{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T13:32:59Z","timestamp":1762522379308,"version":"3.40.5"},"reference-count":46,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T00:00:00Z","timestamp":1571616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Institutes of Health (NIH)\/National Institute of Nursing Research","award":["1R01NR015079"],"award-info":[{"award-number":["1R01NR015079"]}]},{"name":"Lipedema Foundation Postdoctoral Fellowship"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance in Med"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To quantify chemical exchange saturation transfer contrast in upper extremities of participants with lymphedema before and after standardized lymphatic mobilization therapy using correction procedures for <jats:italic>B<\/jats:italic><jats:sub>0<\/jats:sub> and <jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> heterogeneity, and <jats:italic>T<\/jats:italic><jats:sub>1<\/jats:sub> relaxation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Females with (n = 12) and without (n = 17) breast cancer treatment\u2010related lymphedema (BCRL) matched for age and body mass index were scanned at 3.0T MRI. <jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> efficiency and <jats:italic>T<\/jats:italic><jats:sub>1<\/jats:sub> were calculated in series with chemical exchange saturation transfer in bilateral axilla (<jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> amplitude = 2<jats:italic>\u00b5<\/jats:italic>T, \u0394<jats:italic>\u03c9<\/jats:italic> = \u00b15.5 ppm, slices = 9, spatial resolution = 1.8 \u00d7 1.47 \u00d7 5.5 mm<jats:sup>3<\/jats:sup>). <jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> dispersion measurements (<jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> = 1\u20103 <jats:italic>\u00b5<\/jats:italic>T; increment = 0.5 <jats:italic>\u00b5<\/jats:italic>T) were performed in controls (n = 6 arms in 3 subjects). BCRL participants were scanned pre\u2010 and post\u2010manual lymphatic drainage\u00a0(MLD) therapy. Chemical exchange saturation transfer amide proton transfer\u00a0(<jats:italic>APT<\/jats:italic>) and nuclear Overhauser effect (NOE) metrics corrected for <jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> efficiency were calculated, including proton transfer ratio\u00a0(<jats:italic>PTR'<\/jats:italic>), magnetization transfer ratio asymmetry <jats:inline-graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"graphic\/mrm28031-math-0001.png\" xlink:title=\"urn:x-wiley:07403194:media:mrm28031:mrm28031-math-0001\"\/>, and apparent exchange\u2010dependent relaxation (AREX'). Nonparametric tests were used to evaluate relationships between metrics in BCRL participants pre\u2010 versus post\u2010MLD (two\u2010sided <jats:italic>P<\/jats:italic> &lt; 0.05 required for significance).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> dispersion experiments showed nonlinear dependence of <jats:italic>Z<\/jats:italic>\u2010values on <jats:italic>B<\/jats:italic><jats:sub>1<\/jats:sub> efficiency in the upper extremities; <jats:italic>PTR'<\/jats:italic> showed &lt; 1% mean fractional difference between subject\u2010specific and group\u2010level correction procedures. <jats:italic>PTR'<jats:sub>APT<\/jats:sub><\/jats:italic> significantly correlated with <jats:italic>T<\/jats:italic><jats:sub>1<\/jats:sub> (Spearman's rho = 0.57, <jats:italic>P<\/jats:italic> &lt; 0.001) and body mass index (Spearman's rho = \u22120.37, <jats:italic>P<\/jats:italic> = 0.029) in controls and with lymphedema stage (Spearman's rho = 0.48, <jats:italic>P<\/jats:italic> = 0.017) in BCRL participants. Following MLD therapy, <jats:italic>PTR'<jats:sub>APT<\/jats:sub><\/jats:italic> significantly increased in the affected arm of BCRL participants (pre\u2010 vs. post\u2010MLD: 0.41 \u00b1 0.05 vs. 0.43 \u00b1 0.03, <jats:italic>P<\/jats:italic> = 0.02), consistent with treatment effects from mobilized lymphatic fluid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Chemical exchange saturation transfer metrics, following appropriate correction procedures, respond to lymphatic mobilization therapies and may have potential for evaluating treatments in participants with secondary lymphedema.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mrm.28031","type":"journal-article","created":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T08:00:46Z","timestamp":1571644846000},"page":"1760-1773","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["CEST MRI quantification procedures for breast cancer treatment\u2010related lymphedema therapy evaluation"],"prefix":"10.1002","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-4570","authenticated-orcid":false,"given":"Rachelle","family":"Crescenzi","sequence":"first","affiliation":[{"name":"Department of Radiology Vanderbilt University Medical Center Nashville Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula M. 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