Fig. 10

Illustration of mesenteric INE under CT guidance. An hour after prior lipiodol-based laparotomic lymphangiography, the conventional CT was performed, which showed opacified mesenteric lymph nodes [A, incl. the cannulated lymph node in the previous lymphangiography (white arrowhead) and a surrounding lymph node as the target for following INE procedure (*)] and intermittent opacified thoracic duct (B, white arrows). In INE procedure, the target lymph node in the mesentery (*) was punctured using a 22-gauge Chiba needle under CT guidance (C). Make sure the needle tip is at the center of the lymph node and remove the stylet; then, inject 1 ml lipiodol into the target lymph node (*) to confirm the eligible needle position, where the efferent lymphatic vessels (white arrowheads) and distal lymph node (white arrow) were visualized but without obvious peripheral extravasation (D). After confirmation, inject 4 ml NBCA/lipiodol mixture (1:4); afterwards, the CT was re-implemented to present the embolized efferent mesenteric lymphatic vessels (E, white arrowheads) and hepatic lymphatic vessels (E, white arrow) owing to the glue reflux from embolized cisterna chyli (F, white arrowhead). Images were from Pig No. 4. Abbreviations: INE, intranodal embolization; CT, computed tomography; NBCA, N-butyl-2-cyanoacrylate; CBCT, cone-beam computed tomography