Assessment of lymphatic impairment and interstitial protein accumulation in patients with breast cancer treatment-related lymphedema using CEST MRI.
OBJECTIVE
Lymphatic impairment is known to reduce quality of life in some of the most crippling diseases of the 21st century, including obesity, lymphedema, and cancer. However, the lymphatics are not nearly as well-understood as other bodily systems, largely owing to a lack of sensitive imaging technologies that can be applied using standard clinical equipment. Here, proton exchange-weighted MRI is translated to the lymphatics in patients with breast cancer treatment-related lymphedema (BCRL).


METHODS
Healthy volunteers (N = 8) and BCRL patients (N = 7) were scanned at 3 Tesla using customized structural MRI and amide proton transfer (APT) chemical exchange saturation transfer (CEST) MRI in sequence with the hypothesis that APT effects would be elevated in lymphedematous tissue. APT contrast, lymphedema stage, symptomatology, and histology information were evaluated.


RESULTS
No significant difference between proton-weighted APT contrast in the right and left arms of healthy controls was observed. An increase in APT contrast in the affected arms of patients was found (P = 0.025; Cohen's d = 2.4), and variability among patients was consistent with documented damage to lymphatics as quantified by lymphedema stage.


CONCLUSIONS
APT CEST MRI may have relevance for evaluating lymphatic impairment in patients with BCRL, and may extend to other pathologies where lymphatic compromise is evident.
Department of Radiology, Vanderbilt School of Medicine, Nashville, Tennessee.|Department of Psychiatry, Vanderbilt School of Medicine, Nashville, Tennessee.|Department of Neurology, Vanderbilt School of Medicine, Nashville, Tennessee.|Department of Physics and Astronomy, Vanderbilt School of Medicine, Nashville, Tennessee.
Manus J
MJ
Donahue
Physical Medicine and Rehabilitation, Vanderbilt School of Medicine, Nashville, Tennessee.|Dayani Center for Health and Wellness, Nashville, Tennessee.
Paula C M
PC
Donahue
Department of Radiology, Vanderbilt School of Medicine, Nashville, Tennessee.
Swati
S
Rane
Vanderbilt University Institute of Imaging Science, Vanderbilt School of Medicine, Nashville, Tennessee.
Christopher R
CR
Thompson
Department of Radiology, Vanderbilt School of Medicine, Nashville, Tennessee.
Megan K
MK
Strother
Department of Radiology, Vanderbilt School of Medicine, Nashville, Tennessee.
Allison O
AO
Scott
Department of Radiology, Vanderbilt School of Medicine, Nashville, Tennessee.
Seth A
SA
Smith
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001943:Breast Neoplasms / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes; D008209:Lymphedema / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008875:Middle Aged; D057054:Molecular Imaging / Q000379:methods; D011506:Proteins / Q000378:metabolism*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D015415:Biomarkers; D011506:Proteins
APT; CEST; MRI; breast cancer; lymphatic; lymphedema