Differentiating the histologic grades of gliomas preoperatively using amide proton transfer‐weighted (APTW) and intravoxel incoherent motion MRI

• Published in: NMR in biomedicine Vol. 31; no. 1
• Main Authors: Zou, Tianyu, Yu, Hao, Jiang, Chunxiu, Wang, Xianlong, Jiang, Shanshan, Rui, Qihong, Mei, Yingjie, Zhou, Jinyuan, Wen, Zhibo
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2018
• Subjects: Adolescent; Adult; amide proton transfer; Amides - chemistry; Biological products; Brain Neoplasms - diagnosis; Brain Neoplasms - pathology; Brain tumors; Demography; Diagnostic systems; Diffusion coefficient; Female; Glioma; Glioma - diagnosis; Glioma - pathology; Glioma - surgery; Histopathology; Humans; intravoxel incoherent motion; Magnetic Resonance Imaging; Male; Middle Aged; Motion; NMR; Nuclear magnetic resonance; Patients; Perfusion; Preoperative Care; preoperative grading; Protons; Reproducibility of Results; Solid tumors; Substantia alba; Young Adult; amide proton transfer; glioma; preoperative grading; intravoxel incoherent motion
• ISSN: 0952-3480; 1099-1492
• DOI: 10.1002/nbm.3850

The purpose of this work was to investigate the diagnostic performance of amide proton transfer‐weighted (APTW) and intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the preoperative grading of gliomas. Fifty‐one patients with suspected gliomas were recruited and underwent a preoperative MRI examination that included APTW and IVIM sequences. All cases were confirmed by postsurgical histopathology. APTW signal intensity, true diffusion coefficient (D), perfusion fraction (f) and pseudo‐diffusion coefficient (D*) were applied to assess the solid tumor component and contralateral normal‐appearing white matter. The relative APTW signal intensity (rAPTW) was also used. Independent‐sample and paired‐sample t‐tests were used to compare differences in MRI parameters between low‐grade glioma (LGG) and high‐grade glioma (HGG) groups. The diagnostic performance was assessed with the receiver operating characteristic curve. Twenty‐six patients were pathologically diagnosed with LGG and 25 were diagnosed with HGG. APTW, rAPTW and f values were significantly higher (all p < 0.001), whereas D values were significantly lower (p < 0.001) in the HGG group than in the LGG group. There was no significant difference between D* values for the two groups. rAPTW had an area under the curve (AUC) of 0.957, with a sensitivity of 100% and a specificity of 84.6%, followed by APTW, f, D and D*. The combined use of APTW and IVIM showed the best diagnostic performance, with an AUC of 0.986. In conclusion, APTW and IVIM, as two promising supplementary sequences for routine MRI, could be valuable in differentiating LGGs from HGGs. Amide proton transfer‐weighted (APTW) imaging can generate image contrast mainly related to endogenous cellular proteins in tissue, and intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) can separate water molecular diffusion from microcirculation. Fifty‐one patients with glioma were recruited to investigate the diagnostic performance of APT and IVIM MRI. Our results show that these supplementary MRI methods are valuable in differentiating low‐ from high‐grade glioma.