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Clinical Feasibility of Noninvasive Visualization of Lymphatic Flow using Principles of Spin Labeling MRI: Implications for Lymphedema Assessment

Identifieur interne : 002440 ( Pmc/Checkpoint ); précédent : 002439; suivant : 002441

Clinical Feasibility of Noninvasive Visualization of Lymphatic Flow using Principles of Spin Labeling MRI: Implications for Lymphedema Assessment

Auteurs : Swati Rane [États-Unis] ; Paula M. C. Donahue [États-Unis] ; Ted Towse [États-Unis] ; Sheila Ridner [États-Unis] ; Michael Chappell [États-Unis] ; John Jordi [Royaume-Uni] ; John Gore [États-Unis] ; Manus J. Donahue [États-Unis]

Source :

RBID : PMC:4485559

Abstract

Purpose

To extend a commonly employed, noninvasive arterial spin labeling (ASL) MRI method for measuring blood flow to evaluate lymphatic flow.

Materials and Methods

All volunteers (n=12) provided informed consent in accordance with IRB and HIPAA regulations. Quantitative relaxation time (T1 and T2) measurements were made in extracted human lymphatic fluid at 3.0T. Guided by these parameters, an ASL MRI approach was adapted to measure lymphatic flow (flow-alternating-inversion-recovery lymphatic water labeling; 3×3×5 mm3) in healthy subjects (n=6; 30±1 yrs; recruitment duration=2 months). Lymphatic flow velocity was quantified by performing spin labeling measurements as a function of post-labeling delay time and measuring the time-to-peak of signal in axillary lymph nodes. Clinical feasibility was evaluated in Stage II lymphedema patients (n=3; 60yr/F, 43yr/F, 64yr/F) and control subjects with unilateral cuff-induced lymphatic stenosis (n=3; 31yr/M, 31yr/M, 35yr/F).

Results

T1 and T2 of lymphatic fluid at 3.0T were 3100±160 ms (range=2930-3210 ms; median=3200 ms) and 610±12 ms (range=598-618 ms; median=610 ms), respectively. Healthy lymphatic flow (afferent vessel to axillary node) velocity was found to be 0.61±0.13 cm/min (n=6). A reduction (P<0.005) in lymphatic flow velocity in the affected arms of patients and the affected arms of healthy subjects with manipulated cuff-induced flow reduction was observed. The ratio of unaffected to affected axilla lymphatic velocity (1.24±0.18) was significantly (P<0.005) higher than the Left/Right ratio in healthy subjects (0.91±0.18).

Conclusion

This work provides a foundation for clinical investigations whereby lymphedema etiogenesis and therapies may be interrogated without exogenous agents and with clinically available imaging equipment.


Url:
DOI: 10.1148/radiol.13120145
PubMed: 23864103
PubMed Central: 4485559


Affiliations:

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PMC:4485559

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</sec>
<sec id="S2">
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<p id="P2">All volunteers (n=12) provided informed consent in accordance with IRB and HIPAA regulations. Quantitative relaxation time (
<italic>T</italic>
<sub>1</sub>
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<italic>T</italic>
<sub>2</sub>
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<sup>3</sup>
) in healthy subjects (n=6; 30±1 yrs; recruitment duration=2 months). Lymphatic flow velocity was quantified by performing spin labeling measurements as a function of post-labeling delay time and measuring the time-to-peak of signal in axillary lymph nodes. Clinical feasibility was evaluated in Stage II lymphedema patients (n=3; 60yr/F, 43yr/F, 64yr/F) and control subjects with unilateral cuff-induced lymphatic stenosis (n=3; 31yr/M, 31yr/M, 35yr/F).</p>
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<italic>T</italic>
<sub>1</sub>
and
<italic>T</italic>
<sub>2</sub>
of lymphatic fluid at 3.0T were 3100±160 ms (range=2930-3210 ms; median=3200 ms) and 610±12 ms (range=598-618 ms; median=610 ms), respectively. Healthy lymphatic flow (afferent vessel to axillary node) velocity was found to be 0.61±0.13 cm/min (n=6). A reduction (P<0.005) in lymphatic flow velocity in the affected arms of patients and the affected arms of healthy subjects with manipulated cuff-induced flow reduction was observed. The ratio of unaffected to affected axilla lymphatic velocity (1.24±0.18) was significantly (P<0.005) higher than the Left/Right ratio in healthy subjects (0.91±0.18).</p>
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<p id="P4">This work provides a foundation for clinical investigations whereby lymphedema etiogenesis and therapies may be interrogated without exogenous agents and with clinically available imaging equipment.</p>
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<surname>Towse</surname>
<given-names>Ted</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A4">4</xref>
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<contrib contrib-type="author">
<name>
<surname>Ridner</surname>
<given-names>Sheila</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
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<given-names>Michael</given-names>
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<xref ref-type="aff" rid="A6">6</xref>
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<contrib contrib-type="author">
<name>
<surname>Jordi</surname>
<given-names>John</given-names>
</name>
<xref ref-type="aff" rid="A7">7</xref>
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<contrib contrib-type="author">
<name>
<surname>Gore</surname>
<given-names>John</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A4">4</xref>
<xref ref-type="aff" rid="A5">5</xref>
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<contrib contrib-type="author">
<name>
<surname>Donahue</surname>
<given-names>Manus J.</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
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<aff id="A1">
<label>1</label>
Department of Radiology and Radiological Sciences, Vanderbilt Physical Medicine and Rehabilitation, Nashville, TN</aff>
<aff id="A2">
<label>2</label>
Vanderbilt Dayani Center for Health and Wellness, Vanderbilt Physical Medicine and Rehabilitation, Nashville, TN</aff>
<aff id="A3">
<label>3</label>
School of Nursing, Nashville, TN</aff>
<aff id="A4">
<label>4</label>
Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN</aff>
<aff id="A5">
<label>5</label>
Vanderbilt University Institute of Imaging Science, Nashville, TN</aff>
<aff id="A6">
<label>6</label>
Department of Physics and Astronomy ,Nashville, TN</aff>
<aff id="A7">
<label>7</label>
Institute of Biomedical Engineering, University of Oxford, Oxford, England, John Radcliffe Hospital, Oxford Center for Functional MRI of the Brain, Oxford, England</aff>
<aff id="A8">
<label>8</label>
Siskin Hospital Lymphedema Clinic, Chattanooga, TN</aff>
<author-notes>
<corresp id="CR1">
<bold>Correspondence:</bold>
Swati Rane Vanderbilt University Institute of Imaging Science, 1161 21st Ave South, Medical Center North, AA-3107, Nashville, TN 37232-2310</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>18</day>
<month>6</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="epub">
<day>28</day>
<month>10</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub">
<month>12</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>28</day>
<month>6</month>
<year>2015</year>
</pub-date>
<volume>269</volume>
<issue>3</issue>
<fpage>893</fpage>
<lpage>902</lpage>
<pmc-comment>elocation-id from pubmed: 10.1148/radiol.13120145</pmc-comment>
<abstract>
<sec id="S1">
<title>Purpose</title>
<p id="P1">To extend a commonly employed, noninvasive arterial spin labeling (ASL) MRI method for measuring blood flow to evaluate lymphatic flow.</p>
</sec>
<sec id="S2">
<title>Materials and Methods</title>
<p id="P2">All volunteers (n=12) provided informed consent in accordance with IRB and HIPAA regulations. Quantitative relaxation time (
<italic>T</italic>
<sub>1</sub>
and
<italic>T</italic>
<sub>2</sub>
) measurements were made in extracted human lymphatic fluid at 3.0T. Guided by these parameters, an ASL MRI approach was adapted to measure lymphatic flow (flow-alternating-inversion-recovery lymphatic water labeling; 3×3×5 mm
<sup>3</sup>
) in healthy subjects (n=6; 30±1 yrs; recruitment duration=2 months). Lymphatic flow velocity was quantified by performing spin labeling measurements as a function of post-labeling delay time and measuring the time-to-peak of signal in axillary lymph nodes. Clinical feasibility was evaluated in Stage II lymphedema patients (n=3; 60yr/F, 43yr/F, 64yr/F) and control subjects with unilateral cuff-induced lymphatic stenosis (n=3; 31yr/M, 31yr/M, 35yr/F).</p>
</sec>
<sec id="S3">
<title>Results</title>
<p id="P3">
<italic>T</italic>
<sub>1</sub>
and
<italic>T</italic>
<sub>2</sub>
of lymphatic fluid at 3.0T were 3100±160 ms (range=2930-3210 ms; median=3200 ms) and 610±12 ms (range=598-618 ms; median=610 ms), respectively. Healthy lymphatic flow (afferent vessel to axillary node) velocity was found to be 0.61±0.13 cm/min (n=6). A reduction (P<0.005) in lymphatic flow velocity in the affected arms of patients and the affected arms of healthy subjects with manipulated cuff-induced flow reduction was observed. The ratio of unaffected to affected axilla lymphatic velocity (1.24±0.18) was significantly (P<0.005) higher than the Left/Right ratio in healthy subjects (0.91±0.18).</p>
</sec>
<sec id="S4">
<title>Conclusion</title>
<p id="P4">This work provides a foundation for clinical investigations whereby lymphedema etiogenesis and therapies may be interrogated without exogenous agents and with clinically available imaging equipment.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations>
<list>
<country>
<li>Royaume-Uni</li>
<li>États-Unis</li>
</country>
<region>
<li>Angleterre</li>
<li>Tennessee</li>
</region>
</list>
<tree>
<country name="États-Unis">
<region name="Tennessee">
<name sortKey="Rane, Swati" sort="Rane, Swati" uniqKey="Rane S" first="Swati" last="Rane">Swati Rane</name>
</region>
<name sortKey="Chappell, Michael" sort="Chappell, Michael" uniqKey="Chappell M" first="Michael" last="Chappell">Michael Chappell</name>
<name sortKey="Donahue, Manus J" sort="Donahue, Manus J" uniqKey="Donahue M" first="Manus J." last="Donahue">Manus J. Donahue</name>
<name sortKey="Donahue, Manus J" sort="Donahue, Manus J" uniqKey="Donahue M" first="Manus J." last="Donahue">Manus J. Donahue</name>
<name sortKey="Donahue, Manus J" sort="Donahue, Manus J" uniqKey="Donahue M" first="Manus J." last="Donahue">Manus J. Donahue</name>
<name sortKey="Donahue, Paula M C" sort="Donahue, Paula M C" uniqKey="Donahue P" first="Paula M. C." last="Donahue">Paula M. C. Donahue</name>
<name sortKey="Gore, John" sort="Gore, John" uniqKey="Gore J" first="John" last="Gore">John Gore</name>
<name sortKey="Gore, John" sort="Gore, John" uniqKey="Gore J" first="John" last="Gore">John Gore</name>
<name sortKey="Gore, John" sort="Gore, John" uniqKey="Gore J" first="John" last="Gore">John Gore</name>
<name sortKey="Rane, Swati" sort="Rane, Swati" uniqKey="Rane S" first="Swati" last="Rane">Swati Rane</name>
<name sortKey="Ridner, Sheila" sort="Ridner, Sheila" uniqKey="Ridner S" first="Sheila" last="Ridner">Sheila Ridner</name>
<name sortKey="Towse, Ted" sort="Towse, Ted" uniqKey="Towse T" first="Ted" last="Towse">Ted Towse</name>
<name sortKey="Towse, Ted" sort="Towse, Ted" uniqKey="Towse T" first="Ted" last="Towse">Ted Towse</name>
</country>
<country name="Royaume-Uni">
<region name="Angleterre">
<name sortKey="Jordi, John" sort="Jordi, John" uniqKey="Jordi J" first="John" last="Jordi">John Jordi</name>
</region>
</country>
</tree>
</affiliations>
</record>

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