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Linda Knutsson

Professor

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Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas

Författare

  • Faris Durmo
  • Anna Rydhög
  • Frederik Testud
  • Jimmy Lätt
  • Benjamin Schmitt
  • Anna Rydelius
  • Elisabet Englund
  • Johan Bengzon
  • Peter van Zijl
  • Linda Knutsson
  • Pia C Sundgren
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Summary, in English

PURPOSE: Radiological assessment of primary brain neoplasms, both high (HGG) and low grade tumors (LGG), based on contrast-enhancement alone can be inaccurate. We evaluated the radiological value of amide proton transfer weighted (APTw) MRI as an imaging complement for pre-surgical radiological diagnosis of brain tumors.

METHODS: Twenty-six patients were evaluated prospectively; (22 males, 4 females, mean age 55 years, range 26-76 years) underwent MRI at 3T using T1-MPRAGE pre- and post-contrast administration, conventional T2w, FLAIR, and APTw imaging pre-surgically for suspected primary/secondary brain tumor. Assessment of the additional value of APTw imaging compared to conventional MRI for correct pre-surgical brain tumor diagnosis. The initial radiological pre-operative diagnosis was based on the conventional contrast-enhanced MR images. The range, minimum, maximum, and mean APTw signals were evaluated. Conventional normality testing was performed; with boxplots/outliers/skewness/kurtosis and a Shapiro-Wilk's test. Mann-Whitney U for analysis of significance for mean/max/min and range APTw signal. A logistic regression model was constructed for mean, max, range and Receiver Operating Characteristic (ROC) curves calculated for individual and combined APTw signals.

RESULTS: Conventional radiological diagnosis prior to surgery/biopsy was HGG (8 patients), LGG (12 patients), and metastasis (6 patients). Using the mean and maximum: APTw signal would have changed the pre-operative evaluation the diagnosis in 8 of 22 patients (two LGGs excluded, two METs excluded). Using a cut off value of >2.0% for mean APTw signal integral, 4 of the 12 radiologically suspected LGG would have been diagnosed as high grade glioma, which was confirmed by histopathological diagnosis. APTw mean of >2.0% and max >2.48% outperformed four separate clinical radiological assessments of tumor type, P-values = .004 and = .002, respectively.

CONCLUSIONS: Using APTw-images as part of the daily clinical pre-operative radiological evaluation may improve diagnostic precision in differentiating LGGs from HGGs, with potential improvement of patient management and treatment.

Avdelning/ar

  • LUCC: Lunds universitets cancercentrum
  • Diagnostisk radiologi, Lund
  • MR Physics
  • Medicinsk strålningsfysik, Lund
  • Patologi, Lund
  • MultiPark: Multidisciplinary research focused on Parkinson´s disease
  • Neurokirurgi
  • StemTherapy: National Initiative on Stem Cells for Regenerative Therapy
  • Lund University Bioimaging Center

Publiceringsår

2020

Språk

Engelska

Publikation/Tidskrift/Serie

PLoS ONE

Volym

15

Issue

12

Dokumenttyp

Artikel i tidskrift

Förlag

Public Library of Science (PLoS)

Ämne

  • Radiology, Nuclear Medicine and Medical Imaging
  • Other Physics Topics

Status

Published

Forskningsgrupp

  • MR Physics

ISBN/ISSN/Övrigt

  • ISSN: 1932-6203