Imaging of Lymphatic Anomalies

Lymphatic anomalies (LA) are a spectrum of rare diseases classified into lymphatic tumors and
malformations. Complicated LA cases in the past have been called lymphangiomatosis because of
varied disseminated involvement including soft tissue and viscera such as the spleen, liver
and bone. Pleural effusions and pericardial effusions are often associated with these
lesions. These are now classified into different phenotypes such as Generalized Lymphatic
Anomaly (GLA), Gorham's Stout Disease (GSD) and Kaposiform Lymphangiomatosis (KLA). These
complicated phenotypes can cause massive osteolysis causing a morbidity and mortality from
infection or paralysis or worsening pulmonary function and effusions (GSD, GLA, KLA).

The major cause of mortality and morbidity in these patients is the deterioration of
pulmonary function by chronic chylous effusions and progressive interstitial lung disease.
Unfortunately, little is known about biomarkers, risk stratification or the pathophysiology
of this progression. The understanding of changes in patients' lymphatic anatomy with LA is
hindered by the difficulty of imaging the lymphatic system. Dynamic Contrast Enhanced MR
Lymphangiogram (DCMRL) is a technique that has recently been developed, allowing dynamic MR
imaging of the lymphatic system by injecting gadolinium contrast agent in the groin lymph
nodes.

This technique has been previously used to identify pathological lymphatic perfusion of the
lung parenchyma in patients with plastic bronchitis and neonatal chylothorax. Based on these
imaging findings, a treatment algorithm has been designed and used to successfully treat the
majority of those patients with these conditions.

Inclusion Criteria:

- Subjects diagnosed with Lymphatic Anomalies (GLA, KL, Gorham disease) with
radiological and or pathological confirmation of lung involvement will be considered
for the study.

- Girls > 11 y.o. with a negative urine pregnancy test and contraception use.

- Registration in the International Lymphangiomatosis and Gorham's Disease Alliance
(LGDA) Patient Registry or referral by a physician.

Exclusion Criteria:

- Subjects with contraindications to contrast enhanced MRI: allergy to gadolinium
imaging agents, impaired renal function (GFR<30) and presence of paramagnetic objects.

- Claustrophobia or contraindications to sedation/anesthesia

- Uncorrectable coagulopathy (bleeding disorders).

- Pregnant or lactating females.