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Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study

Background: Contrast-Enhanced Magnetic Resonance Lymphangiography (CE-MRL) presents some limitations: (i) it does not quantify lymphatic functionality; and (ii) enhancement of vascular structures may confound image interpretation. Furthermore, although CE-MRL is well described in the published liter...

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Autores principales: Borri, Marco, Schmidt, Maria A., Gordon, Kristiana D., Wallace, Toni A., Hughes, Julie C., Scurr, Erica D., Koh, Dow-Mu, Leach, Martin O., Mortimer, Peter S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mary Ann Liebert, Inc. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492592/
https://www.ncbi.nlm.nih.gov/pubmed/25774851
http://dx.doi.org/10.1089/lrb.2014.0039
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author Borri, Marco
Schmidt, Maria A.
Gordon, Kristiana D.
Wallace, Toni A.
Hughes, Julie C.
Scurr, Erica D.
Koh, Dow-Mu
Leach, Martin O.
Mortimer, Peter S.
author_facet Borri, Marco
Schmidt, Maria A.
Gordon, Kristiana D.
Wallace, Toni A.
Hughes, Julie C.
Scurr, Erica D.
Koh, Dow-Mu
Leach, Martin O.
Mortimer, Peter S.
author_sort Borri, Marco
collection PubMed
description Background: Contrast-Enhanced Magnetic Resonance Lymphangiography (CE-MRL) presents some limitations: (i) it does not quantify lymphatic functionality; and (ii) enhancement of vascular structures may confound image interpretation. Furthermore, although CE-MRL is well described in the published literature for the lower limbs, there is a paucity of data with regards to its use in the upper limbs. In this proof-of-principle study, we propose a new protocol to perform CE-MRL in the upper limbs of patients with breast cancer-related lymphedema (BCRL) which addresses these limitations. Methods and Results: CE-MRL was performed using a previously published (morphological) protocol and the proposed protocol (quantitative) on both the ipsilateral (abnormal) and contralateral (normal) arms of patients with BCRL. The quantitative protocol employs contrast agent (CA) intradermal injections at a lower concentration to prevent T2*-related signal decay. Both protocols provided high-resolution three-dimensional images of upper limb lymphatic vessels. CA uptake curves were utilized to distinguish between lymphatic vessels and vascular structures. The quantitative protocol minimized venous enhancement and avoided spurious delays in lymphatic enhancement due to short T2* values, enabling correct CA uptake characterization. The quantitative protocol was therefore employed to measure the lymphatic fluid velocity, which demonstrated functional differences between abnormal and normal arms. The velocity values were in agreement with previously reported lymphoscintigraphy and near infra-red lymphangiography measurements. Conclusions: This work demonstrated the feasibility of CE-MRL of the upper limbs in patients with BRCL, introducing an advanced imaging and analysis protocol suitable for anatomical and functional study of the lymphatic system.
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spelling pubmed-44925922015-09-23 Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study Borri, Marco Schmidt, Maria A. Gordon, Kristiana D. Wallace, Toni A. Hughes, Julie C. Scurr, Erica D. Koh, Dow-Mu Leach, Martin O. Mortimer, Peter S. Lymphat Res Biol Original Articles Background: Contrast-Enhanced Magnetic Resonance Lymphangiography (CE-MRL) presents some limitations: (i) it does not quantify lymphatic functionality; and (ii) enhancement of vascular structures may confound image interpretation. Furthermore, although CE-MRL is well described in the published literature for the lower limbs, there is a paucity of data with regards to its use in the upper limbs. In this proof-of-principle study, we propose a new protocol to perform CE-MRL in the upper limbs of patients with breast cancer-related lymphedema (BCRL) which addresses these limitations. Methods and Results: CE-MRL was performed using a previously published (morphological) protocol and the proposed protocol (quantitative) on both the ipsilateral (abnormal) and contralateral (normal) arms of patients with BCRL. The quantitative protocol employs contrast agent (CA) intradermal injections at a lower concentration to prevent T2*-related signal decay. Both protocols provided high-resolution three-dimensional images of upper limb lymphatic vessels. CA uptake curves were utilized to distinguish between lymphatic vessels and vascular structures. The quantitative protocol minimized venous enhancement and avoided spurious delays in lymphatic enhancement due to short T2* values, enabling correct CA uptake characterization. The quantitative protocol was therefore employed to measure the lymphatic fluid velocity, which demonstrated functional differences between abnormal and normal arms. The velocity values were in agreement with previously reported lymphoscintigraphy and near infra-red lymphangiography measurements. Conclusions: This work demonstrated the feasibility of CE-MRL of the upper limbs in patients with BRCL, introducing an advanced imaging and analysis protocol suitable for anatomical and functional study of the lymphatic system. Mary Ann Liebert, Inc. 2015-06-01 /pmc/articles/PMC4492592/ /pubmed/25774851 http://dx.doi.org/10.1089/lrb.2014.0039 Text en © The Author(s) 2015; Published by Mary Ann Liebert, Inc. This Open Access article is distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
spellingShingle Original Articles
Borri, Marco
Schmidt, Maria A.
Gordon, Kristiana D.
Wallace, Toni A.
Hughes, Julie C.
Scurr, Erica D.
Koh, Dow-Mu
Leach, Martin O.
Mortimer, Peter S.
Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study
title Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study
title_full Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study
title_fullStr Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study
title_full_unstemmed Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study
title_short Quantitative Contrast-Enhanced Magnetic Resonance Lymphangiography of the Upper Limbs in Breast Cancer Related Lymphedema: An Exploratory Study
title_sort quantitative contrast-enhanced magnetic resonance lymphangiography of the upper limbs in breast cancer related lymphedema: an exploratory study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4492592/
https://www.ncbi.nlm.nih.gov/pubmed/25774851
http://dx.doi.org/10.1089/lrb.2014.0039
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