{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:55:18Z","timestamp":1791374118212,"version":"4.3.1"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell Dev. Biol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lipedema is a chronic adipose tissue disorder characterized by a disproportionate accumulation of painful subcutaneous fat on the extremities. Manual lymphatic drainage (MLD) is routinely used as therapeutic intervention, but its immediate physiological effects remain unclear. We evaluated the immediate impact of MLD on tissue composition in Lipedema using multiparametric Magnetic-resonance-imaging (MRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Fifteen women with Lipedema (5 women each for stages I\/II\/III; median age 43.7 [20.4\u201368.8] years), thirteen with lower-limb lymphedema (3\/5\/5 women for stages I\/II\/III; median age 57.6 [18.6\u201370.4] years) underwent quantitative MRI of the legs including volumetry, sodium MRI, proton-densitiy fat-fraction (PDFF), T1, T2 and fat-suppressed T2 mapping before and after a standardized 1\u00a0h MLD session. Five normal controls (median age 41.9 [23.3\u201366.2] years) were examined only before MLD. Regions of interest in skin, subcutaneous adipose tissue (SAT), and muscle were analyzed. Pain was assessed by numeric rating scale (NRS). Wilcoxon tests and Spearman correlations were applied to test for differences pre- and post-MLD as well as for associations between measurements and clinical parameters (p &amp;lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At baseline, women with Lipedema showed higher tissue sodium and water-sensitive MRI measures compared to controls (skin sodium: median 17.7 vs. 12.3\u00a0mmol\/L, p &amp;lt; 0.001; skin T2: 56 vs. 37\u00a0ms, p = 0.03), though lower than lymphedema (skin sodium: 32.1\u00a0mmol\/L, skin T2: 70\u00a0ms). Tissue sodium in women with Lipedema correlated with clinical stage (r = 0.775, p = 0.001) and pain intensity (r = 0.656, p = 0.01). After MLD, perceived pain intensity decreased (median NRS 2 \u2192 0, p = 0.007) and edema-related MRI metrics including tissue sodium decreased in women with Lipedema (skin sodium: 17.7 \u2192 14.8\u00a0mmol\/L, p = 0.001; skin T2: 56 \u2192 43\u00a0ms, p = 0.001). Parameter changes in the same direction after MLD were detected in women with Lymphedema (skin sodium: 32.1 \u2192 27.1\u00a0mmol\/L, p = 0.001; skin T2: 70 \u2192 61\u00a0ms, p = 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Manual lymphatic drainage produces immediate, quantifiable changes in treated tissue in women with lipedema, indicating mobilization of sodium-rich interstitial fluid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcell.2026.1808579","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:27:32Z","timestamp":1791372452000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Manual lymphatic drainage reduces tissue sodium and self-reported pain in women with lipedema: a quantitative MRI study"],"prefix":"10.3389","volume":"14","author":[{"given":"E","family":"N\u00f6ll","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University of Bonn, University Hospital of Bonn","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Henkel","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University of Bonn, University Hospital of Bonn","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.E.","family":"Cornely","sequence":"additional","affiliation":[{"name":"Institute for Basic Lymphological Research, LY.SEARCH gGmbH","place":["D\u00fcsseldorf, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Dinnendahl","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Translational Pain Research, Medical Faculty and University Hospital of Cologne, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Breuer","sequence":"additional","affiliation":[{"name":"TheraNova, Centre for Physical Therapy","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University of Bonn, University Hospital of Bonn","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Hucho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Translational Pain Research, Medical Faculty and University Hospital of Cologne, University of Cologne","place":["Cologne, Germany"]},{"name":"Department of Anesthesiology and Intensive Care Medicine, Pain Center, University Hospital of Cologne, University of Cologne","place":["Cologne, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. A.","family":"Luetkens","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University of Bonn, University Hospital of Bonn","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. C.","family":"Pieper","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, University of Bonn, University Hospital of Bonn","place":["Bonn, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e55260","DOI":"10.7759\/cureus.55260","article-title":"Efficacy of liposuction in the treatment of lipedema: a meta-analysis","volume":"16","author":"Amato","year":"2024","journal-title":"Cureus"},{"key":"B2","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1089\/lrb.2020.0019","article-title":"The effects of complete decongestive therapy or intermittent pneumatic compression therapy or exercise only in the treatment of severe lipedema: a randomized controlled trial","volume":"19","author":"Atan","year":"2021","journal-title":"Lymphat. Res. 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