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Erschienen in: Heart and Vessels 4/2023

01.11.2022 | Original Article

Abdominal lymphatic pathway in Fontan circulation using non-invasive magnetic resonance lymphangiography

verfasst von: Yumi Shiina, Kei Inai, Eriko Shimada, Reiko Sakai, Katsutoshi Tokushige, Koichiro Niwa, Michinobu Nagao

Erschienen in: Heart and Vessels | Ausgabe 4/2023

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Abstract

Lymphatic congestion is known to play an important role in the development of late Fontan complications. This study aimed to (1) develop a gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) contrast three-dimensional heavily T2-weighed MR technique that can detect abnormal lymphatic pathway in the abdomen while simultaneously evaluating hepatocellular carcinoma (HCC) and to (2) propose a new classification of abnormal abdominal lymphatic pathway using a non-invasive method in adults with Fontan circulation. Twenty-seven adults with Fontan circulation who underwent Gd-EOB-DTPA abdominal MR imaging were prospectively enrolled in this study. We proposed MR lymphangiography that suppresses the vascular signal on heavily T2-weighted imaging after EOB contrast. The patients were classified as follows: grade 1 with almost no lymphatic pathway, grade 2 with a lymphatic pathway mainly around the bile duct and liver surface, and grade 3 with a lymphatic pathway mainly around the vertebral body and inferior vena cava. The grade 3 group showed the lowest oxygen saturation level, highest central venous pressure, highest incidence of massive ascites, HCC, and focal nodular hyperplasia. This group also tended to have patients with the oldest age and highest cardiac index; however, the difference was not statistically significant. As for the blood test, the grade 3 group showed the lowest platelet count and serum albumin level and the highest fibrosis-4 index. A novel technique, Gd-EOB-DTPA MR lymphangiography, can detect abnormal abdominal lymphatic pathways in Fontan circulation, which can reflect the severity of failing Fontan.
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Metadaten
Titel
Abdominal lymphatic pathway in Fontan circulation using non-invasive magnetic resonance lymphangiography
verfasst von
Yumi Shiina
Kei Inai
Eriko Shimada
Reiko Sakai
Katsutoshi Tokushige
Koichiro Niwa
Michinobu Nagao
Publikationsdatum
01.11.2022
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 4/2023
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-022-02196-8

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