular tumours, CT increased the recognition of lymph node metastases and their extent, particularly of high para-aortic deposits which were frequently underestimated by lymphography. Lymph nodes in the pelvis are more easily identified. CT is the first choice for the investigation of systemic disease and testicular tumours. This will, in addition, also demonstrate abnormalities of the organs and assist in radiation planning. CT is a simple procedure which is also very valuable in following the effect of treatment. For metastases from other origins, lymphography is often more valuable since CT is unable to identify metastases in lymph nodes if these are not enlarged. The two methods complement each other and their combination provides improved diagnostic information.

Carcinoma, Squamous Cell↗
PubMed1979

[A new contrast medium emulsion for lymphography (author's transl)].

A new contrast medium for lymphography has been developed. It is suitable for direct, such as bi-pedal, lymphangiography, and has certain advantages compared with the commercially available contrast medium Ethiodol, such as absence of a lipogranulomatous reaction and less extensive oil emboli in the lungs. It is also possible to use the substance for indirect, retrosternal lymphography. The substance is indirect, retrosternal lymphography. The substance is an emulsion of triglycerides of iodinated poppy seed oil. The method of preparation of the emulsion is described.

Animals↗
PubMed1980

[Lymphography in the head and neck: observations on lymphatic flow at various points--dog experiments (author's transl)].

Because of technical difficulties, lymphography of the neck is still in its developmental stage. The course of lymph flow in the head and neck has not been definitely elucidated. In order to clarify lymphatic pathways and localise cervical lymph nodes, lymphography was performed in the dog. The results show that, particularly for diseases of the tongue and oral cavity, maximum information is obtained by lymphography of the chin.

Animals↗
PubMed2002

Interstitial magnetic resonance lymphography with gadobutrol in rats: evaluation of contrast kinetics.

RATIONALE AND OBJECTIVE: To evaluate the contrast kinetics of gadobutrol for interstitial MR lymphography. MATERIALS AND METHODS: In 11 rats, 0.5 mL undiluted gadobutrol was injected subcutaneously into the hind paw. Contrast kinetics were measured in lymph nodes, kidney, liver, muscle, and blood of six animals using a time-resolved 2D GRE sequence. Additionally, high-resolution 3D T1-weighted data sets were obtained in five animals. RESULTS: Immediately after injection, a pronounced signal intensity loss was observed in popliteal, inguinal and aorto-iliac lymph nodes, followed by a continuous signal intensity increase. From the data peak concentrations of up to 78 mmol/L were estimated for selected lymph nodes. A contrast enhancement was also observed in kidneys, liver, muscle, and blood. Regional lymphatic vessels, the thoracic duct, as well as popliteal, inguinal, aorto-iliac, and axillary lymph node groups could be visualized with the high-resolution 3D MRI. CONCLUSION: Gadobutrol is suitable for interstitial MR lymphography, as it rapidly appears in the lymphatic system. Based on estimates of local tissue concentrations future studies have to assess the optimal contrast agent dosage. Furthermore, the investigation of metastatic lymph nodes is required to evaluate the further potential of gadobutrol for interstitial MR lymphography.

Animals↗