Rengui Wang

Background: When systemic lupus erythematosus (SLE) affects the lymphatic system, it disrupts the normal physiological function of the lymphatic circulation, leading to clinical chylous effusion and lymphedema. Currently, the computed tomography lymphangiography (CTL) or technetium-99m dextran (⁹⁹Tc^m-DX) lymphoscintigraphy features of patients with SLE complicated by chylous effusion and lymphedema have not been published, and studies on the imaging features of different subtypes are lacking. This study aimed to analyze the imaging characteristics of CTL and ⁹⁹Tc^m-DX lymphoscintigraphy in 23 patients with SLE complicated with chylous effusion and/or lymphedema, and describe the differences in imaging findings among different subtypes, so as to provide a reference for the clinical understanding of this disease. Methods: A retrospective analysis was conducted on the clinical and imaging data of 23 patients with SLE complicated by chylous effusion and/or lymphedema. All patients underwent CTL and ⁹⁹Tc^m-DX lymphoscintigraphy. The patients were divided into three subgroups: chylous effusion (n=19), chylous effusion and lymphedema (n=3), and lymphedema (n=3). The signs of lymphatic abnormalities detected by the two examinations were compared using the McNemar test (with the exact probability method), and diagnostic consistency was evaluated using the kappa test (PResults: No significant differences were found between CTL and ⁹⁹TC^m-DX lymphoscintigraphy in depicting thoracic duct outlet obstruction, thoracic segment tortuosity or dilation of the thoracic duct, left subclavian trunk visualization, abnormal perineal distribution, chylothorax, or chylous ascites (P>0.05), with kappa values of 0.623, 0.862, 0.511, 0.646, 0.425, and 0.777, indicating diagnostic agreement levels of good, almost perfect, good, good, moderate, and good, respectively. However, the two methods differed significantly in showing combined chylothorax and chylous ascites (PConclusions: CTL demonstrates subtle morphological abnormalities of lymphatic vessels and provides precise anatomical localization. ⁹⁹TC^m-DX lymphoscintigraphy is useful for dynamically evaluating lymphatic drainage and detecting chylous effusion. The two modalities are complementary and provide comprehensive information for SLE complicated by chylous effusion and/or lymphedema. Distinct imaging patterns among the three subgroups may support clinical subtyping of this condition.

Objective: To investigate the diagnostic value of combined non-contrast MR lymphangiography (NCMRL) and ⁹⁹ TC ^m -DX lymphoscintigraphy in systemic lupus erythematosus(SLE) and rheumatoid arthritis(RA) with lymphatic system involvement. Methods: A retrospective analysis was conducted on the clinical and imaging data of 25 SLE patients with lymphatic system involvement and 18 RA patients with lymphatic system involvement. All patients underwent NCMRL and ⁹⁹ TC ^m -DX lymphoscintigraphy examinations. The chi-square test or Fisher’s exact test was used to analyze the distribution differences of abnormal lymphatic system signs in NCMRL and ⁹⁹Tcᵐ-DX lymphangiography between the two groups of patients. McNemar’s test was used to compare the abnormal lymphatic vessel signs detected by the two imaging modalities in 43 patients with SLE or RA with lymphatic system involvement. The Kappa test was applied to evaluate the diagnostic consistency of the two imaging modalities in identifying abnormal lymphatic vessels in these patients. P < 0.05 was statistically significant. Results: MRL showed that the incidence of thoracic duct outlet obstruction in SLE patients with lymphatic system involvement (25, 100.0%) was significantly higher than that in RA patients with lymphatic system involvement (6, 33.3%) ( P = 0.000). In ⁹⁹Tcᵐ - DX lymphoscintigraphy, the incidence of chylous effusion in SLE patients with lymphatic system involvement (22, 88.0%) was significantly higher than that in RA patients with lymphatic system involvement (4, 22.2%), while the incidence of limb lymphedema in RA patients with lymphatic system involvement (14, 77.8%) was significantly higher than that in SLE patients with lymphatic system involvement (4 cases, 20.0%) ( P = 0.000). There was no statistically significant difference ( P > 0.05) in the detection rates of obstruction of the thoracic duct outlet, tortuous dilation of the thoracic segment of the thoracic duct, abnormality of the bronchial mediastinum, and dilation of the iliac lymphatic vessels and lumbar trunk between the two examinations. The Kappa values were rated as follows: almost perfect (1.000), good (0.788), moderate (0.482), and fair agreement (0.256). Conclusion: ⁹⁹Tcᵐ-DX lymphoscintigraphy dynamically reflects lymphatic reflux and identifies lymphedema and chylous effusion in SLE and RA patients with lymphatic involvement, but has low spatial resolution. NCMRL clearly displays systemic lymphatic vessel abnormalities and surrounding tissue conditions, yet cannot confirm chylous effusions or localize active chyle leakage. Combined use of the two modalities provides comprehensive imaging information for the clinical diagnosis of SLE and RA with lymphatic system involvement.

Introduction: The manifestations of the central lymphatic vessels in primary lower-extremity lymphedema (LEL) remain incompletely understood. Advanced magnetic resonance imaging (MRI) techniques offer the potential to noninvasively evaluate central lymphatic vessels and their relationship with disease severity. Our objective was to investigate the differences in imaging performance of central lymphatics and inguinal lymph nodes in primary LEL of different clinical stages, and to assess the ability of MRI to grade primary LEL. Methods: Patients were staged according to the International Society of Lymphology (ISL), with 92 cases in stage I, 134 in stage II, and 53 in stage III. All patients underwent lower-extremity MRI, pelvic MRI, and magnetic resonance thoracic ductography (MRTD). Chi-squared tests and Fisher’s exact tests were used to compare the relationship between the central lymphatic vessels and inguinal lymph nodes with clinical staging. LEL was graded based on MRI images, and a partial correlation coefficient was employed to assess the correlation between MRI grading and clinical staging. Results: A significant correlation was observed between clinical staging and MRI grading ( R = 0.728, p < 0.001). The incidence of abnormalities in the terminal thoracic duct and the lumbar and iliac lymphatic vessels differed significantly across clinical stages ( p ⩽ 0.001). Additionally, the frequency of enlarged inguinal lymph nodes on both the affected and the unaffected sides showed statistically significant differences ( p = 0.001). Conclusion: MRI grading demonstrates a high correlation with clinical staging. Changes in central lymphatic vessels and inguinal lymph nodes, as identified through MRTD, provide valuable insights for the clinical staging of primary LEL.

Background: Complex lymphatic anomaly is a type of lymphatic malformation involving multiple organs and systems, and its clinical and imaging manifestations are varied. The aim of this study was to retrospectively analyze the clinical and imaging features of conventional computed tomography (CT) and CT lymphangiography in patients with thoracic complex lymphatic anomaly. Further, we aimed to explore the imaging features and differences among different subtypes of thoracic complex lymphatic anomaly (generalized lymphatic anomaly, Gorham-Stout disease, central conducting lymphatic anomaly). Methods: This study enrolled 119 patients with thoracic complex lymphatic anomaly in Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine) from January 2017 to December 2020. The differences in gender, symptoms, lesion location, lesion morphology, and abnormal deposition of lipiodol among the three types of thoracic complex lymphatic anomaly were compared. Chi-square test or Fisher’s exact test was used, and Bonferroni test was used for pairwise comparison. Results: Among the 119 patients with thoracic complex lymphatic anomaly, 67 patients had generalized lymphatic anomaly, 21 patients had Gorham-Stout disease, and 31 patients had central conducting lymphatic anomaly. There were significant differences in the age (P=0.005), limb swelling (P=0.009), diarrhea (PConclusions: The different types of thoracic complex lymphatic anomaly have different clinical and imaging manifestations. Conventional chest CT and CT lymphangiography can provide imaging information for the diagnosis of different types of patients, which is conducive to accurate diagnosis and treatment.

To explore the value of non-enhanced magnetic resonance thoracic ductography (NMRTD) combined with MR abdominopelvic scanning in the diagnosis of chylous leakage of the female reproductive system. A retrospective analysis was conducted on the multimodal imaging data from non-enhanced magnetic resonance thoracic ductography (NMRTD), direct lymphangiography (DLG), and abdominopelvic magnetic resonance imaging (MRI) for 18 female patients with reproductive system chylous leakage. Among these patients, 7 had vaginal chylous leakage, 10 had vulvar cutaneous chylous leakage, and 1 had both conditions.The rate of successful visualization of the thoracic duct, the consistency of the drainage directions of the outlet of the thoracic duct, and the degree of visualization of each segment of the thoracic duct by NMRTD and DLG were analyzed. A retrospective analysis was performed on the abnormal manifestations of abdominopelvic MR. NMRTD had a significant advantage over DLG in terms of successful visualization of the thoracic duct (94.4% vs. 66.7%, P = 0.035). The display of the drainage directions in the outlet area of the thoracic duct by the two methods showed excellent consistency (kappa value = 0.815) in 12 patients whose outlet areas were visualized by both methods. The degrees of visualization of the upper, middle, and lower segments of the thoracic duct in the NMRTD group were significantly greater than those in the DLG group (P values were 0.02, 0.00 and 0.00, respectively). All 18 patients (100%) showed dilatation of the lymph vessels in the pelvic cavity and retroperitoneum on abdominopelvic MR and DLG as well as pelvic perineal reflux or leakage on DLG. MR revealed multiple-site abnormalities that could not be detected by DLG, including multiple long T1 and long T2 lesions of the spleen in 8 patients (44.4%), of the subcutaneous in 7 patients (38.9%), of the bone in 6 patients (33.3%), perineal lymphedema in 18 patients (100%), and abdominopelvic effusion in 10 patients (55.6%). NMRTD combined with abdominopelvic MR has advantages in comprehensively evaluating the thoracic duct and multiple systemic abnormalities in patients with chylous leakage of the female reproductive system.

Background: The difficulty in the diagnosis of chylothorax lies mainly in the fine structure of the lymphatic system, and the rupture of microscopic, branched lymphatic vessels which cannot be accurately diagnosed, and spectral computed tomography (CT) scanning can fill the gaps in the diagnosis of chylothorax in terms of the structure of the lymphatic system and the analysis of material composition. The study aims to elucidate the value of spectral CT plain scan after direct lymphangiography (DLG) in the diagnosis of chylothorax. Methods: From January 2018 to December 2023, we retrospectively recruited 59 patients with clinically confirmed diagnosis of chylothorax, and all patients underwent spectral CT after DLG scanning to observe the abnormalities of lymphatic vessels and the CT findings of other thoracic abnormalities, including abnormal contrast deposition, abnormal changes in the lungs, pleura, thoracic cavity, and mediastinum. Results: In all the 59 patients with chylothorax, abnormal contrast deposition was seen on spectral CT plain scan after DLG, and could be seen simultaneously in different areas of the superior mediastinum, the mediastinum and both sides of the mediastinum. In terms of anatomical sites, the location of abnormal contrast agent deposition was most common in the left venous angle. And multiple abnormalities in the lungs, the pleura, and the mediastinum were seen. Conclusions: Spectral CT plain scan after DLG is valuable for the diagnosis of chylothorax. Abnormal distribution of contrast in the lungs, lymphatic ducts and lymphatic trunks in spectral CT plain scan after DLG is an important manifestation of chylothorax, suggesting abnormal distribution and severity of the thoracic organs, lymphatic ducts and lymphatic trunks, and its imaging findings provide a basis for the clinical diagnosis and treatment of the disease.

Objectives: This study aims to develop and validate a novel predictive model combining clinical features and CT radiomics to forecast recurrence in CRLM patients. Methods: Data from 181 patients were sourced from The Cancer Imaging Archive. Lasso regression identified 15 clinical and 5 radiomic features as significant predictors. Logistic regression models were developed for clinical, radiomic, and combined datasets. Model performance was evaluated using ROC curves, calibration plots, and DCA. Results: The combined model demonstrated superior predictive accuracy with an Area Under the Curve of 0.818 in the training set and 0.742 in the testing set. Calibration plots showed a high degree of accuracy, with predicted probabilities closely matching observed outcomes. DCA indicated that the combined model provided the highest net benefit across various threshold probabilities. Risk stratification revealed distinct cumulative recurrence rates at 2 and 5 years, validating the model’s ability to effectively classify patients into low, intermediate, and high-risk categories. Conclusions: This study presents a novel predictive model that integrates clinical and radiomic features to enhance recurrence prediction in CRLM patients, offering significant potential for improving clinical outcomes and optimizing CRLM management.

Objectives To investigate the diagnostic value of CT lymphangiography (CTL) and non-contrast MR lymphangiography (MRL) in lymphatic plastic bronchitis. Materials and methods The clinical and imaging data of 31 patients with lymphatic plastic bronchitis diagnosed by clinical, imaging and pathological results were retrospectively analyzed. All patients underwent CTL and MRL. The imaging findings of patients include: (i) abnormal lymphatic reflux of the bronchial mediastinal trunk, the subclavian trunk, the cervical trunk, the thoracic duct and the right lymphatic duct; Abnormal CTL reflux refers to abnormal iodide deposition outside the normal lymphatic reflux pathway; If the MRL can observe abnormal lymphatic dilatation, hyperplasia, or morphological abnormalities, it is assumed that abnormal lymphatic reflux may be present.; (ii) abnormal morphological changes of lymphatic vessels at the extremity of the thoracic duct, the extremity of the right lymphatic duct and the mediastinum, such as spot-like or tubular, cystic changes; (iii) abnormal CTL and MRL signs in the lungs. The Mcnemar test was used to compare the parameters between CTL and MRL. P< 0.05 was statistically significant. The Kappa test was used to evaluate the consistency of CTL and MRL in evaluating lymphatic plastic bronchitis. Results MRL was superior to CTL in detecting abnormal lymphatic reflux in the right lymphatic vessel, thoracic duct, cervical trunk and subclavian trunk (P< 0.05).and the diagnostic consistency was general (Kappa < 0.40). There was no significant difference between MRL and CTL in the detection of abnormal lymphatic reflux in the bronchial mediastinal trunk (P> 0.05), and the diagnostic consistency was good (Kappa > 0.60). MRL was superior to CTL in detecting lymphatic abnormalities such as cystic changes at the extremity of the thoracic duct, spot-like or tubular changes at the extremity of the right lymphatic duct, cystic changes at the extremity of the right lymphatic duct, and cystic changes in the mediastinum (P< 0.05), and the diagnostic consistency was poor, fair, fair, and moderate (Kappa < 0.60), respectively. MRL and CTL showed abnormal signs in the lung: CTL was superior to MRL in showing the thickening of interlobular septum, lung nodules and airway stenosis (P< 0.05), and the diagnostic consistency was moderate, moderate and poor (Kappa < 0.60). There was no significant difference between CTL and MRL in atelectasis, consolidation in lobar and segmental distribution, consolidation in non-lobar and segmental distribution, and the thickening of the bronchovascular bundle (P> 0.05), and the diagnostic consistency was very good, very good, good, good (Kappa > 0.60). There was no significant difference between CTL and MRL in ground glass opacity, airway wall thickening and intralobular interstitial thickening (P> 0.05), and the diagnostic consistency was average, fair and poor (Kappa < 0.40). Conclusion The MRL is superior to CTL in showing the abnormalities of the thoracic duct, the right lymphatic duct and other abnormal lymphatic vessels. CTL is superior to MRL in the detection of pulmonary abnormalities. The combination of CTL and MRL can provide more comprehensive imaging information for diagnosing and treating lymphatic plastic bronchitis.