Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea.
Eur Radiol. 2019 Dec;29(12):6643-6652. doi: 10.1007/s00330-019-06203-x. Epub 2019 Jun 7.
To assess the utility of amide proton transfer (APT) imaging as an imaging biomarker to predict prognosis and molecular marker status in high-grade glioma (HGG, WHO grade III/IV).
We included 71 patients with pathologically diagnosed HGG who underwent preoperative MRI with APT imaging. Overall survival (OS) and progression-free survival (PFS) according to APT signal, clinical factors, MGMT methylation status, and IDH mutation status were analyzed. Multivariate Cox regression models with and without APT signal data were constructed. Model performance was compared using the integrated AUC (iAUC). Associations between APT signals and molecular markers were assessed using the Mann-Whitney test.
High APT signal was a significant predictor for poor OS (HR = 3.21, 95% CI = 1.62-6.34) and PFS (HR = 2.22, 95% CI = 1.33-3.72) on univariate analysis. On multivariate analysis, high APT signals were an independent predictor of poor OS and PFS when clinical factors alone (OS: HR = 2.89; PFS: HR = 2.13), or in combination with molecular markers (OS: HR = 2.85; PFS: HR = 2.00), were included as covariates. The incremental prognostic value of APT signals was significant for OS and PFS. IDH-wild type was significantly associated with high APT signals (p = 0.001) when compared to IDH-mutant; however, there was no difference based on MGMT methylation status (p = 0.208).
High APT signal was a significant predictor of poor prognosis in HGG. APT data showed significant incremental prognostic value over clinical prognostic factors and molecular markers and may also predict IDH mutation status.
• Amide proton transfer (APT) imaging is a promising prognostic marker of high-grade glioma. • APT signals were significantly higher in IDH-wild type compared to IDH-mutant high-grade glioma. • APT imaging may be valuable for preoperative screening and treatment guidance.
评估酰胺质子转移（APT）成像作为预测高级别胶质瘤（HGG，WHO 分级 III/IV）预后和分子标志物状态的成像生物标志物的效用。
我们纳入了 71 名经病理诊断为 HGG 并接受术前 APT 成像 MRI 的患者。根据 APT 信号、临床因素、MGMT 甲基化状态和 IDH 突变状态分析总生存期（OS）和无进展生存期（PFS）。构建了包含和不包含 APT 信号数据的多变量 Cox 回归模型，并使用综合 AUC（iAUC）比较了模型性能。使用 Mann-Whitney 检验评估 APT 信号与分子标志物之间的相关性。
在单因素分析中，高 APT 信号是 OS（HR=3.21，95%CI=1.62-6.34）和 PFS（HR=2.22，95%CI=1.33-3.72）不良的显著预测因子。在多因素分析中，当仅考虑临床因素（OS：HR=2.89；PFS：HR=2.13）或同时考虑临床因素和分子标志物（OS：HR=2.85；PFS：HR=2.00）作为协变量时，高 APT 信号是 OS 和 PFS 的独立不良预后预测因子。APT 信号对 OS 和 PFS 的预后有显著的附加预测价值。与 IDH 突变型相比，IDH 野生型与高 APT 信号显著相关（p=0.001）；然而，基于 MGMT 甲基化状态，两者没有差异（p=0.208）。
高 APT 信号是 HGG 不良预后的重要预测因子。APT 数据在预测预后方面显示出比临床预后因素和分子标志物更高的附加预后价值，并且还可能预测 IDH 突变状态。
APT 成像可能是高级别脑胶质瘤术前筛查和治疗指导的有价值工具。
与 IDH 突变型相比，IDH 野生型高级别脑胶质瘤的 APT 信号明显更高。
APT 成像可能是高级别脑胶质瘤的一种很有前途的预后标志物。
