Background Visualization of the hepatic and mesenteric lymphatics remains challenging despite recent advances in lymphatic imaging, including dynamic contrast-enhanced MR lymphangiography (DCMRL). Purpose To assess the feasibility of intravenous contrast-enhanced MR lymphangiography (IV-MRL) in a swine model and a pilot patient group. Materials and Methods Systemic and portal venous and lymph samples were collected from two swine after intravenous administration of gadolinium (Gd)-based contrast agents (Gd tetraazacyclododecane tetraacetic acid and Gd ethoxybenzyl diethylenetriamine pentaacetic acid; n = 1 each), and Gd quantification was performed. IV-MRL and DCMRL were performed in a separate animal, and the signal intensity (SI) of the lymphatic and vascular structures was measured. In a pilot human study, conducted between September 2024 and August 2025, lymphatic enhancement was assessed by comparing the SI ratios of the thoracic duct (TD) to the inferior vena cava at 1 and 20 minutes after the contrast agent administration. Within-subject differences between time points were analyzed using paired t tests. Results The body fluid sampling study showed that the Gd concentration in the lymph peaked at 20-30 minutes and exceeded those of the portal and systemic veins, indicating the presence of the "lymphatic phase." IV-MRL revealed enhancement of not only the TD and cisterna chyli but also the hepatic and mesenteric lymphatics during the phase. The human pilot study (n = 16; mean age of 56.6 years ± 24.7 [SD]; 11 men) showed a substantial increase in TD/inferior vena cava SI ratio from 0.49 ± 0.21 at 1 minute to 1.47 ± 0.32 at 20 minutes (all values are means ± SDs; P < .001). Conclusion IV-MRL had potential as a noninvasive technique for comprehensive visualization of the lymphatics, including hepatic and mesenteric ones, which are often incompletely assessed by conventional lymphatic studies such as DCMRL. © RSNA, 2026 Supplemental material is available for this article.

ABSTRACT Aims To quantify the risk of cardiovascular disease (CVD) and all‐cause mortality associated with diabetic foot ulcer (DFU)‐related amputation using a large‐scale, nationally representative cohort. Materials and Methods This longitudinal study included individuals with diabetes who underwent standardized national health checkups between 2009 and 2012, with follow‐up data obtained from the Korean National Health Insurance Service claims database. CVD was defined as an incident myocardial infarction or stroke occurring after the index health checkup. Cox proportional hazards models were used to estimate the hazard ratios (HRs) for CVD and mortality in individuals with DFU‐related amputation compared with those with diabetes but without amputation. Results Among 1,229,689 individuals with diabetes, 1,486 (0.12%) had a DFU‐related amputation at baseline. The median follow‐up was 8.2 years in the non‐amputation group and 6.7 years in the DFU‐related amputation group. People with DFU‐related amputation had a significantly higher incidence rate of CVD compared with those without DFU‐related amputation (32.6 vs. 11.0 per 1000 person‐years) with a HR of 1.9 (95% CI 1.6–2.1). The HRs for myocardial infarction and stroke were 2.2 (95% CI 1.9–2.6) and 1.6 (95% CI 1.4–1.8), respectively. All‐cause mortality significantly increased in people with DFU‐related amputation compared with those without, with an HR of 2.1 (95% CI 1.9–2.3). Conclusions In this nationwide population‐based cohort, DFU‐related amputation was associated with nearly a twofold increased risk of cardiovascular events and mortality. These findings underscore the importance of comprehensive cardiovascular risk assessment and management in patients with diabetic foot complications.

Liquid embolic agents are increasingly being adopted for endovascular embolization owing to their permanent occlusive effects, smooth injectability, and high vascular filling efficiency. Histoacryl®, one of the most widely used liquid embolic materials, presents limitations, including lack of intrinsic radiopacity and strong adhesion to microcatheters, which complicate procedural control and increase the risk of catheter entrapment.To overcome these challenges, a novel liquid embolic composition incorporating iodinated and fluorinated cyanoacrylates was developed. The iodinated component, 2-iodoethyl 2-cyanoacrylate (IECA), possesses a high iodine content (1,100 mg I/mL), exceeding that of Lipiodol® (480 mg I/mL), thereby enabling enhanced radiopacity for real-time fluoroscopic monitoring. The fluorinated monomer, 2,2,3,3,3-pentafluoropropyl 2-cyanoacrylate (PFPCA), exhibited a rapid polymerization rate (15.77 ± 1.96 μL/s), attributed to the strong electron-withdrawing effect of its pentafluoropropyl group, and effectively compensated for the slower polymerization of IECA even at low mixing ratios.In addition, the high hydrophobicity of PFPCA contributed to a significant reduction in microcatheter adhesion force (8.65 ± 0.79 N) compared to Histoacryl® (11.51 ± 0.45 N), thereby improving procedural safety and handling. In vivo embolization of rabbit renal arteries using the optimized composition of IECA, PFPCA, and ethyl oleate resulted in complete and stable occlusion of the target vessels.These results demonstrate that the iodinated and fluorinated cyanoacrylate-based liquid embolic formulation offers improved radiopacity, tunable polymerization kinetics, and reduced catheter adhesion, highlighting its potential for enhanced procedural control and minimized complication risks in endovascular embolization.

Transarterial embolization (TAE) has been investigated for chronic lower-extremity musculoskeletal pain refractory to conservative therapy. For greater trochanteric pain syndrome, lateral femoral circumflex artery embolization reduced median visual analog scale scores from 8.5 to 10 to 0 to 2, with clinical success rates of approximately 64% at 30 months. In chronic Achilles tendinopathy and plantar fasciitis, reported success rates range from 73 to 100%, with rapid pain reduction and sustained functional improvement up to 24 to 48 months. Across studies, no major complications were reported. These findings support TAE as a promising option for selected patients, warranting further prospective evaluation.

N-butyl cyanoacrylate (NBCA) glue embolization is a minimally invasive technique widely used in interventional radiology to achieve vascular occlusion. It is a liquid embolic agent that rapidly polymerizes on contact with ionic substances such as blood or saline, allowing immediate solidification and formation of a durable embolus. This property makes it especially effective in controlling arterial bleeding from small-caliber or tortuous vessels that cannot be accessed by using microcatheters or in cases requiring urgent hemostasis due to severe hemorrhage. The embolization process involves mixing NBCA glue with an oil-based contrast agent to adjust the viscosity and regulate the polymerization rate. Under fluoroscopic guidance, the mixture is injected through a microcatheter by using pressure- or flow-dependent techniques. Modified approaches have also been developed and include flow-controlled injection with use of a balloon catheter or the addition of ethanol to reduce adhesiveness. Clinical applications include embolization for gastrointestinal bleeding and arteriovenous, portal vein, and lymphatic anomalies; preoperative devascularization of hypervascular tumors; and balloon-occluded retrograde transvenous obliteration. Despite the effectiveness of NBCA glue embolization, the risk of nontarget embolization remains a significant concern, potentially resulting in tissue necrosis or ischemia. Therefore, a comprehensive understanding of the vascular anatomy and hemodynamics is essential to minimize complications. NBCA glue embolization is a powerful and versatile tool for vascular occlusion. Successful outcomes rely on meticulous patient selection, adherence to procedural protocols, and the experience of the operator. ©RSNA, 2026 Supplemental material is available for this article.

OBJECTIVE:To assess the role and treatment response of percutaneous lymphatic embolization performed for non-traumatic chylothorax in patients with Gorham-Stout disease (GSD) with regard to thoracic duct embolization (TDE) and embolization of pleural or lymphatic collaterals. MATERIALS AND METHODS:This retrospective single-institution study included consecutive patients who underwent percutaneous lymphatic embolization between January 2013 and December 2022. The patients underwent dynamic contrast-enhanced magnetic resonance lymphangiography, fluoroscopic intranodal lymphangiography, or both to evaluate the lymphatic anatomy prior to the intervention. The patients underwent TDE, pleural lymphatic embolization, or both, depending on the imaging findings. The data collected included imaging findings, procedural details, and clinical outcomes (clinical success was defined as removal of the drainage catheter without re-accumulation of effusion or improvement in clinical symptoms). RESULTS:Five male patients (aged 5-29 years) with chylothorax (n = 3) or hemorrhagic chylothorax (n = 2) were included. The key imaging findings included giant thoracic duct (n = 3) and dilated parietal pleural lymphatic system (n = 5). Twelve embolization sessions were performed (median, 2 sessions per patient; range 1-4 sessions). The embolized lymphatic structures included the thoracic duct (n = 4), parietal pleural lymphatics (n = 4), and other lymphatic collaterals (n = 3). The embolic agents used were glue and coils (n = 3), and glue only (n = 2). TDE alone achieved clinical success in only 25% of the cases (1 out of 4). With additional embolization of the parietal pleural lymphatics and other collaterals, clinical success was achieved in 80% of the cases (4 out of 5). One patient developed chylous ascites after the TDE. CONCLUSION:Percutaneous lymphatic embolization targeting the thoracic duct and pleural lymphatic collaterals is a feasible treatment option for GSD-related chylothorax.

To evaluate the feasibility and safety of combined percutaneous sclerotherapy plus transarterial embolization for refractory sports-related tendinopathy in young athletes. Twelve athletes with 20 lesions (13 Achilles tendinopathies, 6 patellar tendinopathies, 1 iliotibial band syndrome), suffering pain persisting >3 months despite conservative management were included. Ultrasound-guided foam sclerosant was injected into the peri-tendinous subcutaneous tissue at the most painful area until approximately 50

Purpose: To evaluate the safety and effectiveness of lymphatic embolization for primary genital lymphorrhea. Materials and Methods: A retrospective analysis was conducted on patients who underwent lymphatic embolization for primary genital lymphorrhea and/or lower limb lymphedema between May 2016 and January 2022 at 3 specialized lymphatic centers. Following radiological evaluation of genital lymphorrhea, affected lymphatic vessels were selectively embolized to occlude abnormal lymphatic flow using a mixture of n-butyl cyanoacrylate glue and ethiodized oil. Clinical success was defined as the cessation of genital lymphorrhea or improvement of lymphedema at 1-month follow-up visit. Results: Among 11 patients (median age, 27 years; age range, 14-60 years; 10 men) included in this study, 5 had genital lymphorrhea, 1 had lower limb lymphedema, and the other 5 had both. A total of 15 embolization procedures were performed, with a technical success rate of 100%. Clinical success was achieved in 90% of genital lymphorrhea (9/10) and 50% of leg lymphedema (3/6). Three patients underwent additional embolization for recurrent genital lymphorrhea at 9 months after the embolization (n = 1) and for further improvement of leg lymphedema per patients' request (n = 2). A procedure-related adverse event with aggravation of pre-existing condition was reported in 1 patient. Conclusions: Lymphatic embolization was effective in the management of primary genital lymphorrhea and associated primary lymphedema in lower limbs.

PURPOSE:To evaluate whether mesenteric lymphangiography (mLAG) is technically feasible and clinically useful for patients with refractory chylous ascites, chylothorax, and protein-losing enteropathy (PLE). MATERIALS AND METHODS:A retrospective study of 35 patients (male, 16; female, 19; mean age, 56 years; range, 20-78 years) who underwent mLAG at 2 institutions between March 2016 and July 2022 was performed. mLAG was performed via intraoperative and/or percutaneous approaches. Imaging findings were categorized into 3 types: Type 0 (technical failure), Type 1 (limited to mesentery), or Type 2 (central propagation). Auxiliary findings including lymphangiectasia, reflux, and leakage were recorded. Interventions included mesenteric lymph node embolization (mLNE), retroperitoneal lymph node embolization, lymphoplasty, and lymphovenous shunt creation. RESULTS:Among 35 patients, 27 presented with refractory chylous ascites and/or chylothorax and 8 with PLE. Of the 35 patients, mLAG was performed percutaneously in 21 (60%) patients, intraoperatively in 9 (26%), and both percutaneously and intraoperatively in 5 (14%) patients. The findings were classified as Type 0 in 4 (11%), Type 1 in 8 (23%), and Type 2 in 23 (66%). Of 35 patients, the auxiliary findings of lymphangiectasia (E), reflux (R), and leakage (L) were observed in 20% (n = 7), 23% (n = 8), and 6% (n = 2), respectively. mLNE was performed in 14 patients. Clinical improvement was achieved in 57% (20 of 35) of the patients. One patient developed bowel wall edema post-mLNE; no other severe adverse event was reported. CONCLUSIONS:mLAG is technically feasible and safe. It can be a useful tool to image the mesenteric lymphatics or perform mesenteric lymphatic embolization.

PURPOSE:To evaluate the long-term outcomes of endovascular treatment for postoperative portomesenteric vein (PMV) obstruction and identify prognostic factors influencing patency rates. MATERIALS AND METHODS:This retrospective single-center study included patients who underwent endovascular intervention for PMV stenosis or occlusion after hepatobiliary and pancreatic surgery between January 2009 and December 2020. Patient characteristics, technical outcomes, and long-term patency rates were evaluated. In total, 116 patients underwent PMV intervention after liver transplantation (n = 66, 56.9%), hepatectomy (n = 21, 18.1%), or pancreatectomy (n = 29, 25%). Interventions included balloon angioplasty alone (n = 7, 6%) or stent placement (n = 106, 91.4%), performed at a median of 125 days (interquartile range, 8.5-436.5 days) after surgery. RESULTS:The technical success rate of the PMV intervention was 95.7%. Patency rates varied significantly across the surgical groups, with liver transplantation showing superior outcomes compared with hepatectomy and pancreatectomy (5-year primary patency rates: 94.4%, 65.4%, and 64.2%, respectively). Multivariate analysis revealed variceal bleeding (subdistribution hazard ratio [sHR], 8.49; 95% confidence interval [CI], 1.56-46.1; P = .013), stent length (sHR, 0.97; 95% CI, 0.95-0.99; P = .008), cumulative time (sHR, 0.32; 95% CI, 0.16-0.65; P = .002), and tumor etiology (sHR, 6.15; 95% CI, 1.02-36.99; P = .047) as independent prognostic factors for patency loss. CONCLUSIONS:High technical success rates were achieved with the PMV interventions, with varying long-term patency rates. This study highlights the significance of the initial type of hepatobiliary and pancreatic surgery and clinical variables such as variceal bleeding, stent length, and tumor etiology in influencing PMV stenosis outcomes.

Congenital lymphatic flow disorders collectively refer to a heterogeneous group of diseases that manifest as chylothorax, chylous ascites, intestinal lymphangiectasia, protein-losing enteropathy, and peripheral extremity or genital lymphedema, all in the absence of identifiable injury to the lymphatic system. We have only recently begun to understand congenital lymphatic flow disorders through the ability to image lymph flow dynamically. Intranodal dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) is a crucial technique for imaging lymphatic flow in pediatric patients with congenital lymphatic flow disorders. However, as lymphatic imaging is still a nascent discipline with many uncertainties regarding optimal imaging and treatment, effective patient management requires a comprehensive understanding of imaging techniques, disease pathophysiology, and multidisciplinary treatment approaches. Above all, a fundamental understanding of the physiological lymphatic flow of the central conducting lymphatics is essential for the correct interpretation of DCMRL images. This knowledge helps to avoid unnecessary examinations, erroneous diagnoses, and potentially harmful treatment approaches. This review provides an overview of the methods, advantages, and precautions for interpreting the DCMRL examination, a state-of-the-art lymphatic system imaging technique, and shares various case studies.

Gorham-Stout disease (GSD) is an extremely rare complex lymphatic anomaly, characterized by intraosseous lymphatic malformation with progressive osteolysis. Chylothorax can occur when the lymphatic malformation involves the thoracic cage and vertebrae. If conservative management is unsuccessful, thoracic duct ligation or embolization can be performed. A recent study proposed an algorithmic approach toward treatment of non-traumatic chylothorax, suggesting that in some scenarios, either thoracic duct embolization (TDE) alone is insufficient, or should not be performed.

To assess the potential of deep learning (DL)-based denoising technique on the reduction of patient radiation dose and image quality improvement in low dose C-arm based interventional Cone-beam Computed Tomography (CBCT). This study collected low-dose (LD) C-arm CBCT datasets from a university hospital. The hospital conducted scans at a level one-fourth of the routine dose (RD) CBCT images for research purposes from December 1, 2019, to January 1, 2022. (RD DAP: s 5796.4 uGym2 vs LD DAP: 1794.8 uGym2). The data was acquired from 90 patients who underwent transarterial chemoembolization (TACE) using Axiom Artis C-arm system (Siemens Healthcare, Forchheim, Germany). All CBCT images were reconstructed via filtered back projection (FBP) and were additionally reconstructed using ClariCT.AI (ClariPi Inc., Seoul, Korea), a DL-based denoising technique that was previously studied for use in MDCT images. Image quality comparison between denoised LD (DLD) and LD images was performed based on image noise and signal-to-noise ratio (SNR). The regions of interest (ROI) for quantitative evaluation abdominal aorta with diameter 1 cm2. After LD and DLD CBCT images were reconstructed MIP images, a radiologist assessed subjective noise, liver vessel visibility. Image noises for DLD were 36.51 ±5.40 HU in liver parenchyma, 37.08 ±27.77 HU in vertebra erector spinae muscles and 53.20 ±11.33 HU in abdominal aorta, resulting in significantly lower noise level than those of LD which were 85.89 ±11.88 HU, 117.14 ±14.71 HU and 178.37 ±70.24 HU, respectively. SNR was 0.84 ±0.39, 0.65 ±0.40 and 0.59 ±0.16 for LD in liver parenchyma, vertebra erector spinae muscles and abdominal aorta, and was 1.97 ±0.89, 1.73 ±1.25 and 1.43 ±0.86 for DLD indicating superior level compared to LD. DLD MIP images showed reduced image noise and improved liver vessel visibility compared to LD MIP images. DL-based denoising can improve image quality in LD C-arm CT images during TACE. Implementing the DL-based denoising technique in C-arm CT can potentially lower patient radiation exposure during TACE procedures, a critical intervention for liver cancer treatment.

In the rapidly evolving healthcare environment, radiologists strive to establish their rightful place. Thus, there is a need for enhanced outpatient and clinical education within the Department of Radiology and exploration of its methodologies. Accordingly, the Korean Society of Radiology established a task force to investigate the clinical and outpatient practice status of radiologists overseas, current state of related education, involvement of other specialties in radiologic practices and education in Korea, and clinical and outpatient practice status among Korean radiologists. Furthermore, a survey on clinical competency enhancement was conducted among the members of the Korean Society of Radiology. These findings suggest the need for visibility and clinical competency enhancement in radiologists and methodologies for strengthening clinical competencies.

Refractory chylous ascites can cause significant nutritional and immunologic morbidity, but no clear treatment has been established. This article introduces a case of a 22-year-old female patient with an underlying lymphatic anomaly who presented with refractory chylous ascites after laparoscopic adnexectomy for ovarian teratoma which aggravated after thoracic duct embolization. Ascites (>3,000 mL/d) had to be drained via a percutaneous catheter to relieve abdominal distention and consequent dyspnea, leading to significant cachexia and weight loss. Two sessions of hybrid lymphovenous anastomosis (LVA) surgery with intraoperative mesenteric lymphangiography guidance were performed to decompress the lymphatics. The first LVA was done between inferior mesenteric vein and left para-aortic enlarged lymphatics in a side-to-side manner. The daily drainage of chylous ascites significantly decreased to 130 mL/day immediately following surgery but increased 6 days later. An additional LVA was performed between right ovarian vein and enlarged lymphatics in aortocaval area in side-to-side and end-to-side manner. The chylous ascites resolved subsequently without any complications, and the patient was discharged after 2 weeks. The patient regained weight without ascites recurrence after 22 months of follow-up. This case shares a successful experience of treating refractory chylous ascites with lymphatic anomaly through LVA, reversing the patient's life-threatening weight loss. LVA was applied with a multidisciplinary approach using intraoperative mesenteric lipiodol, and results showed the possibility of expanding its use to challenging problems in the intraperitoneal cavity.

Endovascular embolization is a promising therapeutic approach broadening its application area due to its minimal invasiveness and short operation time, wherein lesional blood vessels are occluded with liquid embolic agents under X-ray imaging guidance. Histoacryl and its composition with Lipiodol are one of the most widely used liquid embolic agents, however, Histoacryl has critical limitations, such as lack of innate X-ray visibility and strong adhesion to microcatheter. In this study, three different iodinated cyanoacrylates are newly synthesized as alternatives to Histoacryl and employed to develop liquid embolic compositions. Among them, 4-iodobutyl 2-cyanoacrylate (IBCA) is most preferable with high iodine content (730 mgI mL-1) and fast polymerization. The IBCA-based embolic compositions containing ethyl oleate and acetic acid showed moderate viscosity and reduced catheter adhesiveness (≈0.80 N), and their polymerization time is freely controllable from 2 to 15 s. In the embolization test with rabbit models, the renal artery is successfully occluded by IBCA-based embolic compositions without vascular recanalization or nontarget embolization for 4 w. Their embolic effect is further evaluated using swine models, demonstrating the practical applicability in the clinic. In conclusion, IBCA and its compositions are determined to have great potential as novel liquid embolic agents.

ABSTRACT:Congenital lymphatic flow disorders collectively refer to a heterogeneous group of diseases that manifest as chylothorax, chylous ascites, intestinal lymphangiectasia, protein-losing enteropathy, and peripheral extremity or genital lymphedema, all in the absence of identifiable injury to the lymphatic system. We have only recently begun to understand congenital lymphatic flow disorders through the ability to image lymph flow dynamically. Intranodal dynamic contrast-enhanced magnetic resonance lymphangiography (DCMRL) is a crucial technique for imaging lymphatic flow in pediatric patients with congenital lymphatic flow disorders. However, as lymphatic imaging is still a nascent discipline with many uncertainties regarding optimal imaging and treatment, effective patient management requires a comprehensive understanding of imaging techniques, disease pathophysiology, and multidisciplinary treatment approaches. Above all, a fundamental understanding of the physiological lymphatic flow of the central conducting lymphatics is essential for the correct interpretation of DCMRL images. This knowledge helps to avoid unnecessary examinations, erroneous diagnoses, and potentially harmful treatment approaches. This review provides an overview of the methods, advantages, and precautions for interpreting the DCMRL examination, a state-of-the-art lymphatic system imaging technique, and shares various case studies.

Lymphatic disorders encompass a broad spectrum of diseases involving the lymphatic system, ranging from traumatic lymphatic leaks to lymphatic malformations. Lymphatic disorders can be categorized into traumatic and non-traumatic disorders according to their etiology. These two categories may be further divided into subgroups depending on the anatomical location of the lymphatic pathology and their association with clinical syndromes. Thoracic duct embolization was a milestone in the field of lymphatic intervention that encouraged the application of percutaneous embolization techniques to treat leaks and reflux disorders in the lymphatic system. Additional access routes for embolization, including retrograde thoracic duct and transhepatic lymphatic access, have also been developed. This article comprehensively reviews a variety of options for the treatment of lymphatic disorders, from conservative management to the most recent embolization techniques.