UVA Health Receives $6.5 Million NIH Grant to Develop SALT MRI for Lymphatic Disease Diagnosis
Key Insights
UVA Health's Rachelle Crescenzi, PhD, received a $6.5 million NIH grant to develop SALT MRI, a non-invasive imaging approach for lymphedema (search) and lipedema (search).
Lymphedema (search) affects over 10 million Americans and up to 250 million people worldwide, yet patients often face misdiagnosis or delayed treatment due to limited diagnostic tools.
SALT MRI measures sodium, adipose tissue, and lymphatic fluids, with early findings showing tissue sodium increases with disease severity and decreases after physical therapy.
A University of Virginia School of Medicine scientist has been awarded a $6.5 million grant from the National Heart, Lung, and Blood Institute (NHLBI) to pioneer what she calls the "lymphatic medicine exam of the future" — a non-invasive MRI-based approach designed to transform diagnosis and care for millions of patients suffering from chronic lymphatic diseases.
Rachelle Crescenzi, PhD, of UVA's Department of Radiology and Medical Imaging, will lead the effort to develop SALT MRI — short for "sodium, adipose and lymphatic translational sciences" — over the next seven years. The grant (R35HL184172) will support research into lymphedema (search) and lipedema (search), two conditions that cause painful, long-term swelling and remain notoriously difficult to diagnose with current clinical tools.
"For too long, patients with chronic swelling have been dismissed until severe swollen limbs become obvious. Imaging helps us look beneath the skin at early changes in tissue, and we saw something unexpected," said Crescenzi. "We saw sodium builds up in tissue with chronic swelling using a special MRI exam called sodium MRI. Together with vascular imaging, this exam could provide a non-invasive way to detect swelling earlier and identify new treatment strategies."
The Diagnostic Gap in Lymphatic Disease
Lymphedema (search) is estimated to affect more than 10 million Americans and up to 250 million people worldwide. Approximately one-third to 50% of breast cancer survivors develop the condition, as do 20% to 40% of patients recovering from gynecologic cancer. The disease, historically known as dropsy, typically causes the arms or legs to swell as the body retains fluid draining from the lymphatic system, though swelling can also affect the torso, neck, and genitals.
Lipedema (search), a distinct condition characterized by the buildup of uneven, often painful fat deposits causing leg swelling primarily in women, is thought to affect up to 11% of women worldwide. Critically, there are currently no diagnostic tests for lipedema, and patients with both conditions frequently experience significant diagnostic delays.
"They often take 20 years to receive a diagnosis, especially of lipedema (search), because there's just so few tools to even recognize symptoms of lymphatic diseases," Crescenzi noted. "Right now, what's being used in the clinic is a tape measure."
How SALT MRI Works
The SALT MRI approach applies magnetic resonance imaging to measure three key parameters: sodium concentration, adipose tissue distribution, and lymphatic fluids within the body. By tracking how sodium and adipose tissue accumulate, the researchers aim to better understand how these factors affect lymphatic function in both health and disease.
Crescenzi and her team have already completed an observational trial in patients with leg lymphedema (search), which yielded promising results: tissue sodium levels were found to increase with disease severity and, notably, to decrease following standard-of-care physical therapy. These findings suggest that sodium imaging could serve as both a diagnostic biomarker and a tool for monitoring treatment response.
A Seven-Year Research Agenda
Over the course of the grant period, the researchers plan to deploy SALT MRI across three major initiatives: studying the progression of leg lymphedema (search), developing improved diagnostic methods for lipedema (search), and creating a dedicated SALT MRI exam to address breast cancer-related lymphedema.
The broader vision extends beyond individual studies. "This award is the start of establishing a center for lymphatic disease research and clinical excellence at the University of Virginia," Crescenzi said. "We'll be able to train new investigators in the relationship between sodium and the lymphatic system and translate discoveries into meaningful clinical care for patients with lymphedema (search) and lipedema (search)."
The SALT Lab is currently enrolling participants in the Charlottesville area who have arm or leg swelling, as well as healthy volunteers without lymphatic disease to serve as controls.
"We hope that SALT MRI will give doctors more objective ways of viewing and detecting lymphedema (search) and lipedema (search), before symptoms become debilitating," Crescenzi said. "It should not take 20 years to receive a diagnosis for lymphatic diseases. Sodium imaging could give us important clues to earlier diagnosis and also treatment options."