Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas

• Published in: PloS one 2020-12, Vol.15 (12), p.e0244003-e0244003
• Main Authors: Durmo, Faris, Rydhög, Anna, Testud, Frederik, Lätt, Jimmy, Schmitt, Benjamin, Rydelius, Anna, Englund, Elisabet, Bengzon, Johan, van Zijl, Peter, Knutsson, Linda, Sundgren, Pia C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Annan fysik; Biopsy; Brain; Brain cancer; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Brain research; Brain tumors; Clinical Medicine; Diagnosis; Diagnostic systems; Evaluation; Female; Fysik; Glioblastoma multiforme; Glioma; Glioma - diagnostic imaging; Glioma - pathology; Glioma - surgery; Hospitals; Humans; Image contrast; Image enhancement; Klinisk medicin; Kurtosis; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - standards; Male; Medical and Health Sciences; Medical diagnosis; Medical imaging; Medical prognosis; Medicin och hälsovetenskap; Medicine and Health Sciences; Metastases; Methods; Middle Aged; Natural Sciences; Naturvetenskap; Neoplasm Grading; Neoplasms; Neuroimaging; Other Physics Topics; Outliers (statistics); Patients; Physical Sciences; Physiology; Predictive Value of Tests; Preoperative care; Proton magnetic resonance; Protons; Radiologi och bildbehandling; Radiology; Radiology, Nuclear Medicine and Medical Imaging; Regression analysis; Regression models; Research and Analysis Methods; Surgery; Tumors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0244003

Radiological 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. Twenty-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 signals. Conventional 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. Using 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.