Assessment of lymphatic impairment and interstitial protein accumulation in patients with breast cancer treatment-related lymphedema using CEST MRI.

Abstract

PURPOSE:

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.

CONCLUSION:

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.

• Authors: Manus J Donahue, Paula C M Donahue, Swati Rane, Christopher R Thompson, Megan K Strother, Allison O Scott, Seth A Smith
• Journal: Magnetic resonance in medicine (Magn Reson Med) Vol. 75 Issue 1 Pg. 345-55 (Jan 2016) ISSN: 1522-2594 [Electronic] United States
• PMID: 25752499 (Publication Type: Clinical Trial, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 Wiley Periodicals, Inc.

Chemical References

• Biomarkers
• Proteins

Topics

• Adult
• Aged
• Biomarkers (metabolism)
• Breast Neoplasms (complications, pathology, therapy)
• Female
• Humans
• Lymph Nodes
• Lymphedema (etiology, metabolism, pathology)
• Magnetic Resonance Imaging (methods)
• Magnetic Resonance Spectroscopy (methods)
• Middle Aged
• Molecular Imaging (methods)
• Proteins (metabolism)
• Reproducibility of Results
• Sensitivity and Specificity
• Treatment Outcome