Differentiation of Malignant and Benign Head and Neck Tumors with Amide Proton Transfer-Weighted MR Imaging
- 28 Downloads
To prospectively evaluate the feasibility and capability of amide proton transfer-weighted (APTw) imaging for the characterization of head and neck tumors.
Twenty-nine consecutive patients with suspected head and neck tumors were enrolled in this study and underwent APTw magnetic resonance imaging (MRI) on a 3.0-T MRI scanner. The patients were divided into malignant (n = 16) and benign (n = 13) groups, based on pathological results. A map of magnetization transfer ratio asymmetry at 3.5 ppm [MTRasym (3.5 ppm)] was generated for each patient. Interobserver agreement was evaluated and comparisons of MTRasym (3.5 ppm) were made between the malignant and benign groups. Receiver operating characteristic analysis was used to determine the appropriate threshold value of MTRasym (3.5 ppm) for the differentiation of malignant from benign tumors.
The intraclass correlation coefficients of the malignant and benign groups were 0.96 and 0.90, respectively, which indicated a good interobserver agreement. MTRasym (3.5 ppm) was significantly higher for the malignant group (3.66 ± 1.15 %) than for the benign group (1.94 ± 0.93 %, P < 0.001). APTw MRI revealed an area under the curve of 0.904 in discriminating these two groups, with a sensitivity of 81.3 %, a specificity of 92.3 %, and an accuracy of 86.2 %, at the threshold of 2.62 % of MTRasym (3.5 ppm).
APTw MRI is feasible for use in the head and neck tumors and is a valuable imaging biomarker for distinguishing malignant from benign lesions.
Key wordsAPTw imaging CEST imaging Head and neck tumors MRI
This study was supported by grants from the National Natural Science Foundation of China (81361120392, 81401404, and 81771826), Beijing Municipal Natural Science Foundation (7154235), and the National Institutes of Health (R01CA166171, R01CA228188).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.Stewart BW, Wild CP (2014) World cancer report 2014. WHO Press, Lyon, p 423Google Scholar
- 11.Zhang J, Zhu W, Tain R, Zhou XJ, Cai K (2018) Improved differentiation of low-grade and high-grade gliomas and detection of tumor proliferation using APT contrast fitted from Z-spectrum. Mol Imaging Biol. https://doi.org/10.1007/s11307-017-1154-y
- 12.Zhou J, Zhu H, Lim M, Blair L, Quinones-Hinojosa A, Messina SA, Eberhart CG, Pomper MG, Laterra J, Barker PB, van Zijl PCM, Blakeley JO (2013) Three-dimensional amide proton transfer MR imaging of gliomas: initial experience and comparison with gadolinium enhancement. J Magn Reson Imaging 38:1119–1128CrossRefPubMedGoogle Scholar
- 18.Song G, Li C, Luo X, Zhao X, Zhang S, Zhang Y, Jiang S, Wang X, Chen Y, Chen H, Gong T, Zhou J, Chen M (2017) Evolution of cerebral ischemia assessed by amide proton transfer-weighted MRI. Front Neurol 8(67)Google Scholar
- 23.Jiang S, Eberhart CG, Zhang Y, Heo HY, Wen Z, Blair L, Qin H, Lim M, Quinones-Hinojosa A, Weingart JD, Barker PB, Pomper MG, Laterra J, van Zijl PCM, Blakeley JO, Zhou J (2017) Amide proton transfer-weighted magnetic resonance image-guided stereotactic biopsy in patients with newly diagnosed gliomas. Eur J Cancer 83:9–18CrossRefPubMedGoogle Scholar
- 24.Yuan J, Chen S, King AD, Zhou J, Bhatia KS, Zhang Q, Yeung DKW, Wei J, Mok GSP, Wang YX (2014) Amide proton transfer-weighted imaging of the head and neck at 3 T: a feasibility study on healthy human subjects and patients with head and neck cancer. NMR Biomed 27:1239–1247CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Ma B, Blakeley JO, Hong X, Zhang H, Jiang S, Blair L, Zhang Y, Heo HY, Zhang M, van Zijl PCM, Zhou J (2016) Applying amide proton transfer-weighted MRI to distinguish pseudoprogression from true progression in malignant gliomas. J Magn Reson Imaging 44:456–462CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Heo HY, Zhang Y, Lee DH, Hong X, Zhou J (2016) Quantitative assessment of amide proton transfer (APT) and nuclear overhauser enhancement (NOE) imaging with extrapolated semi-solid magnetization transfer reference (EMR) signals: application to a rat glioma model at 4.7 Tesla. Magn Reson Med 75:137–149CrossRefPubMedGoogle Scholar