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.
Bibliographical noteFunding Information:
The authors thank Ha-Kyu Jeong (Korea Basic Science Institute, Chungcheongbuk-do, Korea) for his help with protocol optimization and valuable suggestions. 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. 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). 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.
All Science Journal Classification (ASJC) codes
- Radiology Nuclear Medicine and imaging