![]() The lymphatics of the abdomen have been divided into parietal and visceral systems composed of the lymphatic channels and nodes that drain the walls and contents of the abdominal cavity. There are approximately 230 nodes in the abdomen and pelvis and 400 to 500 lymph nodes in the entire adult body. It provides protection against organisms, particulate matter, and neoplastic cells by the processes of phagocytosis, cell-mediated and antibody-mediated immune complexes, production of B and T lymphocytes, and antibody-producing plasma cells. The lymphatic system is a complex network of lymph nodes connected by lymphatic capillaries and ducts that play an important role in the immune system. Additionally, various clinical manifestations of lymphadenopathy in the abdomen and pelvis will be individually discussed. This chapter will discuss the various imaging modalities and describe their role in imaging of lymph nodes of the abdomen and pelvis. Development of investigational lymphotropic nanoparticles for the diagnosis of lymph node metastases has added a new dimension to the scope of MRI of lymph nodes as well. Fluorodeoxyglucose (FDG)-labeled PET has further revolutionized oncologic imaging by recognizing benign and malignant nodes based on their FDG uptake. However, reliance on size criteria for characterization has limited the accuracy of these modalities in nodal staging of malignancies. The superior soft tissue resolution of CT and MRI has improved the detection and assessment of even small lymph nodes. However, with the advent of imaging techniques such as ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and PET/CT, the role of lymphangiography has now faded and has only a few valid indications. Lymphangiography was once considered the preferred imaging modality for evaluation of nodal disease. A wide range of imaging techniques is available for evaluation of the lymph nodes in the abdomen and pelvis. Therefore, accurate identification and characterization of abnormalities of the lymph nodes in the abdomen and pelvis are crucial to achieve optimal diagnosis and plan treatment strategies. ![]() ![]() This has special relevance in the abdomen because the lymph node system in this region is not readily accessible for clinical examination or tissue sampling. Imaging evaluation of lymph nodes forms an integral component of staging of various malignancies, including lymphomas, and is also helpful in the evaluation of certain infective and inflammatory processes within the abdomen. ![]()
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