European Radiology

, Volume 27, Issue 2, pp 578–588 | Cite as

Grading diffuse gliomas without intense contrast enhancement by amide proton transfer MR imaging: comparisons with diffusion- and perfusion-weighted imaging

  • Osamu Togao
  • Akio HiwatashiEmail author
  • Koji Yamashita
  • Kazufumi Kikuchi
  • Jochen Keupp
  • Koji Yoshimoto
  • Daisuke Kuga
  • Masami Yoneyama
  • Satoshi O. Suzuki
  • Toru Iwaki
  • Masaya Takahashi
  • Koji Iihara
  • Hiroshi Honda
Magnetic Resonance



To investigate whether amide proton transfer (APT) MR imaging can differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) among gliomas without intense contrast enhancement (CE).


This retrospective study evaluated 34 patients (22 males, 12 females; age 36.0 ± 11.3 years) including 20 with LGGs and 14 with HGGs, all scanned on a 3T MR scanner. Only tumours without intense CE were included. Two neuroradiologists independently performed histogram analyses to measure the 90th-percentile (APT90) and mean (APTmean) of the tumours’ APT signals. The apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) were also measured. The parameters were compared between the groups with Student’s t-test. Diagnostic performance was evaluated with receiver operating characteristic (ROC) analysis.


The APT90 (2.80 ± 0.59 % in LGGs, 3.72 ± 0.89 in HGGs, P = 0.001) and APTmean (1.87 ± 0.49 % in LGGs, 2.70 ± 0.58 in HGGs, P = 0.0001) were significantly larger in the HGGs compared to the LGGs. The ADC and rCBV values were not significantly different between the groups. Both the APT90 and APTmean showed medium diagnostic performance in this discrimination.


APT imaging is useful in discriminating HGGs from LGGs among diffuse gliomas without intense CE.

Key Points

Amide proton transfer (APT) imaging helps in grading non-enhancing gliomas

High-grade gliomas showed higher APT signal than low-grade gliomas

APT imaging showed better diagnostic performance than diffusion- and perfusion-weighted imaging


Amide proton transfer imaging Chemical exchange saturation transfer MR imaging Brain tumour Glioma 



Amide proton transfer


Low-grade gliomas


High-grade glioma


Contrast enhancement


Apparent diffusion coefficient


relative cerebral blood volume


Receiver operating characteristic


Dynamic susceptibility contrast






Chemical exchange saturation transfer


World Health Organization


Glioblastoma multiforme




Repetition time


Echo time


Field of view


Two dimensional


Normal-appearing white matter


Fluid attenuation inversion recovery


Asymmetry of the magnetization transfer ratio




Intra-class correlation coefficient


Area under the curve





The scientific guarantor of this publication is Hiroshi Honda.

The authors of this manuscript declare relationships with the following companies: Jochen Keupp is an employee of Philips Reseach Europe, and Masami Yoneyama is an employees of Philips Electronics Japan. This study has received funding by the Japanese Society of Neuroradiology, Japanese Radiological Society, the Fukuoka Foundation for Sound Health Cancer Research Fund, and JSPS KAKENHI Grants-in-Aid for Scientific Research nos. 26461827, 26293278, 26670564 and 22591340. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board.

Methodology: retrospective, diagnostic or prognostic study, performed at one institution.


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Osamu Togao
    • 1
  • Akio Hiwatashi
    • 1
    Email author
  • Koji Yamashita
    • 1
  • Kazufumi Kikuchi
    • 1
  • Jochen Keupp
    • 2
  • Koji Yoshimoto
    • 3
  • Daisuke Kuga
    • 3
  • Masami Yoneyama
    • 4
  • Satoshi O. Suzuki
    • 5
  • Toru Iwaki
    • 5
  • Masaya Takahashi
    • 6
  • Koji Iihara
    • 3
  • Hiroshi Honda
    • 1
  1. 1.Department of Clinical Radiology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Philips ResearchHamburgGermany
  3. 3.Department of Neurosurgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  4. 4.Philips Electronics JapanTokyoJapan
  5. 5.Department of Neuropathology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  6. 6.Advanced Imaging Research Center, UT Southwestern Medical CenterDallasUSA

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