Histogram analysis of APT imaging provided increased accuracy of MR perfusion imaging for the identification of contrast-enhancing low-grade tumor that mimics high-grade tumor.

APT imaging used as a tumor proliferation index showed moderate correlation with MR spectroscopic values and is a superior imaging method to MR spectroscopy, particularly for assessment of posttreatment gliomas.

• APT imaging could provide a reliable distinction between TP and TE • Adding APT imaging to CE-T1WI improved the diagnostic accuracy versus CE-T1WI alone • Multimodal imaging using CE-T1WI, perfusion and APT imaging led to accurate diagnosis • The inter-reader agreement of APT histogram parameters was excellent.