Visualizing Vascular Mechanisms of Lipedema
This work will address clinical unmet needs for patients with lipedema using advanced magnetic resonance imaging (MRI) methods, in sequence with portable clinical tools. We are testing fundamental hypotheses about objective screening tools, lymphatic therapy, and vascular dysfunction in patients with lipedema.
Preliminary data and progress:
Lipedema is a disease marked by legs that are disproportionate to the rest of the body. Lipedema fat accumulation is often accompanied by pain and edema. Importantly, lipedema is commonly misdiagnosed as obesity leading to a mean delayed diagnosis of 22 years, high physical morbidity, and lifelong distress. Despite growing awareness of lipedema as a distinct clinical entity and a recent call to action for lipedema research, fundamental gaps persist in our knowledge regarding both disease mechanisms and treatment options for this debilitating disease.
Our research team of investigators from radiology, vascular medicine, and physical therapy have demonstrated that lipedema has distinct characteristics from obesity. Using whole-body fat-and-water MRI, we demonstrated that lipedema is characterized by a 42% higher lower-extremity fat (subcutaneous adipose tissue) deposition compared to BMI-matched females without lipedema (p<0.001). Using noninvasive sodium MRI technologies optimized in our lab, we demonstrated that skin sodium is also elevated in patients with lipedema compared to controls (14.9±2.9 vs. 11.9±2.0 mmol/L, p=0.01) in the lower extremities, but not upper extremities.
In response to physical therapy, preliminary data in 5 research participants with early lipedema shows skin sodium decreases following 6-weeks of lymphatic stimulation by complete decongestive therapy (CDT).
Recent findings of elevated arterial perfusion and inflammation in lipedema raise significant questions about how blood and lymphatic circulation could be involved in sodium dysregulation in lipedema. The critical barrier to interrogating these systems, and more broadly addressing clinical unmet needs for evidence-based therapies for patients with lipedema, is that noninvasive lymphatic imaging strategies are traditionally underdeveloped. To address this, we are applying noninvasive MRI techniques capable of visualizing lymphatic dilation and stasis in the lower extremities of patients with lipedema.