title: Lymphedema evaluation using noninvasive 3T MR lymphangiography.
abstract: To exploit the long 3.0T relaxation times and low flow velocity of lymphatic fluid to develop a noninvasive 3.0T lymphangiography sequence and evaluate its relevance in patients with lymphedema.
  
  
  
  A 3.0T turbo-spin-echo (TSE) pulse train with long echo time (TEeffective= 600 msec; shot-duration = 13.2 msec) and TSE-factor (TSE-factor = 90) was developed and signal evolution simulated. The method was evaluated in healthy adults (n = 11) and patients with unilateral breast cancer treatment-related lymphedema (BCRL; n = 25), with a subgroup (n = 5) of BCRL participants scanned before and after manual lymphatic drainage (MLD) therapy. Maximal lymphatic vessel cross-sectional area, signal-to-noise-ratio (SNR), and results from a five-point categorical scoring system were recorded. Nonparametric tests were applied to evaluate study parameter differences between controls and patients, as well as between affected and contralateral sides in patients (significance criteria: two-sided P < 0.05).
  
  
  
  Patient volunteers demonstrated larger lymphatic cross-sectional areas in the affected (arm = 12.9 ± 6.3 mm2; torso = 17.2 ± 15.6 mm2) vs. contralateral (arm = 9.4 ± 3.9 mm2; torso = 9.1 ± 4.6 mm2) side; this difference was significant both for the arm (P = 0.014) and torso (P = 0.025). Affected (arm: P = 0.010; torso: P = 0.016) but not contralateral (arm: P = 0.42; torso: P = 0.71) vessel areas were significantly elevated compared with control values. Lymphatic cross-sectional areas reduced following MLD on the affected side (pre-MLD: arm = 8.8 ± 1.8 mm2; torso = 31.4 ± 26.0 mm2; post-MLD: arm = 6.6 ± 1.8 mm2; torso = 23.1 ± 24.3 mm2). This change was significant in the torso (P = 0.036). The categorical scoring was found to be less specific for detecting lateralizing disease compared to lymphatic-vessel areas.
  
  
  
  A 3.0T lymphangiography sequence is proposed, which allows for upper extremity lymph stasis to be detected in ∼10 minutes without exogenous contrast agents.
  
  
  
  1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1349-1360.
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Crescenzi
authors.affiliation: Physical Medicine and Rehabilitation, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.|Dayani Center for Health and Wellness, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Paula M C
authors.identifier: 0000-0003-4656-6539
authors.initials: PMC
authors.lastname: Donahue
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Katherine G
authors.initials: KG
authors.lastname: Hartley
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Aditi A
authors.initials: AA
authors.lastname: Desai
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Allison O
authors.initials: AO
authors.lastname: Scott
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Vaughn
authors.initials: V
authors.lastname: Braxton
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Mahany
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Lants
authors.affiliation: Radiology and Radiological Science, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.|Neurology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.|Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.|Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Manus J
authors.initials: MJ
authors.lastname: Donahue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D042601:Lymphatic Vessels; D008209:Lymphedema / Q000150:complications / Q000000981:diagnostic imaging*; D008220:Lymphography; D008279:Magnetic Resonance Imaging; D000073297:Manual Lymphatic Drainage; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted; D059629:Signal-To-Noise Ratio
chemical_list: D003287:Contrast Media
keywords: MRI; breast cancer; lymphangiography; lymphedema; manual lymphatic drainage; turbo spin echo