Utility of DCMRL in Guiding Interventions for Lymphatic Conditions in Patients with Congenital Heart Disease

Motivation: Lymphatic disease is a major cause of morbidity and mortality in children with congenital heart disease. Goal(s): This was a retrospective analysis of our six-year institutional experience with MR guided lymphatic intervention in patients with congenital heart disease (CHD). Approach: The utility of non-contrast magnetic resonance (MR) lymphangiography and dynamic contrast enhanced magnetic resonance lymphangiography (DCMRL) in patients with CHD was reviewed with respect to interventional planning. Results: Most patients had grade 3 or 4 lymphatic abnormality. Sixteen patients underwent thoracic duct occlusion and six underwent selective lymphatic collateral occlusion based on imaging findings. Lymphovenous connections were noted in sixteen patients. Impact: Use of MR lymphatic imaging to identify lymphatic anatomy, flow characteristics, and lymphovenous connections allows for enhanced understanding of lymphatic pathophysiology and will improve accuracy in identifying targets for selective intervention in patients with congenital heart disease.