[Imaging of the lymphatic vascular system-techniques].

Clinical/methodical issue: Imaging of the lymphatic vascular system is comparatively difficult and logistically demanding.

Standard radiological methods: The field has developed significantly in recent decades. The longest established techniques are conventional X‑ray lymphangiography and lymphoscintigraphy.

Methodological innovations: In recent years, magnetic resonance (MR) and computed tomography (CT) lymphangiography have been developed using different contrast medium (CM) techniques. For interstitial lymphangiography, CM is injected intracutaneously, and absorbed and drained by the lymphatic system. For direct techniques, CM is injected directly into a lymph node or a prepared lymph vessel.

Performance: Lymphangiography procedures offer high anatomical and/or temporal resolution that have method-related differences. They allow better morphological assessment of the lymph vessels compared to lymphoscintigraphy. Furthermore, MR and CT lymphangiography are less invasive than conventional x‑ray lymphangiography.

Evaluation: MR lymphangiography in particular allows dynamic assessment of lymph flow through repetitive imaging, which is particularly valuable in complex situations. While MR lymphangiography is now established in centers despite the off-label use of CM, data regarding CT lymphangiography is still very limited.

Practical recommendations: A number of specific lymphatic imaging techniques are available at specialized centers.