Functional Abnormalities

Chemo Secrets From a Breast Cancer Survivor

Breast Cancer Survivors

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In the case of lymphedema where lymphatic malformations alter lymphatic drainage patterns, the lymphatic flow may be slowed down. Currently, lymphoscintigraphy is the only clinically available method to examine lymphatic function. However, the poor spatial resolution of lymphoscintigraphy does not allow it to be applied to small animals. Even in humans, spatial resolution is inadequate to identify specific lymphatic vessels. In k-cycline transgenic mice, a lymphedema model, the dynamic MR lymphangiogram with a Gd-dendrimer contrast agent was able to diagnose the slowed lymphatic flow characteristics of lymphedema (Figure 2.8) (Sugaya et al., 2005). Another potential clinical application of MR lymphangiography is to investigate the lymphatic function of the sentinel node, which may provide insight into lymphatic flow from cancer tissue to the regional lymph nodes. For this application, the dose might be further minimized for specific local use to detect sentinel nodes metastasis of breast cancer (Figure 2.9a) (Kobayashi et al., 2004). Studies in animals were able to demonstrate detection of multiple lymph nodes, normal flow, and the lymphatic vessels as well. Nodal metastases were detectable as filling defects within the nodes. Thus, MRL using G6 dendrimer could be useful for staging, monitoring,

5 mm 15 min 30 min 45 min 60 min

5 mm 15 min 30 min 45 min 60 min

Figure 2.8. Dynamic MR lymphangiograms of the G8 agent showed delayed detection of the right external iliac node (arrows) in a lymphedema model mouse (k-cycline transgenic; upper), compared to a wild-type littermate (lower).


" Superficial cervical node

Mammary gland

^Lateral thoracic node Axillary node


3D see-through display

Figure 2.9. A chest 3D-MR mammo-lymphangiogram (maximum intensity projection; left anterior oblique view 30°) of a normal mouse obtained with G6 contrast agent at 30 min post-intramammary glands (*) injection clearly depicts draining (sentinel) lymph nodes. 3D see-through display demonstrates the location of lymphatic vessels and sentinel lymph nodes through the skin (3D volume rendering image).

and planning surgical interventions in breast cancer patients to achieve medical and cosmetic objectives. Additionally, serial 3D images of the lymph system can be processed and presented using surface rendering to create a see-through surface (skin) in which the relation of the underlying SLN to the skin surface could be determined (Figure 2.9b).

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