Amide Proton Transfer-Weighted MRI, Associations with Clinical Severity and Prognosis in Ischemic Strokes

Le Zhou; Wanqian Pan; Renjun Huang; Tianye Wang; Zifan Wei; Hui Wang; Yi Zhang; Yonggang Li

doi:10.1002/jmri.29333

Amide Proton Transfer-Weighted MRI, Associations with Clinical Severity and Prognosis in Ischemic Strokes

J Magn Reson Imaging. 2024 Mar 1. doi: 10.1002/jmri.29333. Online ahead of print.

Authors

Le Zhou¹, Wanqian Pan², Renjun Huang¹, Tianye Wang³, Zifan Wei⁴, Hui Wang³, Yi Zhang⁵, Yonggang Li^{1

6}

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou city, Jiangsu Province, China.
² Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
³ Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
⁴ Suzhou Medical College of Soochow University, Suzhou, China.
⁵ Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China.
⁶ Institute of Medical Imaging, Soochow University, Suzhou city, Jiangsu Province, China.

PMID: 38426606
DOI: 10.1002/jmri.29333

Abstract

Background: The National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS) scores have important shortcomings. Amide proton transfer-weighted (APTw) imaging might offer more valuable information in ischemic strokes assessment.

Purpose: To utilize APTw, apparent diffusion coefficient (ADC), and computed tomography perfusion (CTP) for the assessment of clinical symptom severity and 90-day prognosis in patients diagnosed with ischemic stroke.

Study type: Prospective.

Subjects: 61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study.

Field strength/sequence: 3T/turbo spin echo (TSE) T₁ -weighted imaging, T₂ -weighted imaging, T₂ -fluid attenuated inversion recovery (T₂ -FLAIR), diffusion-weighted imaging (DWI), and single-shot TSE APTw imaging.

Assessment: APTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model.

Statistical tests: Kolmogorov-Smirnov test, t-test, Mann-Whitney U test, chi-square test, Pearson correlation analysis, multivariate logistic regression analysis, decision curve analysis (DCA), receiver operating characteristic curves (ROCs). The significance threshold was set at P < 0.05.

Results: Correlation analysis revealed that APTw and NIHSS exhibit the highest correlation (r = -0.634, 95% confidence interval [CI] -0.418 to -0.782), surpassing that of ADC and lesion size. Multivariable analysis revealed APTw (odds ratio [OR] 0.905, 95% CI 0.845-0.970), ADC (OR 0.745, 95% CI 0.609-0.911), and infarct core-cerebral blood volume (IC-CBV) (OR 0.547, 95% CI 0.310-0.964) as potential risk factors associated with a poor prognosis. The nomogram model demonstrated the highest predictive efficacy, with an area under the curve (AUC) of 0.960 (95% CI 0.911-0.988), exceeding that of APTw, ADC, and IC-CBV individually.

Data conclusion: The APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies.

Level of evidence: 1 TECHNICAL EFFICACY: Stage 2.

Keywords: APT; CEST; computed tomography; magnetic resonance imaging; prognosis; stroke.

Abstract

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