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

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

Abstract

Objectives

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.

Results

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).

Conclusion

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.

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Abbreviations

ANOVA:

Analysis of variance

APTw:

Amide proton transfer–weighted

CEST:

Chemical exchange saturation transfer

CI:

Confidence interval

ICC:

Intraclass correlation coefficient

MRI:

Magnetic resonance imaging

MTR:

Magnetization transfer ratio

RF:

Radiofrequency

ROI:

Region of interest

TE:

Echo time

TR:

Repetition time

TSE:

Turbo spin echo

wCV:

Within-subject coefficient of variation

WHO:

World Health Organization

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Acknowledgments

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.

Funding

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).

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Author notes

  1. Jung Bin Lee and Ji Eun Park contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Song pa-gu, Seoul, 138-736, South Korea

    Jung Bin Lee, Ji Eun Park, Seung Chai Jung, Youngheun Jo, Donghyun Kim, Ho Sung Kim, Choong-Gon Choi & Sang Joon Kim

  2. Department of Neurology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea

    Dong-Wha Kang

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  1. Jung Bin Lee
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Correspondence to Seung Chai Jung.

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The scientific guarantor of this publication is Ho Sung Kim.

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The authors declare that they have no conflict of interest.

Statistics and biometry

Seonok Kim kindly provided statistical advice for this manuscript.

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

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Institutional Review Board approval was obtained.

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• performed at one institution

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Lee, J.B., Park, J.E., Jung, S.C. et al. Repeatability of amide proton transfer–weighted signals in the brain according to clinical condition and anatomical location. Eur Radiol 30, 346–356 (2020). https://doi.org/10.1007/s00330-019-06285-7

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