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Amide proton transfer imaging to discriminate between low- and high-grade gliomas: added value to apparent diffusion coefficient and relative cerebral blood volume

European Radiology volume 27, pages 3181–3189 (2017)Cite this article

Abstract

Objectives

To evaluate the added value of amide proton transfer (APT) imaging to the apparent diffusion coefficient (ADC) from diffusion tensor imaging (DTI) and the relative cerebral blood volume (rCBV) from perfusion magnetic resonance imaging (MRI) for discriminating between high- and low-grade gliomas.

Methods

Forty-six consecutive adult patients with diffuse gliomas who underwent preoperative APT imaging, DTI and perfusion MRI were enrolled. APT signals were compared according to the World Health Organization grade. The diagnostic ability and added value of the APT signal to the ADC and rCBV for discriminating between low- and high-grade gliomas were evaluated using receiver operating characteristic (ROC) analyses and integrated discrimination improvement.

Results

The APT signal increased as the glioma grade increased. The discrimination abilities of the APT, ADC and rCBV values were not significantly different. Using both the APT signal and ADC significantly improved discrimination vs. the ADC alone (area under the ROC curve [AUC], 0.888 vs. 0.910; P = 0.007), whereas using both the APT signal and rCBV did not improve discrimination vs. the rCBV alone (AUC, 0.927 vs. 0.923; P = 0.222).

Conclusions

APT imaging may be a useful imaging biomarker that adds value to the ADC for discriminating between low- and high-grade gliomas.

Key points

• Higher APT values were correlated with higher glioma grades.

• Adding the APT signal to the ADC improved glioma grading.

• Adding the APT signal to rCBV did not improve glioma grading.

• APT is a useful adjunct to the ADC for glioma grading.

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Abbreviations

ADC:

apparent diffusion coefficient

APT:

amide proton transfer

AUC:

area under the curve

BSA:

bovine serum albumin

DSC:

dynamic susceptibility contrast-enhanced

DTI:

diffusion tensor imaging

FOV:

field of view

IDI:

integrated discrimination index

MRI:

magnetic resonance imaging

MTRasym :

magnetization transfer ratio asymmetry

rCBV:

relative cerebral blood volume

RF:

radiofrequency

ROC:

receiver operating characteristic

ROI:

region of interest

TE:

echo time

TR:

repetition time

WHO:

World Health Organization

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Acknowledgements

The authors thank Ha-Kyu Jeong (Korea Basic Science Institute, Chungcheongbuk-do, Korea) for his help with protocol optimization and valuable suggestions.

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Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Yoon Seong Choi, Sung Soo Ahn & Seung-Koo Lee

  2. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Jong Hee Chang & Seok-Gu Kang

  3. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Se Hoon Kim

  4. Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jinyuan Zhou

Authors
  1. Yoon Seong Choi
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  2. Sung Soo Ahn
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  3. Seung-Koo Lee
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  4. Jong Hee Chang
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  5. Seok-Gu Kang
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Corresponding author

Correspondence to Sung Soo Ahn.

Ethics declarations

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. No study subjects or cohorts have been previously reported. Methodology: retrospective, observational, performed at one institution.

Funding

This research received funding from the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2014R1A1A1002716) and National Institutes of Health (P41 EB015909, R01 CA166171, R01 EB009731).

Conflict of interest

The scientific guarantor of this publication is Sung Soo Ahn. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Choi, Y.S., Ahn, S.S., Lee, SK. et al. Amide proton transfer imaging to discriminate between low- and high-grade gliomas: added value to apparent diffusion coefficient and relative cerebral blood volume. Eur Radiol 27, 3181–3189 (2017). https://doi.org/10.1007/s00330-017-4732-0

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  • DOI: https://doi.org/10.1007/s00330-017-4732-0

Keywords

  • Amide proton transfer imaging
  • Chemical exchange saturation transfer
  • Magnetic resonance imaging
  • Brain tumour
  • Glioma