Amide proton transfer-weighted MRI in the clinical setting - correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T

A I Friismose; L Markovic; N Nguyen; O Gerke; M K Schulz; B R Mussmann

doi:10.1016/j.radi.2021.08.006

Amide proton transfer-weighted MRI in the clinical setting - correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T

Radiography (Lond). 2022 Feb;28(1):95-101. doi: 10.1016/j.radi.2021.08.006. Epub 2021 Sep 8.

Authors

A I Friismose¹, L Markovic², N Nguyen², O Gerke³, M K Schulz⁴, B R Mussmann⁵

Affiliations

¹ Radiology Department, Odense University Hospital, Odense, Denmark. Electronic address: Ancuta.Ioana.Friismose@rsyd.dk.
² Radiology Department, Odense University Hospital, Odense, Denmark.
³ Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
⁴ Department of Neurosurgery, Odense University Hospital, Odense, Denmark.
⁵ Radiology Department, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Odense Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

PMID: 34509365
DOI: 10.1016/j.radi.2021.08.006

Abstract

Introduction: We investigated the correlation between amide proton transfer-weighted magnetic resonance imaging (APTw MRI) and dynamic susceptibility contrast (DSC) perfusion in order to assess the potential of APTw MRI as an alternative to DSC in adult brain tumor (glioma) imaging.

Methods: After Ethical Committee approval, forty adult patients, treated for histopathologically confirmed glioma (World Health Organization (WHO) grade II-IV), were prospectively imaged at 3 Tesla (3 T) with DSC perfusion and a commercially available three-dimensional (3D) APTw sequence. Two consultant neuroradiologists independently performed region of interest (ROI) measurements on relative cerebral blood volume (rCBV) and APTw maps, co-registered with anatomical images. The correlation APTw MRI-DSC perfusion was assessed using Spearman's rank-order test. Inter-observer agreement was evaluated by the intraclass correlation coefficient (ICC) and Bland-Altman (BA) plots.

Results: A statistically significant moderately strong positive correlation was observed between maximum rCBV (rCBV_max) and maximum APTw (APTw_max) values (observer 1: r = 0.73; p < 0.01; observer 2: r = 0.62; p < 0.01). We found good inter-observer agreement for APTw_max (ICC = 0.82; 95% confidence interval (CI) 0.66-0.90), with somewhat broad outer 95% CI for the BA Limits of Agreement (LoA) (-1.6 to 1.9). ICC for APTw_max was higher than ICC for rCBV_max (ICC = 0.74; 95%; CI 0.50-0.86), but the difference was not statistically significant.

Conclusion: APTw_max values correlate positively with rCBV_max in patients treated for brain glioma. APTw imaging is a reproducible technique, with some observer dependence. Results need to be confirmed by a larger population analysis.

Implications for practice: APTw MRI can be a useful addition to glioma follow-up imaging and a potential alternative to DSC perfusion, especially in patients where contrast agent is contraindicated.

Keywords: Amides; Brain neoplasms; Cerebral blood volume; Glioma; Magnetic resonance imaging; Perfusion.

MeSH terms

Adult
Amides
Glioma* / diagnostic imaging
Glioma* / pathology
Humans
Magnetic Resonance Imaging / methods
Perfusion
Protons*

Substances

Amides
Protons