Noninvasive MR Lymphangiography for assessing lymph fluid congestion in human lymphedema

Motivation: Lymphedema is a chronic progressive disease with no curative therapies. MR lymphangiography has potential to detect lymphatic congestion and characterize fundamental properties of lymphatic fluid flow noninvasively to inform therapeutic strategies. Goal(s): Utilize non-invasive MR lymphangiography (MRL) to assess lymphatic fluid congestion quantitatively in lower-extremity lymphedema. Approach: We assessed adults with lower-extremity lymphedema, gynecologic (GYN) cancer, and healthy participants using noninvasive 3.0T MRL. Results: Patients with lymphedema show significantly elevated vessel/tissue signal compared to those with GYN-cancer and healthy controls, which increases with disease severity. Velocity-suppressed DANTE-prepared MRL signal is less suppressed in patients with lymphedema, indicating slower flow velocity. Impact: Noninvasive MR lymphangiography can be applied in clinically-feasible scan time, and may provide useful imaging biomarkers in assessing severity of edema in lymphedema and lymphatic functioning, which could be used to more deeply characterize lymphedema development and novel therapies.