Quantification of lymphatic burden in patients with Fontan circulation by T2 MR lymphangiography and associations with adverse Fontan status
Authors' conclusion
Quantification of MR lymphatic burden is a reliable tool to assess the lymphatics post-Fontan and is associated with clinical status.
Study context
- Population
- Paediatric Fontan patients (<18 years) with clinical cardiac MRI including lymphatic 3D T2 fast spin echo (FSE) imaging, May 2017–October 201927 males
- Participants
- 48 patients
- Exposure
- Greater vs lower MR lymphatic burden
- Outcome
- Lymphatic burden (thresholding-based segmentation of 3D T2 FSE MIP image, indexed to body surface area) and its association with clinical status
Methodological detailsblinded independent readers, Median age at MRI 12.9 (9.4-14.7) years; time from Fontan to MRI 9.1 (5.9-10.4) years; follow-up post-Fontan 9.4 (6.6-11.0) years
- Blinded independent readers
- Median age at MRI 12.9 (9.4-14.7) years; time from Fontan to MRI 9.1 (5.9-10.4) years; follow-up post-Fontan 9.4 (6.6-11.0) years
Main finding
As reported in the abstract
- Correlation with post-Fontan hospital length of stay
- rs = 0.416, P = 0.004
- Correlation with duration of chest tube drainage
- rs = 0.439, P = 0.002
- Median lymphatic burden, chylous effusions immediately post-Fontan vs none
- 178 (118-393) vs. 113 (46-190) mL/m², P = 0.028
- Median lymphatic burden, composite adverse Fontan status (n = 13) vs none
- 435 (137-822) vs. 114 (51-178) mL/m², P = 0.003
- Lymphatic burden > 600 mL/m² for late adverse Fontan status: sensitivity
- 57%
- Lymphatic burden > 600 mL/m² for late adverse Fontan status: specificity
- 95%
Observational data: associations, not effects.
Further findings
Interobserver reliability of lymphatic burden
- Intraclass correlation coefficient
- 0.96 (0.94-0.98)
Original publication
Quantification of lymphatic burden in patients with Fontan circulation by T2 MR lymphangiography and associations with adverse Fontan status. Eur Heart J Cardiovasc Imaging. Published 3 November 2022. doi:10.
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