Abstract
PurposeRadiological assessment of primary brain neoplasms, both high (HGG) and low grade tumors (LGG), based on contrast-enhancement alone can be inaccurate. We evaluated the radiological value of amide proton transfer weighted (APTw) MRI as an imaging complement for pre-surgical radiological diagnosis of brain tumors.MethodsTwenty-six patients were evaluated prospectively; (22 males, 4 females, mean age 55 years, range 26–76 years) underwent MRI at 3T using T1-MPRAGE pre- and post-contrast administration, conventional T2w, FLAIR, and APTw imaging pre-surgically for suspected primary/secondary brain tumor. Assessment of the additional value of APTw imaging compared to conventional MRI for correct pre-surgical brain tumor diagnosis. The initial radiological pre-operative diagnosis was based on the conventional contrast-enhanced MR images. The range, minimum, maximum, and mean APTw signals were evaluated.Conventional normality testing was performed; with boxplots/outliers/skewness/kurtosis and a Shapiro–Wilk’s test. Mann-Whitney U for analysis of significance for mean/max/min and range APTw signal. A logistic regression model was constructed for mean, max, range and Receiver Operating Characteristic (ROC) curves calculated for individual and combined APTw signalsResultsConventional radiological diagnosis prior to surgery/biopsy was HGG (8 patients), LGG (12 patients), and metastasis (6 patients). Using the mean and maximum: APTw signal would have changed the pre-operative evaluation the diagnosis in 8 of 22 patients (two LGGs excluded, two METs excluded). Using a cut off value of >2.0% for mean APTw signal integral, 4 of the 12 radiologically suspected LGG would have been diagnosed as high grade glioma, which was confirmed by histopathological diagnosis. APTw mean of >2.0% and max >2.48% outperformed four separate clinical radiological assessments of tumor type, P-values = .004 and = .002, respectively.ConclusionsUsing APTw-images as part of the daily clinical pre-operative radiological evaluation may improve diagnostic precision in differentiating LGGs from HGGs, with potential improvement of patient management and treatment.
Highlights
Glioblastoma has been and still is associated with a poor outcome for afflicted patients [1,2,3] with an overall survival rate below 6% [4]
Using a cut off value of >2.0% for mean Amide proton transfer weighted (APTw) signal integral, 4 of the 12 radiologically suspected low grade glioma (LGG) would have been diagnosed as high grade glioma, which was confirmed by histopathological diagnosis
Even when using the current optimal treatment for glioblastoma, the Treatment Protocol Named after (STUPP) protocol [1] consisting of gross total resection (GTR) with follow-up combined radiotherapy and chemotherapy (Temozolomide), the increase in survival is modest with regards to previous treatment regimens [7]
Summary
Glioblastoma has been and still is associated with a poor outcome for afflicted patients [1,2,3] with an overall survival rate below 6% [4]. It is one of the most frequently occurring brain lesions [2,3] and can be, in the early stages of the disease, difficult to discern radiologically from low grade glioma [5], which have a better prognosis [6]. It has been suggested that malignant transformation in low grade glioma (LGG) ensues as a consequence of its natural course over time [10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
