CT Lymphangiography (CTL) in Different Type of Primary Intestinal Lymphangiectasia (PIL): A Comparative Study

Objective: To explore the clinical and imaging characteristics and application value CT lymphangiography (CTL) in patients with different types of primary intestinal lymphangiectasia (PIL). Methods: Patients diagnosed as PIL in our center were recruited in this retrospective study from January 2016 to December 2019, All CTL data were blindly reviewed by two radiologists separately, and the evaluation indicators included: sex, onset age, symptoms and signs, serum albumin, wall thickening, serous cavity effusion, abnormal distribution of lymphatics, lymph reflux, lymph nodes, fistula and abnormal lymphatics around neck area. Based on the abnormal lymphatics in intestinal wall and/or mesentery, PIL was classified into type Ⅰ (positive type) and type Ⅱ (negative type). The clinical and imaging features were compared between the two groups. Results: 34 PIL patients were recruited in this study, including 15 cases of Ⅰ and 19 cases of Ⅱ. Type I showed older age of first onset (15.3±9.4 vs. 8.3±3.8), higher rate of diarrhea, and lower rate of limb and/or facial edema than type Ⅱ, with no statistical difference in sex and serum albumin. For imaging features comparisons, type Ⅰ demonstrated higher rate of abnormal dilated lymphatics and fistula, lower rate of increased attenuation of mesentery and lymph nodes, while no statistical difference was found between wall thickening, serous cavity effusion, lymph reflux and abnormal dilated lymphatics around neck area. Conclusion: CTL demonstrated capability of evaluation in detection of location, distribution and range of abnormal lymphatics in PIL. Based on CTL, the imaging classification of PIL was proposed. Different types of PIL showed different clinical and imaging features, which was useful for therapeutic adoptions.