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Elevated magnetic resonance imaging measures of adipose tissue deposition in women with breast cancer treatment-related lymphedema



Breast cancer treatment-related lymphedema (BCRL) is a common co-morbidity of breast cancer therapies, yet factors that contribute to BCRL progression remain incompletely characterized. We investigated whether magnetic resonance imaging (MRI) measures of subcutaneous adipose tissue were uniquely elevated in women with BCRL.


MRI at 3.0 T of upper extremity and torso anatomy, fat and muscle tissue composition, and T2 relaxometry were applied in left and right axillae of healthy control (n = 24) and symptomatic BCRL (n = 22) participants to test the primary hypothesis that fat-to-muscle volume fraction is elevated in symptomatic BCRL relative to healthy participants, and the secondary hypothesis that fat-to-muscle volume fraction is correlated with MR relaxometry of affected tissues and BCRL stage (significance criterion: two-sided p < 0.05).


Fat-to-muscle volume fraction in healthy participants was symmetric in the right and left sides (p = 0.51); in BCRL participants matched for age, sex, and BMI, fat-to-muscle volume fraction was elevated on the affected side (fraction = 0.732 ± 0.184) versus right and left side in controls (fraction = 0.545 ± 0.221, p < 0.001). Fat-to-muscle volume fraction directly correlated with muscle T2 (p = 0.046) and increased with increasing level of BCRL stage (p = 0.041).


Adiposity quantified by MRI is elevated in the affected upper extremity of women with BCRL and may provide a surrogate marker of condition onset or severity.

Clinical trial


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Data availability

The datasets generated during the current study are available from the corresponding author on reasonable request.

Code availability

Code generated during the current study is available from the corresponding author on reasonable request.


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We are grateful to Christopher Thompson, Clair Jones, Marisa Bush, Joshua Hageman, Charles Nockowski, and Ryan Robinson for experimental support.


This research was funded by Grant Nos. NIH/NINR 1R01NR015079, NIH/NHLBI 1R01HL155523, the Lipedema Foundation (LF) Postdoctoral Research Fellowship, LF Collaborative Grant #12, American Heart Association (AHA) 18CDA34110297, and AHA 19IPLOI34760518. Imaging experiments were performed in the Vanderbilt Human Imaging Core using research resources supported by the NIH grant 1S10OD021771-01. Recruitment through and services at the Clinical Research Center are supported by the National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) Program, award number 5UL1TR002243-03. REDCap resources were provided by NCATS/NIH UL1 TR000445. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Author information




All authors contributed to the study conception and design. Material preparation and data collection were performed by RC, PD, MD, MG, CL, and NP. Analyses were performed by RC, MD, PD, SJ, and VG. The first draft of the manuscript was written by RC and MD. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rachelle Crescenzi.

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Conflict of interest

PMCD is a paid consultant for PureTech Health and Tactile Medical and has received clinical and imaging grants from LymphaTouch Inc. MJD receives research-related support from Philips North America; is a paid consultant for Pfizer Inc, Global Blood Therapeutics, and LymphaTouch; is a paid advisory board member for Novartis and bluebird bio; receives research funding from Pfizer Inc; and is the CEO of Biosight, LLC which provides healthcare technology consulting services. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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This study was approved by the Vanderbilt University Medical Center Institutional Review Board.

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All participants provided written informed consent before study participation.

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Crescenzi, R., Donahue, P.M.C., Garza, M. et al. Elevated magnetic resonance imaging measures of adipose tissue deposition in women with breast cancer treatment-related lymphedema. Breast Cancer Res Treat (2021).

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  • Breast cancer
  • Lymphedema
  • MRI
  • MR relaxometry
  • Adipose tissue
  • Edema