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

• Published in: Journal of magnetic resonance imaging Vol. 60; no. 6; pp. 2509 - 2517
• Main Authors: Zhou, Le, Pan, Wanqian, Huang, Renjun, Wang, Tianye, Wei, Zifan, Wang, Hui, Zhang, Yi, Li, Yonggang
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2024
• Subjects: Blood volume; Cerebral blood flow; Computed tomography; Confidence intervals; Correlation analysis; Diffusion coefficient; Effectiveness; Field strength; Information processing; Ischemia; Medical imaging; Nomograms; Patients; Prognosis; Protons; Regression analysis; Risk factors; Statistical analysis; Statistical models; Statistical tests; Stroke; Subgroups; computed tomography; magnetic resonance imaging; CEST; APT; prognosis; stroke
• ISSN: 1053-1807; 1522-2586; 1522-2586
• DOI: 10.1002/jmri.29333

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. 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. Prospective. 61 patients (mean age 63.2 ± 9.7 years; 46 males, 15 females) with ischemic strokes were included in the study. 3T/turbo spin echo (TSE) T -weighted imaging, T -weighted imaging, T -fluid attenuated inversion recovery (T -FLAIR), diffusion-weighted imaging (DWI), and single-shot TSE APTw imaging. APTw, ADC, and CTP were used to compare patient subgroups and construct a prognostic nomogram model. 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. 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. The APTw technique holds potential value in categorizing and managing patients with ischemic stroke, offering guidance for the implementation of clinical treatment strategies. 1 TECHNICAL EFFICACY: Stage 2.