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Figure 1. 70-year-old woman with bilateral primary lymphoedema. (a) Coronal heavily T2 weighted three-dimensional (3D) turbo spin echo (TSE) source image demonstrates extensive epifascial lymphoedema of both upper legs (arrows). (b) Frontal 3D spoiled gradient echo magnetic resonance lymphography (MRL) maximum intensity projection (MIP) image, obtained 35 min after Prohance injection, clearly depicts one enlarged lymphatic vessel with a beaded appearance in both lower legs (small arrows). Note the concomitantly enhancing vein at the level of the right lower leg, which shows a lower signal intensity (arrowheads). Additionally, extensive areas of dermal backflow are revealed at the dorsal aspect of both feet, indicating delayed lymphatic flow with neovascularization due to obstruction (large arrows). (c) 3D spoiled gradient echo MRL source image reveals left inguinal lymph nodes (arrows) with afferent and efferent lymphatic vessels (arrowheads). Note enhancement of the bladder (asterisk), indicating venous uptake and renal clearance of the contrast media after intracutaneous injection.
