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Wang X, Cao YY, Jiang Y, Jia M, Tian G, Bu CQ, Zhao N, Yue XZ, Shen ZW, Ji Y, Han YD. Effects of Breathing Patterns on Amide Proton Transfer MRI in the Kidney: A Preliminary Comparative Study in Healthy Volunteers and Patients With Tumors. J Magn Reson Imaging 2024; 60:222-230. [PMID: 37888865 DOI: 10.1002/jmri.29099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The amide proton transfer-weighted (APTw) imaging for kidney diseases is important. However, the breathing patterns on APTw imaging remains unexplored. PURPOSE This study aimed to investigate the effects of intermittent breath-hold (IBH) and free breathing (FB) on renal 3D-APTw imaging. STUDY TYPE Healthy volunteers were enrolled prospectively, and renal clear cell carcinoma (RCCC) patients were included retrospectively. POPULATION 58 healthy volunteers and 10 RCCC patients. FIELD STRENGTH/SEQUENCE 3-T, turbo spin echo, and fast field echo. ASSESSMENT 3D-APTw imaging was scanned using the IBH and FB methods in volunteers and using the IBH method in RCCC patients. The image quality was evaluated by three observers according to the 5-point Likert scale. Optimal images rated at three points or higher were used to measure the APT values. STATISTICAL ANALYSIS The measurement repeatability was assessed using the intraclass correlation coefficient (ICC) and the Bland-Altman plot. The APT values were analyzed using McNemar's test, one-way analysis of variance, and t test. RESULTS 50 healthy volunteers and 8 RCCC patients were enrolled. Renal 3D-APTw imaging using the IBH method revealed a higher success rate (88% vs 78%). The ICCs were excellent in the IBH group (ICCs > 0.74) and were good in the FB group (ICCs < 0.74). No significant differences in the APT values among various zones using the IBH (P = 0.263) or FB method (P = 0.506). The mean APT value using the IBH method (2.091% ± 0.388%) was slightly lower than the FB method (2.176% ± 0.292%), but no significant difference (P = 0.233). The APT value of RCCC (4.832% ± 1.361%) was considerably higher than normal renal using the IBH method. CONCLUSIONS The study demonstrated that the IBH method substantially increased the image quality of renal 3D-APTw imaging. Furthermore, APT values may vary between normal and tumor tissues. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- X Wang
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - Y Y Cao
- Department of Imaging Center, First Affiliated Hospital, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Y Jiang
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - M Jia
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - G Tian
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - C Q Bu
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - N Zhao
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
| | - X Z Yue
- Philips Healthcare, Beijing, China
| | - Z W Shen
- Philips Healthcare, Beijing, China
| | - Y Ji
- Department of Imaging Center, First Affiliated Hospital, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Y D Han
- Department of Radiology, Xi'an GaoXin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi, China
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Xu Y, Wan Q, Ren X, Jiang Y, Wang F, Yao J, Wu P, Shen A, Wang P. Amide proton transfer-weighted MRI for renal tumors: Comparison with diffusion-weighted imaging. Magn Reson Imaging 2024; 106:104-109. [PMID: 38135260 DOI: 10.1016/j.mri.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE To investigate the potential of amide proton transfer-weighted (APTw) MRI in identifying benign and malignant renal tumors and to evaluate whether APTw MRI can add diagnostic value to diffusion-weighted imaging (DWI). MATERIALS AND METHODS Participants with renal tumor underwent preoperative multiparametric MRI, including APTw MRI and DWI. The APTw and apparent diffusion coefficient (ADC) of malignant tumors and benign tumors were calculated independently by two radiologists and compared. The value of the mean APTw and the mean ADC for differentiating malignant and benign tumors was evaluated by receiver operating characteristic analysis. RESULTS In total, 65 participants (mean age, 59 years ±14; 41 men) were evaluated: 54 with malignant and 11 with benign renal tumors. Malignant renal tumors showed higher mean APTw values [2.03% (1.63) vs 1.00% (1.60); P < 0.01] and lower mean ADC values (1.22 × 10-3 mm2/s ± 0.37 vs 1.51 × 10-3 mm2/s ± 0.37; P < 0.05) than benign renal tumors. The area under the receiver operating characteristic curve (AUC) of APTw, ADC and the combination of them for the identification of benign and malignant renal tumors was 0.78(95% CI: 0.66, 0.87; P < 0.001),0.70(95% CI: 0.54, 0.86; P < 0.05) and 0.79 (95% CI: 0.67, 0.88; P < 0.001). The optimal cutoff value for mean APTw was 2.14% (sensitivity, 74%; specificity, 73%). There was no difference between these three parameters for differentiating malignant from benign renal tumors (P > 0.05). CONCLUSION The APTw MRI has the potential use as an imaging biomarker for renal malignant and benign tumors.
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Affiliation(s)
- Yun Xu
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Qingxuan Wan
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Xihui Ren
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Yutao Jiang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Fang Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Jing Yao
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China
| | - Peng Wu
- Philips Healthcare, Shanghai 200072, China
| | - Aijun Shen
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China.
| | - Peijun Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China; Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai 200065, China.
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Wu Y, Wood TC, Derks SHAE, Pruis IJ, van der Voort S, van Zanten SEMV, Smits M, Warnert EAH. Reproducibility of APT-weighted CEST-MRI at 3T in healthy brain and tumor across sessions and scanners. Sci Rep 2023; 13:18115. [PMID: 37872418 PMCID: PMC10593824 DOI: 10.1038/s41598-023-44891-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Amide proton transfer (APT)-weighted chemical exchange saturation transfer (CEST) imaging is a recent MRI technique making its way into clinical application. In this work, we investigated whether APT-weighted CEST imaging can provide reproducible measurements across scan sessions and scanners. Within-session, between-session and between scanner reproducibility was calculated for 19 healthy volunteers and 7 patients with a brain tumor on two 3T MRI scanners. The APT-weighted CEST effect was evaluated by calculating the Lorentzian Difference (LD), magnetization transfer ratio asymmetry (MTRasym), and relaxation-compensated inverse magnetization transfer ratio (MTRREX) averaged in whole brain white matter (WM), enhancing tumor and necrosis. Within subject coefficient of variation (COV) calculations, Bland-Altman plots and mixed effect modeling were performed to assess the repeatability and reproducibility of averaged values. The group median COVs of LD APT were 0.56% (N = 19), 0.84% (N = 6), 0.80% (N = 9) in WM within-session, between-session and between-scanner respectively. The between-session COV of LD APT in enhancing tumor (N = 6) and necrotic core (N = 3) were 4.57% and 5.67%, respectively. There were no significant differences in within session, between session and between scanner comparisons of the APT effect. The COVs of LD and MTRREX were consistently lower than MTRasym in all experiments, both in healthy tissues and tumor. The repeatability and reproducibility of APT-weighted CEST was clinically acceptable across scan sessions and scanners. Although MTRasym is simple to acquire and compute and sufficient to provide robust measurement, it is beneficial to include LD and MTRREX to obtain higher reproducibility for detecting minor signal difference in different tissue types.
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Affiliation(s)
- Yulun Wu
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sophie H A E Derks
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ilanah J Pruis
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sebastian van der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Sophie E M Veldhuijzen van Zanten
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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Khormi I, Al-Iedani O, Casagranda S, Papageorgakis C, Alshehri A, Lea R, Liebig P, Ramadan S, Lechner-Scott J. CEST 2022 - Differences in APT-weighted signal in T1 weighted isointense lesions, black holes and normal-appearing white matter in people with relapsing-remitting multiple sclerosis. Magn Reson Imaging 2023:S0730-725X(23)00098-X. [PMID: 37321380 DOI: 10.1016/j.mri.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To evaluate amide proton transfer weighted (APTw) signal differences between multiple sclerosis (MS) lesions and contralateral normal-appearing white matter (cNAWM). Cellular changes during the demyelination process were also assessed by comparing APTw signal intensity in T1weighted isointense (ISO) and hypointense (black hole -BH) MS lesions in relation to cNAWM. METHODS Twenty-four people with relapsing-remitting MS (pw-RRMS) on stable therapy were recruited. MRI/APTw acquisitions were undertaken on a 3 T MRI scanner. The pre and post-processing, analysis, co-registration with structural MRI maps, and identification of regions of interest (ROIs) were all performed with Olea Sphere 3.0 software. Generalized linear model (GLM) univariate ANOVA was undertaken to test the hypotheses that differences in mean APTw were entered as dependent variables. ROIs were entered as random effect variables, which allowed all data to be included. Regions (lesions and cNAWM) and/or structure (ISO and BH) were the main factor variables. The models also included age, sex, disease duration, EDSS, and ROI volumes as covariates. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the diagnostic performance of these comparisons. RESULTS A total of 502 MS lesions manually identified on T2-FLAIR from twenty-four pw-RRMS were subcategorized as 359 ISO and 143 BH with reference to the T1-MPRAGE cerebral cortex signal. Also, 490 ROIs of cNAWM were manually delineated to match the MS lesion positions. A two-tailed t-test showed that mean APTw values were higher in females than in males (t = 3.52, p < 0.001). Additionally, the mean APTw values of MS lesions were higher than those of cNAWM after accounting for covariates (mean lesion = 0.44, mean cNAWM = 0.13, F = 44.12, p < 0.001).The mean APTw values of ISO lesions were higher than those of cNAWM after accounting for covariates (mean ISO lesions = 0.42, mean cNAWM = 0.21, F = 12.12, p < 0.001). The mean APTw values of BH were also higher than those of cNAWM (mean BH lesions = 0.47, mean cNAWM = 0.033, F = 40.3, p < 0.001). The effect size (i.e., difference between lesion and cNAWM) for BH was found to be higher than for ISO (14 vs. 2). Diagnostic performance showed that APT was able to discriminate between all lesions and cNAWM with an accuracy of >75% (AUC = 0.79, SE = 0.014). Discrimination between ISO lesions and cNAWM was accomplished with an accuracy of >69% (AUC = 0.74, SE = 0.018), while discrimination between BH lesions and cNAWM was achieved at an accuracy of >80% (AUC = 0.87, SE = 0.021). CONCLUSIONS Our results highlight the potential of APTw imaging for use as a non-invasive technique that is able to provide essential molecular information to clinicians and researchers so that the stages of inflammation and degeneration in MS lesions can be better characterized.
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Affiliation(s)
- Ibrahim Khormi
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; College of Applied Medical Sciences, University of Jeddah, Jeddah, Saudi Arabia
| | - Oun Al-Iedani
- Hunter Medical Research Institute, New Lambton Heights, Australia; School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | | | | | - Abdulaziz Alshehri
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia; Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rodney Lea
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Saadallah Ramadan
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, New Lambton Heights, Australia; Department of Neurology, John Hunter Hospital, New Lambton Heights, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
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Evaluation of Brain Tumors Using Amide Proton Transfer Imaging: A Comparison of Normal Amide Proton Transfer Signal With Abnormal Amide Proton Transfer Signal Value. J Comput Assist Tomogr 2023; 47:121-128. [PMID: 36112043 DOI: 10.1097/rct.0000000000001378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the relationship of amide proton transfer (APT) signal characteristics in brain tumors and uninvolved brain tissue for patients with glioblastoma and those with brain metastases. METHODS Using the mDIXON 3D-APT sequence of the fast spin echo method, an APT image was obtained. The mean APT signal values of tumor core, peritumor edema, ipsilateral normal-appearing white matter (INAWM), and contralateral normal white matter (CNAWM) were obtained and compared between glioblastoma and brain metastases. Receiver operating characteristic curves were used to evaluate parameters for distinguishing between glioblastoma and brain metastases. In addition, the difference and change rate in APT signal values between tumor core and peritumoral edema (PE) and CNAWM were evaluated, respectively. RESULTS The APT signal values of glioblastoma were the highest in tumor core (3.41% ± 0.49%), followed by PE (2.24% ± 0.29%), INAWM (1.35% ± 0.15%), and CNAWM (1.26% ± 0.12%, P < 0.001). The APT signal value of brain metastases was the highest in tumor core (2.74% ± 0.34%), followed by PE (1.86% ± 0.35%), INAWM (1.17% ± 0.13%), and CNAWM (1.2% ± 0.09%, P < 0.01). The APT change rate (between PE and CNAWM) was not significantly different at 78% and 56% for glioblastoma and brain metastases, respectively ( P > 0.05). CONCLUSIONS Performing APT imaging under the same parameters used in this study may aid in the identification of brain tumors.
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Wamelink IJHG, Kuijer JPA, Padrela BE, Zhang Y, Barkhof F, Mutsaerts HJMM, Petr J, van de Giessen E, Keil VC. Reproducibility of 3 T APT-CEST in Healthy Volunteers and Patients With Brain Glioma. J Magn Reson Imaging 2023; 57:206-215. [PMID: 35633282 PMCID: PMC10084114 DOI: 10.1002/jmri.28239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Amide proton transfer (APT) imaging is a chemical exchange saturation transfer (CEST) technique offering potential clinical applications such as diagnosis, characterization, and treatment planning and monitoring in glioma patients. While APT-CEST has demonstrated high potential, reproducibility remains underexplored. PURPOSE To investigate whether cerebral APT-CEST with clinically feasible scan time is reproducible in healthy tissue and glioma for clinical use at 3 T. STUDY TYPE Prospective, longitudinal. SUBJECTS Twenty-one healthy volunteers (11 females; mean age ± SD: 39 ± 11 years) and 6 glioma patients (3 females; 50 ± 17 years: 4 glioblastomas, 1 oligodendroglioma, 1 radiologically suspected low-grade glioma). FIELD STRENGTH/SEQUENCE 3 T, Turbo Spin Echo - ampling perfection with application optimized contrasts using different flip angle evolution - chemical exchange saturation transfer (TSE SPACE-CEST). ASSESSMENT APT-CEST measurement reproducibility was assessed within-session (glioma patients, scan session 1; healthy volunteers scan sessions 1, 2, and 3), between-sessions (healthy volunteers scan sessions 1 and 2), and between-days (healthy volunteers, scan sessions 1 and 3). The mean APTCEST values and standard deviation of the within-subject difference (SDdiff ) were calculated in whole tumor enclosed by regions of interest (ROIs) in patients, and eight ROIs in healthy volunteers-whole-brain, cortical gray matter, putamen, thalami, orbitofrontal gyri, occipital lobes, central brain-and compared. STATISTICAL TESTS Brown-Forsythe tests and variance component analysis (VCA) were used to assess the reproducibility of ROIs for the three time intervals. Significance was set at P < 0.003 after Bonferroni correction. RESULTS Intratumoral mean APTCEST was significantly higher than APTCEST in healthy-appearing tissue in patients (0.5 ± 0.46%). The average within-session, between-sessions, and between-days SDdiff of healthy control brains was 0.2% and did not differ significantly with each other (0.76 > P > 0.22). The within-session SDdiff of whole-brain was 0.2% in both healthy volunteers and patients, and 0.21% in the segmented tumor. VCA showed that within-session factors were the most important (60%) for scanning variance. DATA CONCLUSION Cerebral APT-CEST imaging may show good scan-rescan reproducibility in healthy tissue and tumors with clinically feasible scan times at 3 T. Short-term measurement effects may be the dominant components for reproducibility. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ivar J H G Wamelink
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joost P A Kuijer
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Beatriz E Padrela
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Petr
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Elsmarieke van de Giessen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vera C Keil
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Jabehdar Maralani P, Chan RW, Lam WW, Oakden W, Oglesby R, Lau A, Mehrabian H, Heyn C, Chan AK, Soliman H, Sahgal A, Stanisz GJ. Chemical Exchange Saturation Transfer MRI: What Neuro-Oncology Clinicians Need To Know. Technol Cancer Res Treat 2023; 22:15330338231208613. [PMID: 37872686 PMCID: PMC10594966 DOI: 10.1177/15330338231208613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
Chemical exchange saturation transfer (CEST) is a relatively novel magnetic resonance imaging (MRI) technique with an image contrast designed for in vivo measurement of certain endogenous molecules with protons that are exchangeable with water protons, such as amide proton transfer commonly used for neuro-oncology applications. Recent technological advances have made it feasible to implement CEST on clinical grade scanners within practical acquisition times, creating new opportunities to integrate CEST in clinical workflow. In addition, the majority of CEST applications used in neuro-oncology are performed without the use gadolinium-based contrast agents which are another appealing feature of this technique. This review is written for clinicians involved in neuro-oncologic care (nonphysicists) as the target audience explaining what they need to know as CEST makes its way into practice. The purpose of this article is to (1) review the basic physics and technical principles of CEST MRI, and (2) review the practical applications of CEST in neuro-oncology.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Rachel W. Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Wilfred W. Lam
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Wendy Oakden
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Ryan Oglesby
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Angus Lau
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Hatef Mehrabian
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Chris Heyn
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Aimee K.M. Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Greg J. Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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Prediction of H3 K27M-mutant in midline gliomas by magnetic resonance imaging: a systematic review and meta-analysis. Neuroradiology 2022; 64:1311-1319. [PMID: 35416485 DOI: 10.1007/s00234-022-02947-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To summarize the predictive value of MRI for H3 K27M-mutant in midline gliomas using meta-analysis. METHODS Systematic electronic searches of the PubMed, Embase, ISI Web of Science, and Cochrane Library up to Jun 31, 2021, were conducted by two experienced neuroradiologists with the keywords of "MRI," "Glioma," and "H3 K27M." The hierarchical summary receiver-operating characteristic (HSROC) model was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR +), negative likelihood ratio (LR -), and diagnostic odds ratio (DOR). Coupled forest plots were used to evaluate the heterogeneity of the included studies. RESULTS Of seven original studies with a total of 593 patients, 240 glioma patients were included, with 45.5-70.6% H3 K27M-mutant gliomas. Using MRI, a pooled sensitivity of 0.78 (95% CI, 0.66-0.87), specificity of 0.85 (95% CI, 0.76-0.91), LR + of 5.07 (95% CI, 3.19-8.08), LR - of 0.26 (95% CI, 0.16-0.42), and DOR of 19.80 (95% CI, 9.28-42.28) were achieved for H3 K27M-mutant prediction. Significant heterogeneity was observed among the studies in terms of sensitivity (Q = 16.83, df = 7, p = 0.02; I2 = 58.40 [95% CI, 25.83-90.97]), LR - (Q = 16.61, df = 7, p = 0.02; I2 = 57.87 [95% CI, 24.81-90.93]), and DOR (Q = 14.05, df = 7, p = 0.05; I2 = 50.18 [95% CI, 10.06-90.31]). CONCLUSIONS This meta-analysis demonstrated a clinical value of MRI to predict H3 K27M-mutant in midline gliomas with a pooled sensitivity of 0.78 and specificity of 0.85.
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Friismose AI, Markovic L, Nguyen N, Gerke O, Schulz MK, Mussmann BR. Amide proton transfer-weighted MRI in the clinical setting - correlation with dynamic susceptibility contrast perfusion in the post-treatment imaging of adult glioma patients at 3T. Radiography (Lond) 2021; 28:95-101. [PMID: 34509365 DOI: 10.1016/j.radi.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We investigated the correlation between amide proton transfer-weighted magnetic resonance imaging (APTw MRI) and dynamic susceptibility contrast (DSC) perfusion in order to assess the potential of APTw MRI as an alternative to DSC in adult brain tumor (glioma) imaging. METHODS After Ethical Committee approval, forty adult patients, treated for histopathologically confirmed glioma (World Health Organization (WHO) grade II-IV), were prospectively imaged at 3 Tesla (3 T) with DSC perfusion and a commercially available three-dimensional (3D) APTw sequence. Two consultant neuroradiologists independently performed region of interest (ROI) measurements on relative cerebral blood volume (rCBV) and APTw maps, co-registered with anatomical images. The correlation APTw MRI-DSC perfusion was assessed using Spearman's rank-order test. Inter-observer agreement was evaluated by the intraclass correlation coefficient (ICC) and Bland-Altman (BA) plots. RESULTS A statistically significant moderately strong positive correlation was observed between maximum rCBV (rCBVmax) and maximum APTw (APTwmax) values (observer 1: r = 0.73; p < 0.01; observer 2: r = 0.62; p < 0.01). We found good inter-observer agreement for APTwmax (ICC = 0.82; 95% confidence interval (CI) 0.66-0.90), with somewhat broad outer 95% CI for the BA Limits of Agreement (LoA) (-1.6 to 1.9). ICC for APTwmax was higher than ICC for rCBVmax (ICC = 0.74; 95%; CI 0.50-0.86), but the difference was not statistically significant. CONCLUSION APTwmax values correlate positively with rCBVmax in patients treated for brain glioma. APTw imaging is a reproducible technique, with some observer dependence. Results need to be confirmed by a larger population analysis. IMPLICATIONS FOR PRACTICE APTw MRI can be a useful addition to glioma follow-up imaging and a potential alternative to DSC perfusion, especially in patients where contrast agent is contraindicated.
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Affiliation(s)
- A I Friismose
- Radiology Department, Odense University Hospital, Odense, Denmark.
| | - L Markovic
- Radiology Department, Odense University Hospital, Odense, Denmark
| | - N Nguyen
- Radiology Department, Odense University Hospital, Odense, Denmark
| | - O Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - M K Schulz
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - B R Mussmann
- Radiology Department, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; OPEN, Odense Patient Data Exploratory Network, Odense University Hospital, Odense, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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10
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Foo LS, Harston G, Mehndiratta A, Yap WS, Hum YC, Lai KW, Mohamed Mukari SA, Mohd Zaki F, Tee YK. Clinical translation of amide proton transfer (APT) MRI for ischemic stroke: a systematic review (2003-2020). Quant Imaging Med Surg 2021; 11:3797-3811. [PMID: 34341751 DOI: 10.21037/qims-20-1339] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/22/2021] [Indexed: 12/15/2022]
Abstract
Amide proton transfer (APT) magnetic resonance imaging (MRI) is a pH-sensitive imaging technique that can potentially complement existing clinical imaging protocol for the assessment of ischemic stroke. This review aims to summarize the developments in the clinical research of APT imaging of ischemic stroke after 17 years of progress since its first preclinical study in 2003. Three electronic databases: PubMed, Scopus, and Cochrane Library were systematically searched for articles reporting clinical studies on APT imaging of ischemic stroke. Only articles in English published between 2003 to 2020 that involved patients presenting ischemic stroke-like symptoms that underwent APT MRI were included. Of 1,093 articles screened, 14 articles met the inclusion criteria with a total of 282 patients that had been scanned using APT imaging. Generally, the clinical studies agreed APT effect to be hypointense in ischemic tissue compared to healthy tissue, allowing for the detection of ischemic stroke. Other uses of APT imaging have also been investigated in the studies, including penumbra identification, predicting long term clinical outcome, and serving as a biomarker for supportive treatment monitoring. The published results demonstrated the potential of APT imaging in these applications, but further investigations and larger trials are needed for conclusive evidence. Future studies are recommended to report the result of asymmetry analysis at 3.5 ppm along with the findings of the study to reduce this contribution to the heterogeneity of experimental methods observed and to facilitate effective comparison of results between studies and centers. In addition, it is important to focus on the development of fast 3D imaging for full volumetric ischemic tissue assessment for clinical translation.
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Affiliation(s)
- Lee Sze Foo
- Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Wun-She Yap
- Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Yan Chai Hum
- Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Khin Wee Lai
- Faculty of Engineering, Department of Biomedical Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Faizah Mohd Zaki
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Kuala Lumpur, Malaysia
| | - Yee Kai Tee
- Lee Kong Chian Faculty of Engineering and Science, Universiti Tunku Abdul Rahman, Kajang, Malaysia
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11
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Zhang H, Yong X, Ma X, Zhao J, Shen Z, Chen X, Tian F, Chen W, Wu D, Zhang Y. Differentiation of low- and high-grade pediatric gliomas with amide proton transfer imaging: added value beyond quantitative relaxation times. Eur Radiol 2021; 31:9110-9119. [PMID: 34047848 DOI: 10.1007/s00330-021-08039-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate whether amide proton transfer (APT) MRI can be used to characterize gliomas in pediatric patients and whether it provides added value beyond relaxation times. METHODS In this prospective study, APT imaging and relaxation time mapping were performed in 203 pediatric patients suspected of gliomas from February 2018 to December 2019. The region of interest (ROI) in the tumor was automatically generated with artifact detection and ROI-shrinking algorithms. Several APT-related metrics (CESTR, CESTRnr, MTRRex, AREX, and APT#) and quantitative T1 and T2 were compared between low-grade and high-grade gliomas using the student's t-test or Mann-Whitney U-test. The performance of these parameters was assessed using the receiver operating characteristic (ROC) analysis. A stepwise multivariate logistic regression model was used to combine the imaging parameters. RESULTS Forty-eight patients (mean age: 6 ± 4 years; 23 males and 25 females) were included in the final analysis. All the APT-related metrics except APT# had significantly (p < 0.05) higher values in the high-grade group than the low-grade group. Under different ROI-shrinking cutoffs, the quantitative T1 (p = 0.045-0.200) and T2 (p = 0.037-0.171) values of high-grade gliomas were typically lower than those of low-grade ones. The stepwise multivariate logistic regression revealed that CESTRnr and APT# were combined significant predictors of glioma grades (p < 0.05), with an area under the ROC curve (AUC) of 0.86 substantially larger than those of T1 (AUC = 0.69) and T2 (AUC = 0.68). CONCLUSIONS APT imaging can be used to differentiate high-grade and low-grade gliomas in pediatric patients and provide added value beyond quantitative relaxation times. KEY POINTS • Amide proton transfer (APT) MRI showed significantly (p < 0.05) higher values in pediatric patients with high-grade gliomas than those with low-grade ones. • The area under the curve was 0.86 for APT MRI to differentiate low-grade and high-grade gliomas in pediatric patients, which was substantially higher than that for quantitative T1 (0.69) and T2 (0.68). • APT MRI demonstrated added value beyond quantitative T1 and T2 mapping in characterizing pediatric gliomas.
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Affiliation(s)
- Hongxi Zhang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xingwang Yong
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaohui Ma
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianjiang Zhao
- Kangqiao Street Community Health Service Center, Gongshu District, Hangzhou, Zhejiang, China
| | - Zhipeng Shen
- Department of Neurosurgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinchun Chen
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fengyu Tian
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China. .,Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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12
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Sartoretti E, Sartoretti T, Wyss M, Reischauer C, van Smoorenburg L, Binkert CA, Sartoretti-Schefer S, Mannil M. Amide proton transfer weighted (APTw) imaging based radiomics allows for the differentiation of gliomas from metastases. Sci Rep 2021; 11:5506. [PMID: 33750899 PMCID: PMC7943598 DOI: 10.1038/s41598-021-85168-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/24/2021] [Indexed: 12/13/2022] Open
Abstract
We sought to evaluate the utility of radiomics for Amide Proton Transfer weighted (APTw) imaging by assessing its value in differentiating brain metastases from high- and low grade glial brain tumors. We retrospectively identified 48 treatment-naïve patients (10 WHO grade 2, 1 WHO grade 3, 10 WHO grade 4 primary glial brain tumors and 27 metastases) with either primary glial brain tumors or metastases who had undergone APTw MR imaging. After image analysis with radiomics feature extraction and post-processing, machine learning algorithms (multilayer perceptron machine learning algorithm; random forest classifier) with stratified tenfold cross validation were trained on features and were used to differentiate the brain neoplasms. The multilayer perceptron achieved an AUC of 0.836 (receiver operating characteristic curve) in differentiating primary glial brain tumors from metastases. The random forest classifier achieved an AUC of 0.868 in differentiating WHO grade 4 from WHO grade 2/3 primary glial brain tumors. For the differentiation of WHO grade 4 tumors from grade 2/3 tumors and metastases an average AUC of 0.797 was achieved. Our results indicate that the use of radiomics for APTw imaging is feasible and the differentiation of primary glial brain tumors from metastases is achievable with a high degree of accuracy.
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Affiliation(s)
- Elisabeth Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Thomas Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Michael Wyss
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Philips Healthsystems, Zürich, Switzerland
| | - Carolin Reischauer
- Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
| | | | | | | | - Manoj Mannil
- Department of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland. .,Institute of Clinical Radiology, University Hospital Münster, University of Münster, Albrecht-Schweitzer-Campus 1, E48149, Münster, Germany.
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13
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Liebert A, Tkotz K, Herrler J, Linz P, Mennecke A, German A, Liebig P, Gumbrecht R, Schmidt M, Doerfler A, Uder M, Zaiss M, Nagel AM. Whole-brain quantitative CEST MRI at 7T using parallel transmission methods and B 1 + correction. Magn Reson Med 2021; 86:346-362. [PMID: 33634505 DOI: 10.1002/mrm.28745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To enable whole-brain quantitative CEST MRI at ultra-high magnetic field strengths (B0 ≥ 7T) within short acquisition times. METHODS Multiple interleaved mode saturation (MIMOSA) was combined with fast online-customized (FOCUS) parallel transmission (pTx) excitation pulses and B 1 + correction to achieve homogenous whole-brain coverage. Examinations of 13 volunteers were performed on a 7T MRI system with 3 different types of pulse sequences: (1) saturation in circular polarized (CP) mode and CP mode readout, (2) MIMOSA and CP readout, and (3) MIMOSA and FOCUS readout. For comparison, the inverse magnetic transfer ratio metric for relayed nuclear Overhauser effect and amide proton transfer were calculated. To investigate the number of required acquisitions for a good B 1 + correction, 4 volunteers were measured with 6 different B1 amplitudes. Finally, time point repeatability was investigated for 6 volunteers. RESULTS MIMOSA FOCUS sequence using B 1 + correction, with both single and multiple points, reduced inhomogeneity of the CEST contrasts around the occipital lobe and cerebellum. Results indicate that the most stable inter-subject coefficient of variation was achieved using the MIMOSA FOCUS sequence. Time point repeatability of MIMOSA FOCUS with single-point B 1 + correction showed a maximum coefficient of variation below 8% for 3 measurements in a single volunteer. CONCLUSION A combination of MIMOSA FOCUS with a single-point B 1 + correction can be used to achieve quantitative CEST measurements at ultra-high magnetic field strengths. Compared to previous B 1 + correction methods, acquisition time can be reduced as additional scans required for B 1 + correction can be omitted.
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Affiliation(s)
- Andrzej Liebert
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina Tkotz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jürgen Herrler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Angelika Mennecke
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alex German
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | | | - Manuel Schmidt
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Moritz Zaiss
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tuebingen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Division of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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14
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Liver MRI with amide proton transfer imaging: feasibility and accuracy for the characterization of focal liver lesions. Eur Radiol 2020; 31:222-231. [PMID: 32785767 DOI: 10.1007/s00330-020-07122-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/28/2020] [Accepted: 07/29/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the feasibility of using amide proton transfer (APT) magnetic resonance imaging (MRI) in the liver and to evaluate its ability to characterize focal liver lesions (FLLs). METHODS A total of 203 patients with suspected FLLs who underwent APT imaging at 3T were included. APT imaging was obtained using a single-slice turbo spin-echo sequence to include FLLs through five breath-holds, and its acquisition time was approximately 1 min. APT signals in the background liver and FLL were measured with magnetization transfer ratio asymmetry (MTRasym) at 3.5 ppm. The technical success rate of APT imaging and the reasons for failure to obtain meaningful MTRasym values were assessed. The Mann Whitney U test was used to compare MTRasym values between different FLLs. RESULTS The technical success rate of APT imaging in the liver was 62.1% (126/203). The reasons for failure were a too large B0 inhomogeneity (n = 43), significant respiratory motion (n = 12), and these two factors together (n = 22), respectively. Among 59 FLLs with analyzable APT images, MTRasym values were compared between 27 patients with liver metastases and 23 patients with hepatocellular carcinomas (HCCs). The MTRasym values of metastases were significantly higher than those of HCC (0.13 ± 2.15% vs. - 1.41 ± 3.68%, p = 0.027). CONCLUSIONS APT imaging could be an imaging biomarker for the differentiation of FLLs. However, further technical improvement is required before APT imaging can be clinically applied to liver MRI. KEY POINTS • Liver APT imaging was technically feasible, but with a relatively low success rate (62.1%). • Liver metastases showed higher APT values than hepatocellular carcinomas.
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