Lymphedema evaluation using noninvasive 3T MR lymphangiography

Crescenzi, Rachelle; Donahue, Paula M. C.; Hartley, Katherine G.; Desai, Aditi A.; Scott, Allison O.; Braxton, Vaughn G.; Mahany, Helen B.; Lants, Sarah K; Donahue, Manus J.

doi:10.1002/jmri.25670

Cited by 26 publications

(37 citation statements)

References 40 publications

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“…The relationship between lymphatic function and tissue sodium storage remains to be evaluated in vivo, although these studies may be possible with the emergence of lymphatic imaging modalities including indocyanine green near-infrared imaging 26 , 27 and magnetic resonance lymphangiography 28 – 30 . Noninvasive lymphangiography approaches 28 , 29 which exploit contrast derived from the long magnetic resonance relaxation times of lymphatic fluid relative to other tissues, may have particular relevance in this field as they can be performed in ten minutes or less and without exogenous contrast agents, thereby making them ideal candidates for surveillance imaging or evaluating therapy responses. Therefore, one logical extension of the current study is to evaluate the relationship between tissue sodium content and lymphatic function in the lower extremities of patients affected by secondary lymphedema.…”

Section: Discussionmentioning

confidence: 99%

Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema

Crescenzi

Marton

Donahue

et al. 2017

Obesity

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Objective To test the hypothesis that tissue sodium and adipose content are elevated in patients with lipedema; if confirmed, this could establish precedence for tissue sodium and adipose content representing a discriminatory biomarker for lipedema. Methods Participants with lipedema (n=10) and control (n=11) volunteers matched for biological sex, age, body-mass-index, and calf circumference were scanned noninvasively with 3.0T sodium and conventional proton MRI. Standardized tissue sodium content was quantified in skin, subcutaneous adipose tissue (SAT), and calf muscle. Dixon MRI was employed to quantify tissue fat and water volumes of the calf. Nonparametric statistical tests were applied to compare regional sodium content and fat-to-water volume ratio between groups (significance: two-sided p≤0.05). Results Skin (p=0.01) and SAT (p=0.04) sodium content were elevated in lipedema (skin: 14.9±2.9 mmol/L; SAT: 11.9±3.1 mmol/L) relative to control (skin: 11.9±2.0 mmol/L; SAT: 9.4±1.6 mmol/L) participants. Relative fat volume in the calf was elevated in lipedema (1.2±0.48 ratio) relative to control (0.63±0.26 ratio, p<0.001) participants. Skin sodium content was directly correlated with fat-to-water volume ratio (Spearman’s-rho=0.54, p=0.01). Conclusions Internal metrics of tissue sodium and adipose content are elevated in patients with lipedema potentially providing objective imaging-based biomarkers for differentially diagnosing the under-recognized condition of lipedema from obesity.

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Section: Discussionmentioning

confidence: 99%

Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema

Crescenzi

Marton

Donahue

et al. 2017

Obesity

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“…Signal‐to‐noise ratio (SNR) in CE T 1 ‐weighted images appears superior to T 2 ‐weighted ones: Crescenzi et al . reported SNR of approximately 10 in the arm and torso LVs using T 2 ‐weighted TSE at 3.0 T, 25 while Mazzei et al . measured peak SNR in leg LVs of >250 with a CE SPGR sequence at 1.5 T 27 .…”

Section: Resultsmentioning

confidence: 99%

“…Signal-to-noise ratio (SNR) in CE T 1 -weighted images appears superior to T 2 -weighted ones: Crescenzi et al . reported SNR of approximately 10 in the arm and torso LVs using T 2 -weighted TSE at 3.0 T, 25 while Mazzei et al . measured peak SNR in leg LVs of >250 with a CE SPGR sequence at 1.5 T. 27 Spatial resolution is also typically superior in T 1 -weighted images compared to T 2 -weighted with voxel sizes ~1 mm 3 reported regularly.…”

Section: Ce T 1 -Weighted Imagingmentioning

confidence: 99%

Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective

Mills

Zanten

Borri

et al. 2021

Magnetic Resonance Imaging

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Background Clinical examination and lymphoscintigraphy are the current standard for investigating lymphatic function. Magnetic resonance imaging (MRI) facilitates three‐dimensional (3D), nonionizing imaging of the lymphatic vasculature, including functional assessments of lymphatic flow, and may improve diagnosis and treatment planning in disease states such as lymphedema. Purpose To summarize the role of MRI as a noninvasive technique to assess lymphatic drainage and highlight areas in need of further study. Study Type Systematic review. Population In October 2019, a systematic literature search (PubMed) was performed to identify articles on magnetic resonance lymphangiography (MRL). Field Strength/Sequence No field strength or sequence restrictions. Assessment Article quality assessment was conducted using a bespoke protocol, designed with heavy reliance on the National Institutes of Health quality assessment tool for case series studies and Downs and Blacks quality checklist for health care intervention studies. Statistical Tests The results of the original research articles are summarized. Results From 612 identified articles, 43 articles were included and their protocols and results summarized. Field strength was 1.5 or 3.0 T in all studies, with 25/43 (58%) employing 3.0 T imaging. Most commonly, imaging of the peripheries, upper and lower limbs including the pelvis (32/43, 74%), and the trunk (10/43, 23%) is performed, including two studies covering both regions. Imaging protocols were heterogenous; however, T2‐weighted and contrast‐enhanced T1‐weighted images are routinely acquired and demonstrate the lymphatic vasculature. Edema, vessel, quantity and morphology, and contrast uptake characteristics are commonly reported indicators of lymphatic dysfunction. Data Conclusion MRL is uniquely placed to yield large field of view, qualitative and quantitative, 3D imaging of the lymphatic vasculature. Despite study heterogeneity, consensus is emerging regarding MRL protocol design. MRL has the potential to dramatically improve understanding of the lymphatics and detect disease, but further optimization, and research into the influence of study protocol differences, is required before this is fully realized. Level of Evidence 2 Technical Efficacy Stage 2

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“…Specifically, a long turbo‐spin‐echo sequence with multiple refocusing pulses will be sensitized to spins with long T 2 decay and slower flow velocities such that the transverse signal is preserved. We have implemented a preliminary version of this sequence to provide a noncontrast MR lymphangiography method based on measured T 2 relaxation of lymphatic fluid, and we have demonstrated its sensitivity to subjects with clinical lymph stasis and enlarged vessels . LNs are typically not visualized in MR lymphangiograms using long turbo spin echo sequences due to the relatively shorter T 2 relaxation compared with lymphatic fluid.…”

Section: Discussionmentioning

confidence: 99%

3.0 T relaxation time measurements of human lymph nodes in adults with and without lymphatic insufficiency: Implications for magnetic resonance lymphatic imaging

et al. 2018

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Purpose: To quantify 3.0T (i) T1 and T2 relaxation times of in vivo human lymph nodes (LNs), and (ii) LN relaxometry differences between healthy LNs and LNs from patients with lymphatic insufficiency secondary to breast cancer treatment-related lymphedema (BCRL). Materials and Methods: MR relaxometry was performed over bilateral axillary regions at 3.0T in healthy female controls (105 LNs from 20 participants) and patients with BCRL (108 LNs from 20 participants). Quantitative T1 maps were calculated using a multi-flip-angle (20, 40, 60 degrees) method with B1-correction (dual-TR method, TR1/TR2=30/130 ms), and T2 maps using a multi-echo (TE=9–189 ms; 12 ms intervals) method. T1 and T2 were quantified in the LN cortex and hilum. A Mann-Whitney U-test was applied to compare LN relaxometry values between patients and controls (significance: two-sided p<0.05). Linear regression was applied to evaluate how LN relaxometry varied with age, BMI, and clinical indicators of disease. Results: LN substructure relaxation times (mean ± standard deviation) in healthy controls were: T1 cortex=1435±391 ms, T1 hilum=714±123 ms; T2 cortex=102±12 ms, and T2 hilum=119±21 ms. T1 of the LN cortex was significantly reduced in the contralateral axilla of BCRL patients compared to the axilla on the surgical side (p<0.001) and compared to bilateral control values (p<0.01). The LN cortex T1 asymmetry discriminated cases vs. controls (p=0.004) in a multiple linear regression, accounting for age and BMI. Conclusion: Human 3.0T T1 and T2 relaxation times in axillary LNs were quantified for the first time in vivo. Measured values are relevant for optimizing acquisition parameters in anatomical lymphatic imaging sequences, and can serve as a reference for novel functional and molecular LN imaging methods that require quantitative knowledge of LN relaxation times.

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Lymphedema evaluation using noninvasive 3T MR lymphangiography

Cited by 26 publications

References 40 publications

Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema

Tissue Sodium Content is Elevated in the Skin and Subcutaneous Adipose Tissue in Women with Lipedema

Systematic Review of Magnetic Resonance Lymphangiography From a Technical Perspective

3.0 T relaxation time measurements of human lymph nodes in adults with and without lymphatic insufficiency: Implications for magnetic resonance lymphatic imaging

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