综合影像学诊断下肢乳糜反流性淋巴水肿

目的 探讨下肢乳糜反流性淋巴水肿的影像学表现.方法 回顾性分析26例患者27侧下肢肢体乳糜反流性淋巴水肿的影像学资料.所有患者均接受直接淋巴管造影(DLG)、造影后CT、核素淋巴显像检查,其中4例接受盆腔MR扫描,11例接受下肢MR扫描.结果 DLG示26例患者可见下肢乳糜反流,26例胸导管出口不同程度受阻；造影后CT所见与其基本吻合.核素淋巴显像显示27侧下肢肢体淋巴肿,伴9例阴囊淋巴水肿,19例胸导管出口梗阻；21例接受单侧淋巴显像,均证实乳糜反流存在.MRI示下肢、盆壁水肿呈网格状长T2信号.结论 DLG及核素淋巴显像可直接、动态显示淋巴系统异常；DLG后CT可弥补二者空间分辨力较低的缺陷,并可清晰显示周围组织的情况.MRI可以明确肢体淋巴水肿的部位及范围,鉴别水肿的类型.

Comprehensive imaging diagnosis of chylous reflux lymphedema of lower limbs

Objective: To explore the imaging appearances of chylous reflux lymphedema of lower limbs. Methods: The imaging materials of 26 patients with 27 lower limbs chylous reflux lymphedema were retrospectively analyzed. All patients underwent direct lymphangiography (DLG) and subsequent CT, as well as radionuclide lymphoscintigraphy. Four patients underwent pelvic MR and 11 underwent lower limbs MR scan. Results: Twenty-six patients represented chylous reflux of lower limbs and thoracic duct exit obstruction on DLG, which consistent with subsequent CT essentially. Twenty-six patients with 27 lower limb lymphedema and 9 scrotum lymphedema were found by radionuclide lymphoscintigraphy, 19 thoracic duct exit obstructions were also detected. Twenty-one patients were examined with unilateral lymphoscintigraphy confirming chylous reflux. Lower limb and pelvic lymphedema manifested long T2 signal intensity graticule on MRI. Conclusion: DLG and radionuclide lymphoscintigraphy can discover lymphatic system abnormality directly and dynamicly, while post-DLG CT can make up the defect of low spatial resolution for both, and display surrounding tissue distinctly. MRI may identify the position and extent of extremity lymphedema, and discriminate the type of edema.