Non-Contrast Magnetic Resonance Lymphography: Technical Approach Toward Protocol Standardization

Background: Lymphedema is a chronic condition for which accurate imaging evaluation of the lymphatic system can contribute to diagnosis, disease assessment, and treatment planning. Non-contrast magnetic resonance lymphangiography (NCMRL) is an imaging technique that enables morphological visualization of lymphatic abnormalities without contrast agent administration. This technical report aims to describe the NCMRL protocol routinely implemented at our institution, with particular emphasis on lower-extremity imaging. Methods: The institutional NCMRL workflow performed on a 3 Tesla (3T) magnetic resonance imaging (MRI) system is described, including patient positioning, three-station anatomical coverage, pulse sequence selection, acquisition parameters, geometric alignment, and image post-processing using segmental and panoramic maximum intensity projection (MIP) reconstructions. Results: The report documents the acquisition and post-processing workflow and illustrates its imaging output through representative clinical images. No systematic assessment of diagnostic accuracy, quantitative image quality, or examination success rates was performed. Conclusions: This technical report provides a structured description of an existing institutional NCMRL workflow for lower-extremity imaging. The documented approach may serve as a reference for future protocol optimization and standardization, while its reproducibility and broader clinical applicability require further evaluation.