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

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], 0.888−0.910; P = 0.007), whereas using both the APT signal and rCBV did not improve discrimination vs. the rCBV alone (AUC, 0.927−0.923; 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.

Addition of Amide Proton Transfer Imaging to FDG-PET/CT Improves Diagnostic Accuracy in Glioma Grading: A Preliminary Study Using the Continuous Net Reclassification Analysis

“…However, few studies have examined glioma grading with multiparametric imaging that included APT imaging and PWI or DWI. 10,16 To the best of our knowledge, our investigation represents the first study to show the utility of multiparametric analysis, including APT and PET, in the preoperative grading of gliomas.…”

“…This study confirmed that APT imaging can be used for grading glial tumors, with a diagnostic accuracy comparable with that of other imaging biomarkers derived from DWI and FDG-PET. Previous studies have shown the diagnostic accuracy of APT imaging to be comparable with DSC-PWI, 13,16 and better than contrastenhanced T1-weighted imaging. 22 As in previous studies, our results also demonstrated excellent interrater reproducibility in the measurement of APT.…”

“…3,[11][12][13][14][15][16][17][18] However, details of the relationships between APT imaging and other clinical imaging parameters of malignancy have yet to be fully elucidated. This study confirmed that APT imaging can be used for grading glial tumors, with a diagnostic accuracy comparable with that of other imaging biomarkers derived from DWI and FDG-PET.…”

“…22 As in previous studies, our results also demonstrated excellent interrater reproducibility in the measurement of APT. 3,[11][12][13][14][15][16] We believe that for the preoperative grading of brain tumors, APT can be considered an alternative approach to PET and other MR imaging methods such as DWI.…”

“…9 This technique has been successfully applied to human brain tumors. 3,[10][11][12][13][14][15][16] Some reports have shown that the APT asymmetry value is useful in tumor grading, allowing differentiation of pseudoprogression from recurrence 17 and the assessment of treatment response. 18,19 However, the relationship between APT and other quantitative imaging values has yet to be investigated.…”