Abstract
IntroductionWe 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. MethodsAfter 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. ResultsA statistically significant moderately strong positive correlation was observed between maximum rCBV (rCBVmax) and maximum APTw (APTwmax) values (observer 1: r = 0.73; p < 0.01; observer 2: r = 0.62; p < 0.01). We found good inter-observer agreement for APTwmax (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 APTwmax was higher than ICC for rCBVmax (ICC = 0.74; 95%; CI 0.50–0.86), but the difference was not statistically significant. ConclusionAPTwmax values correlate positively with rCBVmax 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 practiceAPTw 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.
Highlights
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 imaging
A commercially available three-dimensional (3D) APTw sequence was added to the department's standard glioma followup protocol, consisting of anatomical sequences (3D fluidattenuated inversion recovery (FLAIR), T2, 3D T1 pre- and postcontrast) and DSC perfusion
The intraclass correlation coefficient (ICC) showed good inter-observer agreement for APTw imaging, while the slightly broad outer 95% confidence interval (CI) for the Limits of Agreement (LoA) on the BA plot indicated the APTw technique has some degree of observer dependence
Summary
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. Dynamic susceptibility contrast (DSC) perfusion is an advanced magnetic resonance imaging (MRI) technique, widely used in Please cite this article as: A.I. Friismose, L. A variety of studies have been conducted investigating noncontrast, less susceptibility artifact prone alternatives to DSC.5e7 Three-dimensional (3D) pseudo-continuous arterial spin labeling (pCASL) perfusion, susceptibility-weighted imaging (SWI) and dynamic contrast enhanced (DCE) (T1) perfusion have shown significant correlations with DSC, fewer susceptibility artifacts and similar diagnostic performance in tumor grading and differentiating progression from treatment effects.[6,7]
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