{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T02:21:59Z","timestamp":1787624519948,"version":"build-2736575974"},"reference-count":39,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","award":["R01HL155523"],"award-info":[{"award-number":["R01HL155523"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"crossref","award":["R01HL157378"],"award-info":[{"award-number":["R01HL157378"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["F32"],"award-info":[{"award-number":["F32"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["T32 EB001628"],"award-info":[{"award-number":["T32 EB001628"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100013317","name":"Lipedema Foundation","doi-asserted-by":"crossref","award":["12"],"award-info":[{"award-number":["12"]}],"id":[{"id":"10.13039\/100013317","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      There are few objective tools to quantify lymphatic disease changes in anatomy and physiology of affected tissues. Tissue sodium could be a relevant physiological indicator of lymphatic disease. However, the importance of sodium to lymphatic physiology in humans has not been well-characterized nor exploited for clinical applications due to a lack of imaging methods to observe sodium and lymphatics together\n                      <jats:italic toggle=\"yes\">in\u00a0vivo<\/jats:italic>\n                      . The purpose of this study was to apply\n                      <jats:sup>23<\/jats:sup>\n                      Na-MRI to measure tissue sodium content (TSC) in human subjects with or without lower extremity lymphedema (LEL) and investigate the relationship between lymphatic dysfunction and tissue sodium.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      A prospective, cross-sectional observational clinical trial enrolled participants with LEL and controls without lymphedema.\n                      <jats:sup>23<\/jats:sup>\n                      Na-MRI measured standardized TSC in the mid-calf. For each leg with lymphedema, clinical stage was determined by a licensed clinician, and lymphedema severity was determined by radiology assessment of noncontrast hydrogen (\n                      <jats:sup>1<\/jats:sup>\n                      H)\u2013magnetic resonance lymphangiography (MRL). Linear mixed-effects models determined differences in TSC between cases and controls and measured the association of TSC with clinical stage and lymphedema severity. Image subregions were analyzed to observe spatial patterns of TSC involvement. Results found that TSC was nearly 50% higher in lymphedema (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 52 legs) in the skin (1.51-fold) and adipose tissue (1.47-fold) compared with controls (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 31 legs;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) and was directly related to both clinical stage and lymphedema severity by\n                      <jats:sup>1<\/jats:sup>\n                      H-MRL in the skin (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) and adipose tissue (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). TSC accumulated in patterns in the anterior subcutaneous adipose tissue, increasing with disease severity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      <jats:sup>23<\/jats:sup>\n                      Na-MRI demonstrates that standardized TSC is distinctly elevated in lymphedema, sensitive to lymphedema disease severity, and a potential objective imaging tool for evaluating lymphedema in future clinical trials.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15578585261452761","type":"journal-article","created":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T04:48:19Z","timestamp":1781326099000},"page":"163-173","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["<sup>23<\/sup>\n                    Na-MRI Measures Tissue Sodium in Human Leg Lymphedema"],"prefix":"10.1177","volume":"24","author":[{"given":"Shannon L.","family":"Taylor","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA."},{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa N.","family":"Crain","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheau-Chiann","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D.","family":"Pridmore","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Garza","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Beasley","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheyenne N.","family":"Whaley","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miracle P.","family":"Darrington","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison O.","family":"Scott","sequence":"additional","affiliation":[{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Aumann","sequence":"additional","affiliation":[{"name":"Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akwasi","family":"Opoku","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelson","family":"Nwumeh","sequence":"additional","affiliation":[{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaina J.","family":"Brown","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula M.C.","family":"Donahue","sequence":"additional","affiliation":[{"name":"Physical Medicine &amp; Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, Tennessee, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-4570","authenticated-orcid":false,"given":"Rachelle L.","family":"Crescenzi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA."},{"name":"Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA."},{"name":"Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, 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The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology. 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L-dex ratio in detecting breast cancer-related lymphedema: Reliability, sensitivity, and specificity. Lymphology, 2013; 46(2):85\u201396.","journal-title":"Lymphology"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.3233\/bd-201008"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2014.0019"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.111.183517"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2016.0011"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1172\/jci.insight.123775"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-060116-022900"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000007783"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI171582"},{"key":"e_1_3_3_39_2","unstructured":"Lymphatic Education and Research Network (LE&RN). 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Available from: https:\/\/www.lipedema.org\/roadmap [Last accessed: January 2025]."}],"container-title":["Lymphatic Research and Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15578585261452761","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15578585261452761","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15578585261452761","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T02:04:38Z","timestamp":1787623478000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15578585261452761"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":39,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8,1]]}},"alternative-id":["10.1177\/15578585261452761"],"URL":"https:\/\/doi.org\/10.1177\/15578585261452761","relation":{},"ISSN":["1539-6851","1557-8585"],"issn-type":[{"value":"1539-6851","type":"print"},{"value":"1557-8585","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}