Practical data acquisition method for human brain tumor amide proton transfer (APT) imaging

Amide proton transfer MR imaging of prostate cancer: a preliminary study

PURPOSE

To evaluate the capability of amide proton transfer (APT) MR imaging for detection of prostate cancer that typically shows a higher tumor cell proliferation rate and cellular density leading to an MRI-detectable overall elevated mobile protein level in higher grade tumors.

MATERIALS AND METHODS

Twelve patients with biopsy-proven prostate cancer were imaged on a 3 Tesla MR imaging system before prostatectomy. APT-MR images were acquired by means of a single-slice single-shot turbo spin echo sequence with a saturation prepulse preparation using 33 different frequency offsets (-8 to 8 ppm, interval 0.5 ppm). For quantification we used the APT ratio (APTR) based on the asymmetry of the magnetization transfer ratio at 3.5 ppm in respect to the water signal. Tumor and peripheral zone benign regions of interest (ROIs) were delineated based on whole mount pathology slides after prostatectomy.

RESULTS

APTR in prostate cancer ROIs was 5.8% ± 3.2%, significantly higher than that in the peripheral zone benign regions (0.3% ± 3.2%, P = 0.002).

CONCLUSION

APT-MR imaging is feasible in prostate cancer detection and has the potential to discriminate between cancer and noncancer tissues.

MRI & MRS assessment of the role of the tumour microenvironment in response to therapy

MRI and MRS techniques are being applied to the characterisation of various aspects of the tumour microenvironment and to the assessment of tumour response to therapy. For example, kinetic parameters describing tumour blood vessel flow and permeability can be derived from dynamic contrast-enhanced MRI data and have been correlated with a positive tumour response to antivascular therapies. The ongoing development and validation of noninvasive, high-resolution anatomical/molecular MR techniques will equip us with the means to detect specific tumour biomarkers early on, and then to monitor the efficacy of cancer treatments efficiently and reliably, all within a clinically relevant time frame. Reliable tumour microenvironment imaging biomarkers will provide obvious advantages by enabling tumour-specific treatment tailoring and potentially improving patient outcome. However, for routine clinical application across many disease types, such imaging biomarkers must be quantitative, robust, reproducible, sufficiently sensitive and cost-effective. These characteristics are all difficult to achieve in practice, but image biomarker development and validation have been greatly facilitated by an increasing number of pertinent preclinical in vivo cancer models. Emphasis must now be placed on discovering whether the preclinical results translate into an improvement in patient care and, therefore, overall survival.

Amide proton transfer imaging with improved robustness to magnetic field inhomogeneity and magnetization transfer asymmetry using saturation with frequency alternating RF irradiation

Amide proton transfer (APT) imaging has shown promise as an indicator of tissue pH and as a marker for brain tumors. Sources of error in APT measurements include direct water saturation, and magnetization transfer (MT) from membranes and macromolecules. These are typically suppressed by postprocessing asymmetry analysis. However, this approach is strongly dependent on B(0) homogeneity and can introduce additional errors due to intrinsic MT asymmetry, aliphatic proton features opposite the amide peak and radiation damping-induced asymmetry. Although several methods exist to correct for B(0) inhomogeneity, they tremendously increase scan times and do not address errors induced by asymmetry of the z-spectrum. In this article, a novel saturation scheme-saturation with frequency alternating RF irradiation (SAFARI)-is proposed in combination with a new magnetization transfer ratio (MTR) parameter designed to generate APT images insensitive to direct water saturation and MT, even in the presence of B(0) inhomogeneity. The feasibility of the SAFARI technique is demonstrated in phantoms and in the human brain. Experimental results show that SAFARI successfully removes direct water saturation and MT contamination from APT images. It is insensitive to B(0) offsets up to 180 Hz without using additional B(0) correction, thereby dramatically reducing scanning time.

The evolution of imaging in cancer: current state and future challenges

Molecular imaging allows for the remote, noninvasive sensing and measurement of cellular and molecular processes in living subjects. Drawing upon a variety of modalities, molecular imaging provides a window into the biology of cancer from the subcellular level to the patient undergoing a new, experimental therapy. As signal transduction cascades and protein interaction networks become clarified, an increasing number of relevant targets for cancer therapy--and imaging--become available. Although conventional imaging is already critical to the management of patients with cancer, molecular imaging will provide even more relevant information, such as early detection of changes with therapy, identification of patient-specific cellular and metabolic abnormalities, and the disposition of therapeutic, gene-tagged cells throughout the body--all of which will have a considerable impact on morbidity and mortality. This overview discusses molecular imaging in oncology, providing examples from a variety of modalities, with an emphasis on emerging techniques for translational imaging.

Chemical exchange saturation transfer (CEST): what is in a name and what isn't?

Chemical exchange saturation transfer (CEST) imaging is a relatively new magnetic resonance imaging contrast approach in which exogenous or endogenous compounds containing either exchangeable protons or exchangeable molecules are selectively saturated and after transfer of this saturation, detected indirectly through the water signal with enhanced sensitivity. The focus of this review is on basic magnetic resonance principles underlying CEST and similarities to and differences with conventional magnetization transfer contrast. In CEST magnetic resonance imaging, transfer of magnetization is studied in mobile compounds instead of semisolids. Similar to magnetization transfer contrast, CEST has contributions of both chemical exchange and dipolar cross-relaxation, but the latter can often be neglected if exchange is fast. Contrary to magnetization transfer contrast, CEST imaging requires sufficiently slow exchange on the magnetic resonance time scale to allow selective irradiation of the protons of interest. As a consequence, magnetic labeling is not limited to radio-frequency saturation but can be expanded with slower frequency-selective approaches such as inversion, gradient dephasing and frequency labeling. The basic theory, design criteria, and experimental issues for exchange transfer imaging are discussed. A new classification for CEST agents based on exchange type is proposed. The potential of this young field is discussed, especially with respect to in vivo application and translation to humans.

Development of chemical exchange saturation transfer at 7 T

Chemical exchange saturation transfer (CEST) MRI is a molecular imaging method that has previously been successful at reporting variations in tissue protein and glycogen contents and pH. We have implemented amide proton transfer (APT), a specific form of chemical exchange saturation transfer imaging, at high field (7 T) and used it to study healthy human subjects and patients with multiple sclerosis. The effects of static field inhomogeneities were mitigated using a water saturation shift referencing method to center each z-spectrum on a voxel-by-voxel basis. Contrary to results obtained at lower fields, APT imaging at 7 T revealed significant contrast between white and gray matters, with a higher APT signal apparent within the white matter. Preliminary studies of multiple sclerosis showed that the APT asymmetry varied with the type of lesion examined. An increase in APT asymmetry relative to healthy tissue was found in some lesions. These results indicate the potential utility of APT at high field as a noninvasive biomarker of white matter pathology, providing complementary information to other MRI methods in current clinical use.

Saturation power dependence of amide proton transfer image contrasts in human brain tumors and strokes at 3 T

Amide proton transfer (APT) imaging is capable of detecting mobile cellular proteins and peptides in tumor and monitoring pH effects in stroke, through the saturation transfer between irradiated amide protons and water protons. In this work, four healthy subjects, eight brain tumor patients (four with high-grade glioma, one with lung cancer metastasis, and three with meningioma), and four stroke patients (average 4.3 ± 2.5 days after the onset of the stroke) were scanned at 3 T, using different radiofrequency saturation powers. The APT effect was quantified using the magnetization transfer ratio (MTR) asymmetry at 3.5 ppm with respect to the water resonance. At a saturation power of 2 μT, the measured APT-MRI signal of the normal brain tissue was almost zero, due to the contamination of the negative conventional magnetization transfer ratio asymmetry. This irradiation power caused an optimal hyperintense APT-MRI signal in the tumor and an optimal hypointense signal in the stroke, compared to the normal brain tissue. The results suggest that the saturation power of 2 μT is ideal for APT imaging of these two pathologies at 3 T with the existing clinical hardware.

Quantitative assessment of mobile protein levels in human knee synovial fluid: feasibility of chemical exchange saturation transfer (proteinCEST) MRI of osteoarthritis

PURPOSE

To establish the feasibility of chemical exchange saturation transfer (proteinCEST) MRI in the differentiation of osteoarthritis (OA) knee joints from non-OA joints by detecting mobile protein and peptide levels in synovial fluid by determining their relative distribution.

MATERIALS AND METHODS

A total of 25 knees in 11 men and 12 women with knee injuries were imaged using whole knee joint proteinCEST MRI sequence at 3 T. The joint synovial fluid was segmented and the asymmetric magnetization transfer ratio at 3.5 ppm MTR(asym) (3.5 ppm) was calculated to assess protein content in the synovial fluid. The 85th percentile of synovial fluid MTR(asym) (3.5 ppm) distribution profile was compared using the independent Student's t test. The diagnostic performance of the 85th percentile of synovial fluid MTR(asym) (3.5 ppm) in differentiating OA and non-OA knee joints was evaluated.

RESULTS

The 85th percentile of synovial fluid MTR(asym) (3.5 ppm) in knee joints with OA was 8.6%±3.4% and significantly higher than that in the knee joints without OA (6.3%±1.4%, P<.05). A knee joint with an 85th percentile of synovial fluid MTR(asym) (3.5 ppm) greater than 7.7% was considered to be an OA knee joint. With the threshold, the sensitivity, specificity and overall accuracy for differentiating knee joints with OA from the joints without OA were 54% (7/13), 92% (11/12) and 72% (18/25), respectively.

CONCLUSION

proteinCEST MRI appears feasible as a quantitative methodology to determine mobile protein levels in synovial fluid and identify patterns characteristic for OA disease.

Fast 3D chemical exchange saturation transfer (CEST) imaging of the human brain

Chemical exchange saturation transfer magnetic resonance imaging can detect low-concentration compounds with exchangeable protons through saturation transfer to water. This technique is generally slow, as it requires acquisition of saturation images at multiple frequencies. In addition, multislice imaging is complicated by saturation effects differing from slice to slice because of relaxation losses. In this study, a fast three-dimensional chemical exchange saturation transfer imaging sequence is presented that allows whole-brain coverage for a frequency-dependent saturation spectrum (z-spectrum, 26 frequencies) in less than 10 min. The approach employs a three-dimensional gradient- and spin-echo readout using a prototype 32-channel phased-array coil, combined with two-dimensional sensitivity encoding accelerations. Results from a homogenous protein-containing phantom at 3T show that the sequence produced a uniform contrast across all slices. To show translational feasibility, scans were also performed on five healthy human subjects. Results for chemical exchange saturation transfer images at 3.5 ppm downfield of the water resonance, so-called amide proton transfer images, show that lipid signals are sufficiently suppressed and artifacts caused by B(0) inhomogeneity can be removed in postprocessing. The scan time and image quality of these in vivo results show that three-dimensional chemical exchange saturation transfer MRI using gradient- and spin-echo acquisition is feasible for whole-brain chemical exchange saturation transfer studies at 3T in a clinical time frame.

Amide proton transfer imaging of the human brain

Amide proton transfer (APT) imaging is a new MRI technique that detects endogenous mobile proteins and peptides in tissue via saturation of the amide protons in the peptide bonds. Initial studies have shown promise in detecting tumor and stroke, but this technique was hampered by magnetic field inhomogeneity and a low signal-to-noise ratio. Several important prerequisites for performing APT imaging experiments include designing an effective APT imaging pulse sequence based on the hardware capability, optimizing the experimental protocol for the best clinical imaging quality, and developing data-processing approaches for effective image assessment. In this chapter, technical issues, such as pulse sequence design and optimization, magnetic field inhomogeneity correction, specific absorption rate minimization, and scan duration, are addressed.

Differentiation between glioma and radiation necrosis using molecular magnetic resonance imaging of endogenous proteins and peptides

It remains difficult to distinguish tumor recurrence from radiation necrosis after brain tumor therapy. Here we show that these lesions can be distinguished using the amide proton transfer (APT) magnetic resonance imaging (MRI) signals of endogenous cellular proteins and peptides as an imaging biomarker. When comparing two models of orthotopic glioma (SF188/V+ glioma and 9L gliosarcoma) with a model of radiation necrosis in rats, we could clearly differentiate viable glioma (hyperintense) from radiation necrosis (hypointense to isointense) by APT MRI. When we irradiated rats with U87MG gliomas, the APT signals in the irradiated tumors had decreased substantially by 3 d and 6 d after radiation. The amide protons that can be detected by APT provide a unique and noninvasive MRI biomarker for distinguishing viable malignancy from radiation necrosis and predicting tumor response to therapy.

Encoding the frequency dependence in MRI contrast media: the emerging class of CEST agents

CEST agents represent a very promising class of MRI contrast media as they encode a frequency dependence that is not like the classical relaxation-based agents. This peculiar property enables novel applications such as the detection of more than one agent in the same MR image as well as the set-up of ratiometric methods for the quantitative assessment of physico-chemical and biological parameters that characterize the micro-environment in which they are distributed. This survey is aimed at providing the reader with the basic properties and the potential of these compounds. Fundamental aspects, such as the theoretical basis of the saturation transfer via chemical exchange, the generation of the CEST contrast, the classification and sensitivity of CEST agents, and some representative examples displaying their potential in the field of MR-molecular imaging, are presented and discussed in detail.

Diffusion imaging of brain tumors

MRI offers a tremendous armamentarium of different methods that can be employed in brain tumor characterization. MR diffusion imaging has become a widely accepted method to probe for the presence of fluid pools and molecular tissue water mobility. For most clinical applications of diffusion imaging, it is assumed that the diffusion signal vs diffusion weighting factor b decays monoexponentially. Within this framework, the measurement of a single diffusion coefficient in brain tumors permits an approximate categorization of tumor type and, for some tumors, definitive diagnosis. In most brain tumors, when compared with normal brain tissue, the diffusion coefficient is elevated. The presence of peritumoral edema, which also exhibits an elevated diffusion coefficient, often precludes the delineation of the tumor on the basis of diffusion information alone. Serially obtained diffusion data are useful to document and even predict the cellular response to drug or radiation therapy. Diffusion measurements in tissues over an extended range of b factors have clearly shown that the monoparametric description of the MR diffusion signal decay is incomplete. Very high diffusion weighting on clinical systems requires substantial compromise in spatial resolution. However, after suitable analysis, superior separation of malignant brain tumors, peritumoral edema and normal brain tissue can be achieved. These findings are also discussed in the light of tissue-specific differences in membrane structure and the restrictions exerted by membranes on diffusion. Finally, measurement of the directional dependence of diffusion permits the assessment of white matter integrity and dislocation. Such information, particularly in conjunction with advanced post-processing, is considered to be immensely useful for therapy planning. Diffusion imaging, which permits monoexponential analysis and provides directional diffusion information, is performed routinely in brain tumor patients. More advanced methods require improvement in acquisition speed and spatial resolution to gain clinical acceptance.

Alternate ascending/descending directional navigation approach for imaging magnetization transfer asymmetry

A new method for imaging magnetization transfer (MT) asymmetry with no separate saturation pulse is proposed in this article. MT effects were generated from sequential two-dimensional balanced steady-state free precession imaging, where interslice MT asymmetry was separated from interslice blood flow and magnetic field inhomogeneity with alternate ascending/descending directional navigation (ALADDIN). Alternate ascending/descending directional navigation provided high-resolution multislice MT asymmetry images within a reasonable imaging time of ∼ 3 min. MT asymmetry signals measured with alternate ascending/descending directional navigation were 1-2% of baseline signals (N = 6), in agreement with those from the conventional methods. About 70% of MT asymmetry signals were determined by the first prior slice. The frequency offset ranges in this study were >8 ppm from the water resonance frequency, implying that the MT effects were mostly associated with solid-like macromolecules. Potential methods to make alternate ascending/descending directional navigation feasible for imaging amide proton transfer (∼ 3.5 ppm offset from the water resonance frequency) were discussed.

Tumor pH and its measurement

Studies over the last few decades have demonstrated that the intracellular pH of solid tumors is maintained within a range of 7.0-7.2, whereas the extracellular pH is acidic. A low extracellular pH may be an important factor inducing more aggressive cancer phenotypes. Research into the causes and consequences of this acidic pH of tumors is highly dependent on accurate, precise, and reproducible measurements, and these have undergone great changes in the last decade. This review focuses on the most recent advances in the in vivo measurement of tumor pH by pH-sensitive PET radiotracers, MR spectroscopy, MRI, and optical imaging.

MR imaging of high-grade brain tumors using endogenous protein and peptide-based contrast

Amide proton transfer (APT) imaging is a novel MRI technique, in which the amide protons of endogenous proteins and peptides are irradiated to accomplish indirect detection using the bulk water signal. In this paper, the APT approach was added to a standard brain MRI protocol at 3T, and twelve patients with high-grade gliomas confirmed by histopathology were scanned. It is shown that all tumors, including one with minor gadolinium enhancement, showed heterogeneous hyperintensity on the APT images. The average APT signal intensities of the viable tumor cores were significantly higher than those of peritumoral edema and normal-appearing white matter (P<0.001). The average APT signal intensities were significantly lower in the necrotic regions than in the viable tumor cores (P=0.004). The APT signal intensities of the cystic cavities were similar to those of the viable tumor cores (P>0.2). The initial results show that APT imaging at the protein and peptide level may enhance non-invasive identification of tissue heterogeneity in high-grade brain tumors.

Simultaneous determination of labile proton concentration and exchange rate utilizing optimal RF power: Radio frequency power (RFP) dependence of chemical exchange saturation transfer (CEST) MRI

Chemical exchange saturation transfer (CEST) MRI is increasingly used to probe mobile proteins and microenvironment properties, and shows great promise for tumor and stroke diagnosis. However, CEST MRI contrast mechanism is complex, depending not only on the CEST agent concentration, exchange and relaxation properties, but also varying with experimental conditions such as magnetic field strength and RF power. Hence, it remains somewhat difficult to quantify apparent CEST MRI contrast for properties such as pH, temperature and protein content. In particular, CEST MRI is susceptible to RF spillover effects in that RF irradiation may directly saturate the bulk water MR signal, leading to an optimal RF power at which the CEST contrast is maximal. Whereas RF spillover is generally considered an adverse effect, it is noted here that the optimal RF power strongly varies with exchange rate, although with negligible dependence on labile proton concentration. An empirical solution suggested that optimal RF power may serve as a sensitive parameter for simultaneously determining the labile proton content and exchange rate, hence, allowing improved characterization of the CEST system. The empirical solution was confirmed by numerical simulation, and experimental validation is needed to further evaluate the proposed technique.

Magnetization transfer phenomenon in the human brain at 7 T

Magnetization transfer is an important source of contrast in magnetic resonance imaging which is sensitive to the concentration of macromolecules and other solutes present in the tissue. Magnetization transfer effects can be visualized in magnetization transfer ratio images or quantified via the z-spectrum. This paper presents methods of measuring the z-spectrum and of producing high-resolution MTR images and maps of z-spectrum asymmetry in vivo at 7 T, within SAR limits. It also uses a 3-compartment model to measure chemical exchange and magnetization transfer parameters from the z-spectrum data. The peak in the z-spectrum associated with chemical exchange between amide and water protons (amide proton transfer, APT, effects) is much more apparent at 7 T than at 3 T. Furthermore at 7 T quantitative APT results varied between the corpus callosum and other white matter structures, suggesting that quantitative APT imaging could be used as a method of measuring myelination. The results also suggest that chemical exchange is not responsible for the phase shift observed in susceptibility weighted images between grey matter and white matter.