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The Cisterna Chyli: Enhancement on Delayed Phase MR Images after Intravenous Administration of Gadolinium Chelate¹

¹ From the Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 1094 Main Bldg, Philadelphia, PA 19107. Received September 1, 2006; revision requested October 27; revision received November 9; accepted December 18; final version accepted February 1, 2007. Address correspondence to D.G.M. (e-mail: donald.mitchell{at}jefferson.edu).

View larger version (147K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Transverse MR images of CC in 56-year-old man with cirrhosis. (a) Single-shot fast spin-echo T2-weighted image (180–200-msec effective echo time) shows uniform high signal intensity of the CC (arrow)—similar to the cerebrospinal fluid signal intensity—in the right retrocrural space. (b) Nonenhanced 3D gradient-echo image (5/1.4, 12° flip angle) shows the CC (arrow) with low signal intensity. Corresponding contrast-enhanced (c) arterial phase and (d) portal venous phase images (5/1.4, 12° flip angle) show the CC (arrow) with no visible enhancement. In d, the azygos vein and tributary (arrowhead) are enhancing intensely. (e) Image obtained 3–5 minutes after gadolinium chelate injection shows the CC (arrow) with strong homogeneous enhancement, similar to the enhancement of the surrounding blood vessels.

View larger version (129K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Transverse MR images of CC in 56-year-old man with cirrhosis. (a) Single-shot fast spin-echo T2-weighted image (180–200-msec effective echo time) shows uniform high signal intensity of the CC (arrow)—similar to the cerebrospinal fluid signal intensity—in the right retrocrural space. (b) Nonenhanced 3D gradient-echo image (5/1.4, 12° flip angle) shows the CC (arrow) with low signal intensity. Corresponding contrast-enhanced (c) arterial phase and (d) portal venous phase images (5/1.4, 12° flip angle) show the CC (arrow) with no visible enhancement. In d, the azygos vein and tributary (arrowhead) are enhancing intensely. (e) Image obtained 3–5 minutes after gadolinium chelate injection shows the CC (arrow) with strong homogeneous enhancement, similar to the enhancement of the surrounding blood vessels.

View larger version (144K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Transverse MR images of CC in 56-year-old man with cirrhosis. (a) Single-shot fast spin-echo T2-weighted image (180–200-msec effective echo time) shows uniform high signal intensity of the CC (arrow)—similar to the cerebrospinal fluid signal intensity—in the right retrocrural space. (b) Nonenhanced 3D gradient-echo image (5/1.4, 12° flip angle) shows the CC (arrow) with low signal intensity. Corresponding contrast-enhanced (c) arterial phase and (d) portal venous phase images (5/1.4, 12° flip angle) show the CC (arrow) with no visible enhancement. In d, the azygos vein and tributary (arrowhead) are enhancing intensely. (e) Image obtained 3–5 minutes after gadolinium chelate injection shows the CC (arrow) with strong homogeneous enhancement, similar to the enhancement of the surrounding blood vessels.

View larger version (157K): [in this window] [in a new window] [Download PPT slide]   Figure 1d: Transverse MR images of CC in 56-year-old man with cirrhosis. (a) Single-shot fast spin-echo T2-weighted image (180–200-msec effective echo time) shows uniform high signal intensity of the CC (arrow)—similar to the cerebrospinal fluid signal intensity—in the right retrocrural space. (b) Nonenhanced 3D gradient-echo image (5/1.4, 12° flip angle) shows the CC (arrow) with low signal intensity. Corresponding contrast-enhanced (c) arterial phase and (d) portal venous phase images (5/1.4, 12° flip angle) show the CC (arrow) with no visible enhancement. In d, the azygos vein and tributary (arrowhead) are enhancing intensely. (e) Image obtained 3–5 minutes after gadolinium chelate injection shows the CC (arrow) with strong homogeneous enhancement, similar to the enhancement of the surrounding blood vessels.

View larger version (151K): [in this window] [in a new window] [Download PPT slide]   Figure 1e: Transverse MR images of CC in 56-year-old man with cirrhosis. (a) Single-shot fast spin-echo T2-weighted image (180–200-msec effective echo time) shows uniform high signal intensity of the CC (arrow)—similar to the cerebrospinal fluid signal intensity—in the right retrocrural space. (b) Nonenhanced 3D gradient-echo image (5/1.4, 12° flip angle) shows the CC (arrow) with low signal intensity. Corresponding contrast-enhanced (c) arterial phase and (d) portal venous phase images (5/1.4, 12° flip angle) show the CC (arrow) with no visible enhancement. In d, the azygos vein and tributary (arrowhead) are enhancing intensely. (e) Image obtained 3–5 minutes after gadolinium chelate injection shows the CC (arrow) with strong homogeneous enhancement, similar to the enhancement of the surrounding blood vessels.

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: (a) Coronal single-shot fast spin-echo T2-weighted MR image (180–200-msec echo time) shows a high-signal-intensity retroperitoneal cystic structure (arrow) of uncertain origin and without visible communication with the CC (arrowhead). (b) Transverse 3D gradient-echo delayed phase MR image (5/1.4, 12° flip angle) shows no enhancement of the cystic structure (arrow). (c) Transverse 3D gradient-echo delayed phase MR image (5/1.4, 12° flip angle) obtained at a level slightly higher than b shows the CC (arrowhead) enhancing intensely.

View larger version (162K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: (a) Coronal single-shot fast spin-echo T2-weighted MR image (180–200-msec echo time) shows a high-signal-intensity retroperitoneal cystic structure (arrow) of uncertain origin and without visible communication with the CC (arrowhead). (b) Transverse 3D gradient-echo delayed phase MR image (5/1.4, 12° flip angle) shows no enhancement of the cystic structure (arrow). (c) Transverse 3D gradient-echo delayed phase MR image (5/1.4, 12° flip angle) obtained at a level slightly higher than b shows the CC (arrowhead) enhancing intensely.

View larger version (168K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: (a) Coronal single-shot fast spin-echo T2-weighted MR image (180–200-msec echo time) shows a high-signal-intensity retroperitoneal cystic structure (arrow) of uncertain origin and without visible communication with the CC (arrowhead). (b) Transverse 3D gradient-echo delayed phase MR image (5/1.4, 12° flip angle) shows no enhancement of the cystic structure (arrow). (c) Transverse 3D gradient-echo delayed phase MR image (5/1.4, 12° flip angle) obtained at a level slightly higher than b shows the CC (arrowhead) enhancing intensely.