European Radiology

, Volume 30, Issue 1, pp 346–356 | Cite as

Repeatability of amide proton transfer–weighted signals in the brain according to clinical condition and anatomical location

  • Jung Bin Lee
  • Ji Eun Park
  • Seung Chai JungEmail author
  • Youngheun Jo
  • Donghyun Kim
  • Ho Sung Kim
  • Choong-Gon Choi
  • Sang Joon Kim
  • Dong-Wha Kang
Magnetic Resonance



To investigate whether clinical condition, imaging session, and locations affect repeatability of amide proton transfer–weighted (APTw) magnetic resonance imaging (MRI) in the brain.

Materials and methods

Three APTw MRI data sets were acquired, involving two intrasession scans and one intersession scan for 19 healthy, 15 glioma, and 12 acute stroke adult participants (mean age 53.8, 54.6, and 68.5, respectively) on a 3T MR scanner. The mean APTw signals from five locations in healthy brain (supratentorial and infratentorial locations) and from entire tumor and stroke lesions (supratentorial location) were calculated. The within-subject coefficient of variation (wCV) and intraclass correlation coefficient (ICC) were calculated for each clinical conditions, image sessions, and anatomic locations. Differences in APTw signals between sessions were analyzed using repeated-measures analysis of variance.


The ICC and wCV were 0.96 (95% confidence interval [CI], 0.91–0.99) and 16.1 (12.6–21.3) in glioma, 0.93 (0.82–0.98) and 15.0 (11.4–20.6) in stroke, and 0.84 (0.72–0.91) and 34.0 (28.7–41.0) in healthy brain. There were no significant differences in APTw signal between three sessions, irrespective of disease condition and location. The ICC and wCV were 0.85 (0.68–0.94) and 27.4 (21.8–35.6) in supratentorial, and 0.44 (− 0.18 to 0.76) and 32.7 (25.9 to 42.9) in infratentorial locations. There were significant differences in APTw signal between supra- (mean, 0.49%; 95% CI, 0.38–0.61) and infratentorial locations (1.09%, 0.98–1.20; p < 0.001).


The repeatability of APTw signal was excellent in supratentorial locations, while it was poor in infratentorial locations due to severe B0 inhomogeneity and susceptibility which affects MTR asymmetry.

Key Points

• In supratentorial locations, APTw MRI showed excellent intrasession and intersession repeatability in brains of healthy controls and patients with glioma, as well as in stroke-affected regions.

• APTw MRI showed excellent repeatability in supratentorial locations, but poor repeatability in infratentorial locations.

• Considering poor repeatability in the infratentorial locations, the use of APTw MRI in longitudinal assessment in infratentorial locations is not indicated.


Amides Repeatability Brain tumors Stroke Magnetic resonance imaging 



Analysis of variance


Amide proton transfer–weighted


Chemical exchange saturation transfer


Confidence interval


Intraclass correlation coefficient


Magnetic resonance imaging


Magnetization transfer ratio




Region of interest


Echo time


Repetition time


Turbo spin echo


Within-subject coefficient of variation


World Health Organization



The authors sincerely thank all patients with glioma and stroke, as well as the healthy volunteers, who kindly agreed to participate in the present study. We also thank Seonok Kim in the Department of Clinical Epidemiology and Biostatistics at Asan Medical Center, Seoul, South Korea, for her contributions regarding interpretation of the results.


This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry for Health, Welfare & Family Affairs, Republic of Korea (HI12C1847).

Compliance with ethical standards


The scientific guarantor of this publication is Ho Sung Kim.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

Seonok Kim kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution

Supplementary material

330_2019_6285_MOESM1_ESM.docx (588 kb)
ESM 1 (DOCX 588 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea
  2. 2.Department of NeurologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulSouth Korea

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