UVA scientist uses $6.5 million grant to improve lymphatic disease diagnoses

CHARLOTTESVILLE, VA (CVILLE RIGHT NOW) – A University of Virginia School of Medicine scientist has received a $6.5 million NIH grant awarded by the National Heart, Lung and Blood Institute to develop the “lymphatic medicine exam of the future” to improve care for chronic swelling, known as lymphedema, and other lymphatic diseases, UVA Health announced on Monday.

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 with UVA’s Department of Radiology and Medical Imaging., 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.  “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.” 

Crescenszi told Cville Right Now said the assessment can be made with any MRI machine.

“It’s a regular MRI system and it just has a unique detector that you add on and that detector is sensitive to sodium,” Crescenzi said. “It’s sensitive to the sodium that’s naturally occurring in our body, we don’t have to inject anything from the outside. Every day we eat sodium and we normally think of excreting it, but our body actually stores some of it and we sometimes store too much. So, we can see that with sodium MRI, which is just a simple added detector.”

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 current ways we diagnose are using a tape measure to measure the volume of a swollen limb, and to measure maybe its disproportionate nature to the other side of the body” Crescenzi said. “But a tape measure is pretty course. It’s not reproducible or repeatable in multiple people’s hands, and it only measure in one small location from the outside of the limb.

“With imaging, we’re able to look deeper into the tissue and see what’s really being affected by the disease and how we can get it out.

The lymphatic system is a group of organs, tissues and vessels that provide protection from infections and balance fluids throughout your body.

Crescenzi said there are a number of reasons why some are more susceptible to lymphatic diseases then others.

“It could be they have a reduced ability to circulate their fluids in just that part of the body, sometimes from a treatment they had, or a trauma they had that might have affected lymph node or their lymphatic vessels,” said Crescenzi. “But then why it builds up sodium is still a mystery to us.

“We know that sodium is in certain cartilage areas of the body like in our joint spaces, but it was pretty remarkable to see sodium in the soft tissue of the body in things like the fat tissue of the skin. And that’s what saw that was really interesting in lymphedema patients.”

The crude nature of the previous diagnosing systems in addition to a lack of knowledge about what’s happening set many patients behind for some 20 years before proper diagnosis.

“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.