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Amide proton transfer imaging seems to provide higher diagnostic performance in post-treatment high-grade gliomas than methionine positron emission tomography

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Abstract

Objectives

To compare the diagnostic performance of amide proton transfer (APT) imaging and 11-C methionine positron emission tomography (MET-PET) for in vivo molecular imaging of protein metabolism in post-treatment gliomas.

Materials and methods

This study included 43 patients (12 low and 31 high grade) with post-treatment gliomas who underwent both APT and MET-PET imaging within 3 weeks. APT-weighted voxel values and semi-quantitative tumour-to-normal ratios (TNR) were obtained from tumour portions. The voxel-wise relationships between TNR and APT were assessed. The diagnostic performance for recurrence of high-grade gliomas was calculated, using the area under the receiver operating characteristic curve (AUC) with maximum (TNRmax and APTmax) and 90% histogram values (TNR90 and APT90).

Results

A moderate positive correlation between TNR and APT was found in low-grade recurrences (r = 0.47, p < 0.001), but not in high-grade ones (r = −0.24, p < 0.001). For distinguishing recurrence in post-treatment high-grade gliomas, APTmax (AUC, 0.88) and APT90 (AUC, 0.78–0.83) had a similar to better diagnostic performance than TNRmax (AUC, 0.71, p = 0.08) or TNR90 (AUC, 0.53–0.59, p = 0.01–0.05).

Conclusions

In post-treatment high-grade gliomas, APT provides different regional information to MET-PET and provides higher diagnostic performance. This difference needs to be considered when using APT or MET-PET as a surrogate marker for tumour protein metabolism.

Key Points

• APT and TNR values in low-grade recurrence showed a moderate voxel-wise correlation.

• APT and TNR demonstrated regional differences in post-treatment high-grade gliomas.

• APT90 showed better diagnostic performance than TNR90 in high-grade recurrence.

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Abbreviations

AUC:

Area under the receiver-operating characteristic curve

APT:

Amide proton transfer

CEST:

Chemical exchange saturation transfer

MET-PET:

11-C-methionine positron emission tomography

RF:

Radiofrequency

ROC:

Receiver-operating characteristic

TNR:

Tumour-to-normal ratio

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Funding

This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (grant no. NRF-2017R1C1B2007258), by a grant from the National R&D Program for Cancer Control, Ministry of Health and Welfare, Republic of Korea (1720030).

Author information

Author notes

  1. Ji Eun Park and Ji Ye Lee 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, Seoul, 138-736, Korea

    Ji Eun Park, Ho Sung Kim, Joo-Young Oh, Seung Chai Jung & Sang Joon Kim

  2. Department of Radiology, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, 420-767, Korea

    Ji Ye Lee

  3. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul, 05505, Korea

    Ho Sung Kim

  4. Philips Research, Hamburg, Germany

    Jochen Keupp

  5. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Minyoung Oh & Jae Seung Kim

Authors
  1. Ji Eun Park
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Corresponding author

Correspondence to Ho Sung Kim.

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Guarantor

The scientific guarantor of this publication is Sang Joon Kim.

Conflict of interest

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.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board of Asan Medical Center approved this study (2017-0528).

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Park, J.E., Lee, J.Y., Kim, H.S. et al. Amide proton transfer imaging seems to provide higher diagnostic performance in post-treatment high-grade gliomas than methionine positron emission tomography. Eur Radiol 28, 3285–3295 (2018). https://doi.org/10.1007/s00330-018-5341-2

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