Lymphatic congestion in Fontan circulation demostrated by Gd-EOB-DTPA magnetic resonance lymphangiography

Motivation: In the Fontan circulation, congestive liver and lymphatic congestion caused by elevated central venous pressure become permanent. These complications (called as FALD) are considered poor prognostic factors as Fontan-associated liver disease, and hyperplasia of abnormal lymphatic pathway have often been seen. Goal(s): We attempt to depict abnormal lymphatic pathway using Gd-EOB-DTPA MRI and propose a classification of their severity. Approach: MR lymphangiography was scanned using three-dimensional heavily T2-weighted imaging with a 3-tesla scanner 10 minutes after Gd-EOB-DTPA administration. Patients were classified into the three grades. Results: MR lymphangiography with Gd-EOB-DTPA, demonstrates the localization and extent of the abnormal lymphatic pathways in Fontan circulation. Impact: In the Fontan circulation, the higer the lymphangiographic grade using MR lymphangiography with Gd-EOB-DTPA was, the more the adverse events was seen. The lymphangiographic grade is associated with the adverse events in Fontan-associated liver disease.