Grading diffuse gliomas without intense contrast enhancement by amide proton transfer MR imaging: comparisons with diffusion- and perfusion-weighted imaging
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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.
• 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
KeywordsAmide proton transfer imaging Chemical exchange saturation transfer MR imaging Brain tumour Glioma
Amide proton transfer
Apparent diffusion coefficient
relative cerebral blood volume
Receiver operating characteristic
Dynamic susceptibility contrast
Chemical exchange saturation transfer
World Health Organization
Field of view
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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