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Added value of amide proton transfer imaging to conventional and perfusion MR imaging for evaluating the treatment response of newly diagnosed glioblastoma

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Abstract

Objectives

To determine the added value of amide proton transfer (APT) imaging to conventional and perfusion MRI for differentiating tumour progression (TP) from the treatment-related effect (TE) in patients with post-treatment glioblastomas.

Methods

Sixty-five consecutive patients with enlarging contrast-enhancing lesions following concurrent chemoradiotherapy were assessed using contrast-enhanced T1-weighted MRI (CE-T1WI), 90th percentile histogram parameters of normalized cerebral blood volume (nCBV90) and APT asymmetry value (APT90). Diagnostic performance was determined using the area under the receiver operating characteristic curve (AUC) and cross validations.

Results

There were statistically significant differences in the mean APT90 between the TP and the TE groups (3.87–4.01 % vs. 1.38–1.41 %; P < .001). Compared with CE-T1WI alone, the addition of APT90 to CE-T1WI significantly improved cross-validated AUC from 0.58–0.74 to 0.89–0.91 for differentiating TP from TE. The combination of CE-T1WI, nCBV90 and APT90 resulted in greater diagnostic accuracy for differentiating TP from TE than the combination of CE-T1WI and nCBV90 (cross-validated AUC, 0.95–0.97 vs. 0.84–0.91). The inter-reader agreement between the expert and trainee was excellent for the measurements of APT90 (intraclass correlation coefficient, 0.94).

Conclusion

Adding APT imaging to conventional and perfusion MRI improves the diagnostic performance for differentiating TP from TE.

Key Points

• APT imaging could provide a reliable distinction between TP and TE

• Adding APT imaging to CE-T1WI improved the diagnostic accuracy versus CE-T1WI alone

• Multimodal imaging using CE-T1WI, perfusion and APT imaging led to accurate diagnosis

• The inter-reader agreement of APT histogram parameters was excellent

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Abbreviations

APT:

Amide proton transfer

APT90:

90th percentile value of histogram cutoff for the amide proton transfer imaging

AUC:

Area under the ROC curve

CCRT:

Concurrent chemotherapy and radiation therapy

CE-T1WI:

Contrast-enhanced T1 weighted image

DSC:

T2*-weighted dynamic susceptibility contrast-enhanced

DWI:

Diffusion-weighted imaging

nCBV:

Normalized cerebral blood volume

nCBV90:

90th percentile value of histogram cutoff for the normalized cerebral blood volume

ROC:

Receiver operating characteristics

ROI:

Region of interest

TE:

Treatment-related effect

TP:

Tumour progression

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Acknowledgments

The scientific guarantor of this publication is Prof. Sang Joon Kim. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (grant number: NRF-2014R1A2A2A01004937). The Institutional Review Board approved our human study (The Institutional Review Board of Asan Medical Center [http://eirb.amc.seoul.kr]: S2015-0578-0001). Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution. The authors thank the Biomedical Imaging Infrastructure, Department of Radiology, Asan Medical Center for technical support in image processing, Ha Kyu Jung for technical support and valuable contributions, and Prof. Hwa Jung Kim for statistical support and valuable contributions.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Korea

    Kye Jin Park, Ho Sung Kim, Ji Eun Park, Woo Hyun Shim & Sang Joon Kim

  2. Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA

    Seth A. Smith

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  1. Kye Jin Park
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  2. Ho Sung Kim
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Correspondence to Ho Sung Kim.

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Park, K.J., Kim, H.S., Park, J.E. et al. Added value of amide proton transfer imaging to conventional and perfusion MR imaging for evaluating the treatment response of newly diagnosed glioblastoma. Eur Radiol 26, 4390–4403 (2016). https://doi.org/10.1007/s00330-016-4261-2

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  • DOI: https://doi.org/10.1007/s00330-016-4261-2

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