Lymphedema Research Study
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Imaging Sodium and Lymphatics in Lymphedema
The overall goal of this work is to evaluate patients with the lymphatic disease, lymphedema, using noninvasive MRI technologies sensitive to sodium and lymphatic circulation.
Preliminary data and progress:
Lymphedema is a chronic and progressive disease for which there remains no reversable treatment. Following lymph node removal procedures for cancer therapy, lymph stasis and inflammation ensue, leading to tissue fibrosis and potentially sodium deposition. While there is a high prevalence of lymphedema, ranging from 27-41% in patients treated for endometrial cancer alone, it remains unclear why only some patients progress to lymphedema. Furthermore, objective biomarkers of lymphedema pathophysiology and disease severity are needed to evaluate lymphedema progression and treatment response.
Clinically-feasible imaging tools sensitive to sodium and lymphatics in humans could help evaluate lymphedema. This possibility is based on recent evidence indicating lymphatics participate in the body's regulation of sodium levels.
We have developed a noninvasive MR lymphangiography (MRL) approach to quantify lymphatic vasculature in patients with unilateral lymphedema. MR lymphangiography can be acquired in series with noninvasive sodium 23Na at 3.0T MRI for measurement of tissue sodium content (TSC) in the legs. In preliminary data in patients with secondary lower-extremity lymphedema (LEL), skin sodium was elevated in affected limbs compared to healthy legs (TSC=24.2±6.8 vs. 14.2±1.8 mmol/L, p<0.001, effect size Cohen's d=1.2). Patterns of lymphatic impairment on MRL and tissue sodium deposition increase with disease severity, and appear modified by lymphatic complete decongestive therapy (CDT).
This study is ongoing. The results are intended to clarify mechanisms of lymphatic clearance of tissue sodium in lymphedema, and evaluate novel imaging biomarkers of lymphedema risk, progression, and treatment response.