Amide Proton Transfer Imaging Allows Detection of Glioma Grades and Tumor Proliferation: Comparison with Ki-67 Expression and Proton MR Spectroscopy Imaging

Su, Changliang; Liu, Chao-Hong; Zhao, Lingyun; Jiang, Jingjing; Zhang, J.; Li, S.; Zhu, Wenzhen; Wang, Jihong

doi:10.3174/ajnr.a5301

Cited by 52 publications

(52 citation statements)

References 27 publications

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“…On the other hand, in patients with pathologically confirmed low‐grade gliomas, including those with gadolinium enhancement, APTw imaging shows isointensity or scattered punctate hyperintensity within the lesion. These initial findings, confirmed by different researchers, indicate that APTw imaging for malignant brain tumors has the unique potential to become a valuable imaging biomarker for separating high‐ from low‐grade gliomas and to detect high‐grade tumors that do not show gadolinium enhancement or false‐positive low‐grade tumors that enhance.…”

Section: Current Applicationsmentioning

confidence: 73%

“…GRADING TUMORS. The early clinical results on 3 T clinical MRI scanners from several labs 23,[81][82][83][84][85][86][87][88] show that APTw hyperintensity (either ring-like or nodular) is a typical feature of high-grade gliomas (grades III and IV). Gadoliniumenhanced MRI is limited in that some high-grade gliomas (roughly 10% of glioblastomas and 30% of anaplastic astrocytomas 89 ) demonstrate no gadolinium enhancement.…”

Section: Current Applicationsmentioning

confidence: 99%

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APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

Zhou

Heo

Knutsson

et al. 2019

Magnetic Resonance Imaging

248

329

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Amide proton transfer‐weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT‐based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:347–364.

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Section: Current Applicationsmentioning

confidence: 73%

Section: Current Applicationsmentioning

confidence: 99%

APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

Zhou

Heo

Knutsson

et al. 2019

Magnetic Resonance Imaging

248

329

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“…In our present study, the results presented that the signal intensity was significantly different between the WHO II, III and IV gliomas, which were also consistent with the results of previous studies. [10,12]…”

Section: Discussionmentioning

confidence: 99%

An evidence-based approach to evaluate the accuracy of amide proton transfer-weighted MRI in characterization of gliomas

Zhao¹,

Huang²,

Xie³

et al. 2019

Medicine

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Backgroud:To perform a meta-analysis to evaluate the diagnostic accuracy of the amide proton transfer (APT) technique in differentiating high-grade gliomas (HGGs) from low grade gliomas (LGGs).Methods:Medical literature databases were searched for studies that evaluated the diagnostic accuracy of APT in patients suspected of brain tumor who underwent APT MRI and surgery. Only English language studies and published before September 2018 were considered to be included in this project. Homogeneity was assessed by the inconsistency index. Mean difference (MD) at 95% confidence interval (CI) of all parameters derived from APT was calculated. Publication bias was explored by Egger's funnel plot.Results:Six eligible studies were included in the meta-analysis, comprising 144 HGGs and 122 LGGs. The APT-related parameter signal intensity (SI) was significantly higher in the HGG than the LGG (WMD = 0.86 (0.61–1.1), P < .0001); A significant difference was also found between grade II and grade III (WMD = 0.6 (0.4–0.8), P < .0001), and between grade II and grade IV (WMD = 1.07 (0.65–1.49), P < .0001).Conclusions:APT imaging may be a useful imaging biomarker for discriminating between LGGs and HGGs. However, large randomized control trials (RCT) were necessary to evaluate its clinical value.

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“…This correlates with APTw intensity values and thus APTw imaging can be used for tumor characterization and diagnosis (Togao et al, 2014; Jiang et al, 2016, 2017a,b, 2019; Ma et al, 2016; Park et al, 2016; Su et al, 2017; Yu et al, 2017; Dreher et al, 2018, 2019; Van de Ven and Keupp, 2018; Zhou et al, 2019). Hence APTw imaging allows the differentiation of low-grade gliomas from high grade gliomas (Jiang et al, 2017a; Su et al, 2017; Van de Ven and Keupp, 2018), the prediction of the isocitrate dehydrogenase (IDH) mutation status in gliomas (Jiang et al, 2017b; Dreher et al, 2018), the differentiation of high grade gliomas from primary central nervous system lymphomas (Jiang et al, 2016) and from metastases (Yu et al, 2017) and the differentiation of tumor progression and treatment effects (Ma et al, 2016; Van de Ven and Keupp, 2018; Jiang et al, 2019). The technique has also been applied for the non-invasive detection of intracranial hemorrhage in various stages of blood degradation in acute, subacute and chronic stages (Ma et al, 2017) and of acute ischemic cerebral strokes (Park et al, 2016; Zhou et al, 2019).…”

Section: Introductionmentioning

confidence: 89%

Amide Proton Transfer Contrast Distribution in Different Brain Regions in Young Healthy Subjects

Sartoretti

Wyss

et al. 2019

Front. Neurosci.

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Objectives: To define normal signal intensity values of amide proton transfer-weighted (APTw) magnetic resonance (MR) imaging in different brain regions. Materials and Methods: Twenty healthy subjects (9 females, mean age 29 years, range 19-37 years) underwent MR imaging at 3 Tesla. 3D APTw (RF saturation B 1,rms = 2 µT, duration 2 s, 100% duty cycle) and 2D T2-weighted turbo spin echo (TSE) images were acquired. Postprocessing (image fusion, ROI measurements of APTw intensity values in 22 different brain regions) was performed and controlled by two independent neuroradiologists. Values were measured separately for each brain hemisphere. A subject was scanned both in prone and supine position to investigate differences between hemispheres. A mixed model on a 5% significance level was used to assess the effect of gender, brain region and side on APTw intensity values. Results: Mean APTw intensity values in the hippocampus and amygdala varied between 1.13 and 1.57%, in the deep subcortical nuclei (putamen, globus pallidus, head of caudate nucleus, thalamus, red nucleus, substantia nigra) between 0.73 and 1.84%, in the frontal, occipital and parietal cortex between 0.56 and 1.03%; in the insular cortex between 1.11 and 1.15%, in the temporal cortex between 1.22 and 1.37%, in the frontal, occipital and parietal white matter between 0.32 and 0.54% and in the temporal white matter between 0.83 and 0.89%. APTw intensity values were significantly impacted both by brain region (p < 0.001) and by side (p < 0.001), whereby overall values on the left side were higher than on the right side (1.13 vs. 0.9%). Gender did not significantly impact APTw intensity values (p = 0.24). APTw intensity values between the left and the right side were partially reversed after changing the position of one subject from supine to prone. Conclusion: We determined normal baseline APTw intensity values in different anatomical localizations in healthy subjects. APTw intensity values differed both between anatomical regions and between left and right brain hemisphere.

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Amide Proton Transfer Imaging Allows Detection of Glioma Grades and Tumor Proliferation: Comparison with Ki-67 Expression and Proton MR Spectroscopy Imaging

Cited by 52 publications

References 27 publications

APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

APT‐weighted MRI: Techniques, current neuro applications, and challenging issues

An evidence-based approach to evaluate the accuracy of amide proton transfer-weighted MRI in characterization of gliomas

Amide Proton Transfer Contrast Distribution in Different Brain Regions in Young Healthy Subjects

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