MRI of Lymphatic Abnormalities After Functional Single-Ventricle Palliation Surgery
MRI of Lymphatic Abnormalities After Functional Single-Ventricle Palliation Surgery
复制标题
DOI：
10.2214/ajr.13.11797
复制
发表时间：
2014-08-01
影响因子：
5
通讯作者：
Itkin, Maxim
中科院分区：
文献类型：
--
作者：
Dori, Yoav;Keller, Marc S.;Itkin, Maxim
目标。蛋白缺失性肠病(PLE)和塑料支气管炎是单脑室手术后发生的严重并发症。淋巴原因已被提出，但尚未有影像相关性的报道。本研究的目的是利用T2加权磁共振淋巴管成像技术评价功能性单心室姑息术后患者和非单心室先天性心脏病患者的淋巴管异常情况。我们回顾了2012年5月1日至2012年10月24日期间在我所接受T2加权磁共振淋巴管成像的48例患者的影像资料。将患者分为4组：上腔静脉-肺连接组、全腔-肺连接组、全腔-肺连接组、淋巴管合并症组、非单心室畸形组。在这些患者中观察到的淋巴异常包括胸腔导管扩张大于3 mm(31%)，淋巴管扩张和淋巴侧化(78%)，以及组织水肿(86%)。有5名PLE患者，1名塑料支气管炎患者，1名慢性乳糜液和上腔静脉-肺连接患者。PLE合并塑料支气管炎患者的胸腔导管最大径(中位数为3.9 mm，范围为3-7.2 mm)明显大于其他全腔静脉-肺动脉连接组(p<；0.01)。在两室组中，未发现异常淋巴管。结论：许多患者在功能性单室姑息术后发现淋巴管异常。T2加权平扫MRI能够对这一患者群体的淋巴系统进行解剖学评估，并有望指导未来的治疗。
OBJECTIVE. Protein-losing enteropathy (PLE) and plastic bronchitis are serious complications that occur after single-ventricle surgery. A lymphatic cause for these conditions has been proposed, but imaging correlation has not been reported. The objective of this study was to evaluate lymphatic abnormalities in patients after functional single-ventricle palliation compared with patients with non-single-ventricle congenital heart conditions using T2-weighted MR lymphangiography.MATERIALS AND METHODS. We retrospectively reviewed imaging data from 48 patients who underwent T2-weighted MR lymphangiography in our institution between May 1, 2012, and October 24, 2012. The patients were divided into four groups: patients who underwent superior cavopulmonary connection, patients who underwent total cavopulmonary connection, patients with total cavopulmonary connection and lymphatic complications, and patients with non-single-ventricle cardiac anomalies.RESULTS. There were 38 patients with single ventricles in this study. The lymphatic abnormalities observed in these patients included thoracic duct dilation greater than 3 mm (31%), lymphangiectasia and lymphatic collateralization (78%), and tissue edema (86%). There were five patients with PLE, one patient with plastic bronchitis, and one patient with chronic chylous effusions and superior cavopulmonary connection. The patients with PLE and plastic bronchitis had statistically significant larger thoracic duct maximal diameters (median, 3.9 mm; range, 3-7.2 mm) than did the other patients with total cavopulmonary connection (p < 0.01). In the two-ventricle patient group, there were no abnormal lymphatic findings.CONCLUSION. Lymphatic abnormalities are found in many patients after functional single-ventricle palliation. T2-weighted unenhanced MRI is capable of anatomic assessment of the lymphatic system in this patient population and has promise for guiding treatment in the future.