3-Tesla Amide Proton Transfer-weighted Imaging (APT-WI): Elevated Signal Also in Tumor Mimics

Overview

Journal Eur Radiol

Specialty Radiology

Date 2024 Nov 26

PMID 39592486

Authors

Guillaume Hamon

Augustin Lecler

Jean-Christophe Ferre

Pierre Bourdillon

Loic Duron

Julien Savatovsky

Affiliations

Soon will be listed here.

Abstract

Objectives: To explore amide proton transfer-weighted imaging (APTwi) for the initial classification of brain masses in clinical practice by systematically reporting APTwi signal intensity (APT-SI) in tumor mimics and brain tumors.

Materials And Methods: Single-center retrospective analysis (2017-2020) of APTwi in 156 patients (84 men, mean age: 50.9 ± 20) who underwent characterization imaging of a brain mass prior to any treatment, using 3-Tesla MRI. 125/156 (80%) patients presented with brain tumor and 31/156 (20%) with tumor mimics. Regions of interest were manually drawn on 2D axial slices by two readers on APTwi map in lesional and perilesional areas and APT-SI, corresponding to the Magnetization Transfer Ratio asymmetry at 3.5 ppm, was systematically reported. Student's t-test or Wilcoxon-test were used to compare groups of patients.

Results: The mean APT-SI in lesional and perilesional areas were significantly higher in tumors compared to tumor mimics: 3% [2.10-4] (median [Q1-Q3]) vs 1.7% [0.80-2.55] (p < 0.001) and 1.9% [1.2-2.80] vs. 1.0% [0.55-2.3] (p < 0.01). There were no differences in mean APT-SI in the tumor core between low and high-grade tumors: 2.5% [1.80-4.0] vs. 3.25% [2.5-4.0]. The mean APT-SI was significantly higher in high-grade glioma compared to low-grade glioma: 3.4% [2.7-4] vs. 2.1% [1.7-2.5] (p < 0.001). Highest mean APT-SI in tumor core were found in mesenchymal tumors (5.83% ± 1.45, mean ± SD), embryonal tumors (5.27% ± 3.5) and meningiomas (4.28% ± 0.70). In tumor mimics, highest mean APT-SI was found in the core of infectious lesions (3.52% ± 0.67).

Conclusion: High signal on ATPwi is not exclusive to high-grade brain tumors but can be observed in some tumor mimics and subtypes of low-grade tumors.

Key Points: Question What is the value of amide proton transfer-weighted imaging (APTwi) in the setting of brain mass classification? Findings High APT-signal intensity in the tumor core of a brain mass could correspond to a high- or low-grade tumor or tumor mimic. Clinical relevance In patients presenting for the initial classification of brain masses, APTwi findings should be interpreted with caution and in conjunction with other MRI parameters, as a high APTwi signal does not necessarily indicate a high-grade tumor.

References

Ward K, Aletras A, Balaban R . A new class of contrast agents for MRI based on proton chemical exchange dependent saturation transfer (CEST). J Magn Reson. 2000; 143(1):79-87. DOI: 10.1006/jmre.1999.1956. View

Wu B, Warnock G, Zaiss M, Lin C, Chen M, Zhou Z . An overview of CEST MRI for non-MR physicists. EJNMMI Phys. 2016; 3(1):19. PMC: 4999387. DOI: 10.1186/s40658-016-0155-2. View

Zhou J, Heo H, Knutsson L, van Zijl P, Jiang S . APT-weighted MRI: Techniques, current neuro applications, and challenging issues. J Magn Reson Imaging. 2019; 50(2):347-364. PMC: 6625919. DOI: 10.1002/jmri.26645. View

Zhou J, Lal B, Wilson D, Laterra J, van Zijl P . Amide proton transfer (APT) contrast for imaging of brain tumors. Magn Reson Med. 2003; 50(6):1120-6. DOI: 10.1002/mrm.10651. View

Dula A, Arlinghaus L, Dortch R, Dewey B, Whisenant J, Ayers G . Amide proton transfer imaging of the breast at 3 T: establishing reproducibility and possible feasibility assessing chemotherapy response. Magn Reson Med. 2012; 70(1):216-24. PMC: 3505231. DOI: 10.1002/mrm.24450. View

Deng X, Liu M, Zhou Q, Zhao X, Li M, Zhang J . Predicting treatment response to concurrent chemoradiotherapy in squamous cell carcinoma of the cervix using amide proton transfer imaging and intravoxel incoherent motion imaging. Diagn Interv Imaging. 2022; 103(12):618-624. DOI: 10.1016/j.diii.2022.09.001. View

Jia G, Abaza R, Williams J, Zynger D, Zhou J, Shah Z . Amide proton transfer MR imaging of prostate cancer: a preliminary study. J Magn Reson Imaging. 2011; 33(3):647-54. PMC: 4287206. DOI: 10.1002/jmri.22480. View

Takayama Y, Nishie A, Sugimoto M, Togao O, Asayama Y, Ishigami K . Amide proton transfer (APT) magnetic resonance imaging of prostate cancer: comparison with Gleason scores. MAGMA. 2016; 29(4):671-9. DOI: 10.1007/s10334-016-0537-4. View

Lin Y, Luo X, Yu L, Zhang Y, Zhou J, Jiang Y . Amide proton transfer-weighted MRI for predicting histological grade of hepatocellular carcinoma: comparison with diffusion-weighted imaging. Quant Imaging Med Surg. 2019; 9(10):1641-1651. PMC: 6828579. DOI: 10.21037/qims.2019.08.07. View

10.

Ohno Y, Yui M, Koyama H, Yoshikawa T, Seki S, Ueno Y . Chemical Exchange Saturation Transfer MR Imaging: Preliminary Results for Differentiation of Malignant and Benign Thoracic Lesions. Radiology. 2015; 279(2):578-89. DOI: 10.1148/radiol.2015151161. View

11.

Yuan J, Chen S, King A, Zhou J, Bhatia K, Zhang Q . Amide proton transfer-weighted imaging of the head and neck at 3 T: a feasibility study on healthy human subjects and patients with head and neck cancer. NMR Biomed. 2014; 27(10):1239-47. PMC: 4160398. DOI: 10.1002/nbm.3184. View

12.

Law B, King A, Ai Q, Poon D, Chen W, Bhatia K . Head and Neck Tumors: Amide Proton Transfer MRI. Radiology. 2018; 288(3):782-790. DOI: 10.1148/radiol.2018171528. View

13.

Zhou J, Zaiss M, Knutsson L, Sun P, Ahn S, Aime S . Review and consensus recommendations on clinical APT-weighted imaging approaches at 3T: Application to brain tumors. Magn Reson Med. 2022; 88(2):546-574. PMC: 9321891. DOI: 10.1002/mrm.29241. View

14.

Suh C, Park J, Jung S, Gon Choi C, Kim S, Kim H . Amide proton transfer-weighted MRI in distinguishing high- and low-grade gliomas: a systematic review and meta-analysis. Neuroradiology. 2019; 61(5):525-534. DOI: 10.1007/s00234-018-02152-2. View

15.

Yu H, Lou H, Zou T, Wang X, Jiang S, Huang Z . Applying protein-based amide proton transfer MR imaging to distinguish solitary brain metastases from glioblastoma. Eur Radiol. 2017; 27(11):4516-4524. PMC: 5744886. DOI: 10.1007/s00330-017-4867-z. View

16.

Jiang S, Yu H, Wang X, Lu S, Li Y, Feng L . Molecular MRI differentiation between primary central nervous system lymphomas and high-grade gliomas using endogenous protein-based amide proton transfer MR imaging at 3 Tesla. Eur Radiol. 2015; 26(1):64-71. PMC: 4627862. DOI: 10.1007/s00330-015-3805-1. View

17.

Ma B, Blakeley J, Hong X, Zhang H, Jiang S, Blair L . Applying amide proton transfer-weighted MRI to distinguish pseudoprogression from true progression in malignant gliomas. J Magn Reson Imaging. 2016; 44(2):456-62. PMC: 4946988. DOI: 10.1002/jmri.25159. View

18.

Jiang S, Zou T, Eberhart C, Villalobos M, Heo H, Zhang Y . Predicting IDH mutation status in grade II gliomas using amide proton transfer-weighted (APTw) MRI. Magn Reson Med. 2017; 78(3):1100-1109. PMC: 5561497. DOI: 10.1002/mrm.26820. View

19.

Joo B, Han K, Ahn S, Choi Y, Chang J, Kang S . Amide proton transfer imaging might predict survival and IDH mutation status in high-grade glioma. Eur Radiol. 2019; 29(12):6643-6652. PMC: 6859837. DOI: 10.1007/s00330-019-06203-x. View

20.

Yu H, Wen X, Wu P, Chen Y, Zou T, Wang X . Can amide proton transfer-weighted imaging differentiate tumor grade and predict Ki-67 proliferation status of meningioma?. Eur Radiol. 2019; 29(10):5298-5306. PMC: 6717551. DOI: 10.1007/s00330-019-06115-w. View