A University of Virginia School of Medicine scientist has received a $6.5 million grant to develop the “lymphatic medicine exam of the future” to improve care for chronic swelling, known as lymphedema, and other lymphatic diseases.
Patients with chronic lymphatic disorders are often misdiagnosed, or face delayed treatment, because of the limitations of existing diagnostic technologies. But UVA’s Rachelle Crescenzi, PhD, and her team aim to use non-invasive magnetic resonance imaging (MRI) to change that.
“For too long, patients with chronic swelling have been dismissed until severe swollen limbs become obvious. Imaging helps us look beneath the skin at early changes in tissue, and we saw something unexpected,” said Crescenzi, of UVA’s Department of Radiology and Medical Imaging. “We saw sodium builds up in tissue with chronic swelling using a special MRI exam called sodium MRI. Together with vascular imaging, this exam could provide a non-invasive way to detect swelling earlier and identify new treatment strategies.”
Understanding Lymphatic Diseases
Lymphedema is estimated to affect more than 10 million Americans and up to 250 million people worldwide. Around one third, and up to 50%, of breast-cancer survivors develop it, as do 20%-40% of patients recovering from gynecologic cancer. Once known as dropsy, lymphedema typically causes the arms or legs to swell as the body retains fluid draining from the lymphatic system. This swelling can also strike the torso, neck and genitals.
Crescenzi is also a recognized leading scientist studying lipedema, a disease that causes swelling of the legs in women because of the buildup of uneven, often painful deposits of fat. These patients’ swollen legs often look like lymphedema. Up to 11% of women worldwide are thought to suffer from the condition. There are no diagnostic tests for lipedema.
The grant will allow Crescenzi and her collaborators to apply MRI to measure sodium, adipose tissue (fat) and lymphatic fluids in the body. By tracking how sodium and adipose tissue accumulate through the body, the researchers will be better able to understand how it affects lymphatic function in both good health and disease. They call their approach SALT MRI, short for “sodium, adipose and lymphatic translational sciences.”
Crescenzi and her team have already found that patients with lymphatic disease store more sodium and adipose tissue in the affected parts of their bodies. They hope that better understanding the amount of sodium within tissues will offer important answers about lymphatic diseases.
“We hope that SALT MRI will give doctors more objective ways of viewing and detecting lymphedema and lipedema, before symptoms become debilitating,” Crescenzi said. “It should not take 20 years to receive a diagnosis for lymphatic diseases. Sodium imaging could give us important clues to earlier diagnosis and also treatment options.”
The researchers already have completed an observational trial in patients with leg lymphedema . They found that tissue sodium increases with disease severity and reduces following standard-of-care physical therapy .
About SALT MRI
Over the next seven years, the scientists plan to deploy SALT MRI to study the progression of leg lymphedema and to develop better ways to diagnose lipedema. They also intend to develop a SALT MRI exam to address breast cancer-related lymphedema.
They hope their work will ultimately provide doctors with important new imaging tools to assist in the diagnosis of lymphatic diseases. This would accelerate how quickly patients receive treatment, help doctors tailor treatments to individual patients and improve the care patients receive.
“This award is the start of establishing a center for lymphatic disease research and clinical excellence at the University of Virginia. We’re thankful for strong support from the National Institutes of Health and the University of Virginia to advance research of these conditions,” Crescenzi said. “We’ll be able to train new investigators in the relationship between sodium and the lymphatic system and translate discoveries into meaningful clinical care for patients with lymphedema and lipedema.”
The $6.5 million NIH grant, R35HL184172, was awarded by the National Heart, Lung and Blood Institute.
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