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Contrast-Enhanced Sonographic Imaging of Lymphatic Channels and Sentinel Lymph Nodes

Jefferson Ultrasound Research and Education Institute, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania USA (B.B.G., D.A.M., J.-B.L., F.F.); and Department of Pathology, Brigham Women’s Hospital, Harvard Medical School, Boston, Massachusetts USA (G.M.).

Address correspondence to Daniel A. Merton, BS, RDMS, The Jefferson Ultrasound Research and Education Institute, Seventh Floor, Main Building, 132 S 10th St, Philadelphia, PA 19107 USA. E-mail: daniel.a.merton{at}mail.tju.edu

Objective. The purpose of this study was to determine whether lymphatic channels (LCs) and sentinel lymph nodes (SLNs) could be detected on sonographic imaging after subcutaneous, submucosal, or parenchymal injections of a sonographic contrast agent (ie, lymphosonography) in a variety of anatomic locations in several animal models. Methods. Eight swine, 7 canines, 4 rabbits, and a monkey were used for these evaluations. Gray scale pulse inversion harmonic imaging of the LCs and the SLNs was performed after subcutaneous (n = 58), submucosal (n = 14), or parenchymal (n = 8) injections of a tissue-specific sonographic contrast agent (Sonazoid; GE Healthcare, Oslo, Norway). In many instances, blue dye was injected into the same locations as Sonazoid, and surgical dissection of the SLNs and LCs was performed for comparison. Scanning electron microscopy (SEM) of contrast-enhanced and control lymph nodes from 2 rabbits was performed to determine the mechanism of contrast agent uptake and retention within SLNs. Results. After subcutaneous, submucosal, or parenchymal contrast agent injections, gray scale pulse inversion harmonic imaging could be used to identify the number and location(s) of LCs and SLNs. After subcutaneous, submucosal, or parenchymal contrast agent injections, Sonazoid was confined to the SLNs (ie, contrast enhancement was not detected in the second-echelon nodes). There was good agreement between the results of lymphosonography and blue dye with surgical dissection in identifying the regional LCs and SLNs. Scanning electron microscopy identified vacuoles representing intact contrast microbubbles within contrast-enhanced SLN macrophages, which were not present in the control lymph nodes. Conclusions. Lymphosonography can be used to detect lymphatic drainage pathways and SLNs in a variety of animal models.

Key Words: lymphatic channels • lymph nodes • lymphosonography • sonographic contrast agent

Abbreviations: AE, acoustic emission • CFI, color flow imaging • GI, gastrointestinal • GSPIHI, gray scale phase inversion harmonic imaging • LC, lymphatic channel • MI, mechanical index • RES, reticuloendothelial system • SEM, scanning electron microscopy • SLN, sentinel lymph node • 3D, 3-dimensional • 2D, 2-dimensional

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