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

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusions

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

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Abbreviations

APT:

Amide proton transfer

LGG:

Low-grade gliomas

HGG:

High-grade glioma

CE:

Contrast enhancement

ADC:

Apparent diffusion coefficient

rCBV:

relative cerebral blood volume

ROC:

Receiver operating characteristic

DSC:

Dynamic susceptibility contrast

PW:

Perfusion-weighted

DW:

Diffusion-weighted

CEST:

Chemical exchange saturation transfer

WHO:

World Health Organization

GBM:

Glioblastoma multiforme

RF:

Radiofrequency

TR:

Repetition time

TE:

Echo time

FOV:

Field of view

2D:

Two dimensional

NAWM:

Normal-appearing white matter

FLAIR:

Fluid attenuation inversion recovery

MTRasym :

Asymmetry of the magnetization transfer ratio

ROI:

Region-of-interest

ICC:

Intra-class correlation coefficient

AUC:

Area under the curve

3D:

Three-dimensional

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Acknowledgments

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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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Osamu Togao, Akio Hiwatashi, Koji Yamashita, Kazufumi Kikuchi & Hiroshi Honda

  2. Philips Research, Röntgenstrasse 24-26, Hamburg, 22335, Germany

    Jochen Keupp

  3. Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Koji Yoshimoto, Daisuke Kuga & Koji Iihara

  4. Philips Electronics Japan, 2-13-37 Konan Minato-ku, Tokyo, 108-8507, Japan

    Masami Yoneyama

  5. Department of Neuropathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan

    Satoshi O. Suzuki & Toru Iwaki

  6. Advanced Imaging Research Center, UT Southwestern Medical Center, 2201 Inwood Rd, Dallas, TX, 75235, USA

    Masaya Takahashi

Authors
  1. Osamu Togao
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  2. Akio Hiwatashi
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  4. Kazufumi Kikuchi
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  6. Koji Yoshimoto
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  7. Daisuke Kuga
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  8. Masami Yoneyama
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  9. Satoshi O. Suzuki
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  11. Masaya Takahashi
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  12. Koji Iihara
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  13. Hiroshi Honda
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Corresponding author

Correspondence to Akio Hiwatashi.

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Togao, O., Hiwatashi, A., Yamashita, K. et al. Grading diffuse gliomas without intense contrast enhancement by amide proton transfer MR imaging: comparisons with diffusion- and perfusion-weighted imaging. Eur Radiol 27, 578–588 (2017). https://doi.org/10.1007/s00330-016-4328-0

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  • DOI: https://doi.org/10.1007/s00330-016-4328-0

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