Amide proton transfer MRI detects early changes in nasopharyngeal carcinoma: providing a potential imaging marker for treatment response

  • Sahrish Qamar
  • Ann D. King
  • Qi-Yong Ai
  • Benjamin King Hong Law
  • Janet S. M. Chan
  • Darren M. C. Poon
  • Macy Tong
  • Frankie Kwok Fai Mo
  • Weitian Chen
  • Kunwar S. Bhatia
  • Anil T. Ahuja
  • Brigette B. Y. Ma
  • David Ka-Wai Yeung
  • Yi-Xiang Wang
  • Jing Yuan
Head & Neck



To determine if treatment of nasopharyngeal carcinoma (NPC) induces early changes in amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI), and to perform a preliminary evaluation of APTw imaging in response assessment.


Sixteen patients with NPC planned for treatment with radiotherapy and/or chemotherapy underwent APTw imaging of the primary tumour pre-treatment and 2-week intra-treatment. Difference in pre- and intra-treatment APT mean (APTmean) was compared using the Wilcoxon signed rank test. Differences in APTmean and percentage change (%Δ) in APTmean were compared between responders and non-responders based on the outcome at 6 months, using the Mann–Whitney U test.


APTmean decreased in 9/16 (56.3%) and increased in 7/16 (43.7%) with no significant difference between the pre- and intra-treatment APT values for the whole group (p > 0.05). NPC showed response in 11/16 (68.8%) and non-response in 5/11 (31.2%). There were significant differences between the %Δ of responders and non-responders for APTmean (p = 0.01). Responders showed %Δ decrease in APTmean of − 23.12% while non-responders showed a %Δ increase in APTmean of + 102.28%.


APT value changes can be detected in early intra-treatment. Intra-treatment %Δ APTmean shows potential in predicting short-term outcome.


Amide proton transfer-weighted imaging Chemical exchange saturation transfer Magnetic resonance imaging Nasopharyngeal carcinoma Treatment response 



The authors thank Dr Jinyuan Zhou, Department of Radiology, Johns Hopkins University, for providing technical advice on pulse sequencing.


The work described in this paper was supported by grants from the Research Grants council of the Hong Kong Special Administrative Region, China (Project no. CUHK141070/14 and SEG_CUHK02).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

405_2018_5231_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 12 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Sahrish Qamar
    • 1
  • Ann D. King
    • 1
  • Qi-Yong Ai
    • 1
  • Benjamin King Hong Law
    • 1
  • Janet S. M. Chan
    • 1
  • Darren M. C. Poon
    • 2
  • Macy Tong
    • 2
  • Frankie Kwok Fai Mo
    • 2
  • Weitian Chen
    • 1
  • Kunwar S. Bhatia
    • 3
  • Anil T. Ahuja
    • 1
  • Brigette B. Y. Ma
    • 2
  • David Ka-Wai Yeung
    • 2
  • Yi-Xiang Wang
    • 1
  • Jing Yuan
    • 4
  1. 1.Department of Imaging and Interventional Radiology, Faculty of MedicineThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong S.A.R.China
  2. 2.Department of Clinical Oncology, State Key Laboratory Translational Oncology, Faculty of MedicineThe Chinese University of Hong Kong, Prince of Wales HospitalHong Kong S.A.R.China
  3. 3.Imaging Department, St Mary’s HospitalImperial College Healthcare, National Health Service TrustLondonUK
  4. 4.Medical Physics and Research DepartmentHong Kong Sanatorium & HospitalHong Kong S.A.R.China

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