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Thelymphaticsystem董龙春董龙春2013.719Thelymphaticsystem董龙春thelymphaticsystemDefinition:The lymphatic system is a network of channels,lymph nodes,and organs Function:to collect and return interstitial fluid,and thus help maintain fluid balanceto defend the body against disease by producing lymphocytes to absorb lipids from the intestine thelymphaticsystemDefinitionOrganizationofThelymphaticsystemtheconductingsystemthelymphoidorganslymphaticcapillarieslymphaticvesselslymphtictrunklymphticductprimarylymphoidorganssecondarylymphoidorgansThymusBonemarrowlymphnodestonsilsspleenadenoidsAppendixOrganizationofThelymphaticPlasmaleaksoutofthecapillarieslymph10%90%ofthisfluidreturnstothevenouscirculationthroughthevenulesandcontinuesasvenousblood.tissuecellinterstitialfluidexchangePlasmaleaksoutofthecapillymphtransparent,usually slightly yellow,often opalescentples()nt liquid about 95 percent waterthe remainder:plasma proteins,other chemical substances cellular component:lymphocytes lymphtransparent,usuallysllined by endothelial cells a thin layer of smooth musclesone-way valves to prevent any backward flowLymphaticvesselslinedbyendothelialcellsLymlymphtictrunkLumbartrunkBronchomediastinaltrunkSubclaviantrunkJugulartrunkIntestinaltrunkUnpairedpairedlymphtictrunkLumbartrunkBrontwolymphticductsRightBronchomediastinaltrunkLeftBronchomediastinaltrunkRightSubclaviantrunkLeftSubclaviantrunkRightJugulartrunkLeftJugulartrunkIntestinaltrunkLumbartrunksrightlymphaticductthoracicductveinhearttwolymphticductsRightBroncLymphaticDrainageAreas“venous angle”LymphaticDrainageAreas“venolymphoidorganslymphoidorgansLymphlymphaticcapillariesafferentlymphvesselsLymphnodesefferentlymphvesselsLymphatic drainage pathwaysLymphatictrunkslymphticductsLymphlymphaticcapillariesaffeElephantiasislegparasite/bacteriainfectionflowoflymphblockagelymphedemaFibrosis,fatsclerosis,fasciathickenedElephantiasislegparasite/bactlymphnode400-450Round/oval/bean shapedDifferent size,usually 1.0cm）long-to-shortaxisratiodecrease(L/S3mm)LymphNodeImagingMalignantteLymphNodeImaging(CT/MRI)Axialcontrast-enhancedCTandT2WIimageoflowerabdomenshowa9-mmaortocavalnode(arrow)withcentralfattyhilum.LymphNodeImaging(CT/MRI)AxiaLymphNodeImaging(CT/MRI)The purple portion within nodes indicates normal nodal tissue,and the pink portion indicates metastatic tissue.LymphNodeImaging(CT/MRI)TheLymphNodeImaging(ultrasound)normallymphnode.Imageshowsflattenedhypoechoiccigar-shapedstructure(arrow).malignantlymphnode.ImageshowsenlargedroundlymphnodewithmixedcysticandsolidcomponentsLymphNodeImaging(ultrasound)LymphNodeImaging(ultrasound)Abnormallymphnodefrompapillarythyroidcarcinomametastasis.AbsenceoftheechogenichilusabnormalperipheralflowLymphNodeImaging(ultrasound)LymphNodeImaging(ultrasound)SWEmode(top)andBmode(bottom)ultrasoundimagingofalymphnodewithalongaxisof19mm.ThisnodewasconsiderednormalonthebasisoftheBmodeultrasoundimage,butshowedhighstiffnessvaluesasdemonstratedbytheQ-Boxmeasurements.Histologicalanalysisfounda5mmmetastaticlesionShearWaveElastography(SWE)LymphNodeImaging(ultrasound)LymphNodeImagingCurrent research trendsfrom conventional anatomic modalities to molecular techniques in functional and physiologic assessment PET/CT and MRI with nanoparticles provide both anatomic and functional information LymphNodeImagingCurrentreseLymphNodeImaging(DWI)a67-year-oldfemalewithgradeIfollicularlymphomaandcervicallymphnodeinvolvementImpededdiffusivityLymphNodeImaging(DWI)a67-yeLymphNodeImaging(MRI)MRlymphography(USPIO)30nm,half-periodlong(AC)Normallymphnodeinleftiliacregion(D-F)Nonenlargediliaclymphnodecompletelyreplacedbytumor(GI)MicrometasasesinretroperitonealnodeLymphNodeImaging(MRI)MRlympMRlymphography(USPIO）Systemically injected long circulating particles gain access to interstitium and are drained through lymphatic vessels.Lymph flow disturbances or disturbances of nodal architecture by metastases lead to abnormal accumulation patterns,detectable by MRIMRlymphography(USPIO）SystemicPET/CTforLNimagingImaging mechanism:the glucose analog 18F-FDG,could be avidly taken up by cells with increased rates of glycolysis.Weak point:the image resolution of PET is relatively low.The implementation of PET and CT fusion either by dual PET/CT or computer registration has evolved to overcome this obstacle.PET/CTforLNimagingImagingmPET/CTforLNimagingA 57-y-old woman with chest pain after lobectomy for lung cancerPET/CTforLNimagingA57-y-olPET/CTforLNimaging62-y-old man with pancreatic cancerPET/CTforLNimaging62-y-oldWhats the different changes between the manlignant LN and the benign reactive hypertrophy LN?lymph channel and vasculature reorganization overexpression of vascular endothelial growth factor-C in tumors can induce hyperplasia of vessels and lymphaticsproliferation rate increasedmore hypercellularitythe lumina of the lymph sinuses become dilated(relatively few lymphocytes)WhatsthedifferentchangesbThank you for Ur attention!Thankyou
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