Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
Division of MR Research, Department of Radiology, Johns Hopkins University, Maryland, USA.
Biomed Res Int. 2020 May 16;2020:6418343. doi: 10.1155/2020/6418343. eCollection 2020.
To evaluate the performance of amide proton transfer-weighted (APTw) imaging against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1w) in children with intracranial infection.
Twenty-eight pediatric patients (15 males and 13 females; age range 1-163 months) with intracranial infection were recruited in this study. 2D APTw imaging and conventional MR sequences were conducted using a 3 T MRI scanner. Kappa () statistics and the McNemar test were performed to determine whether the hyperintensity on APTw was related to the enhancement on Gd-T1w. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of APTw imaging to predict lesion enhancement were calculated.
In twelve patients with brain abscesses, the enhancing rim of the abscesses on the Gd-T1w images was consistently hyperintense on the APTw images. In eight patients with viral encephalitis, three showed slight spotted gadolinium enhancement, while the APTw image also showed a slight spotted high signal. Five of these patients showed no enhancement on Gd-T1w and isointensity on the APTw image. In eleven patients with meningitis, increased APTw signal intensities were clearly visible in gadolinium-enhancing meninges. Sixty infectious lesions (71%) showed enhancement on Gd-T1w images. The sensitivity and specificity of APTw were 93.3% (56/60) and 91.7% (22/24). APTw demonstrated excellent agreement ( = 0.83) with Gd-T1w, with no significant difference ( = 0.69) in detection of infectious lesions.
These initial data show that APTw MRI is a noninvasive technique for the detection and characterization of intracranial infectious lesions. APTw MRI enabled similar detection of infectious lesions to Gd-T1w and may provide an injection-free means of evaluation of intracranial infection.
评估酰胺质子转移加权（APTw）成像与钆增强 T1 加权成像（Gd-T1w）的参考标准在颅内感染患儿中的性能。
本研究纳入了 28 例颅内感染患儿（男 15 例，女 13 例；年龄 1-163 个月）。使用 3T MRI 扫描仪对患儿进行二维 APTw 成像和常规磁共振序列检查。采用 Kappa（）统计和 McNemar 检验来确定 APTw 上的高信号是否与 Gd-T1w 上的增强有关。计算 APTw 成像预测病变增强的灵敏度、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
在 12 例脑脓肿患者中，脓肿的 Gd-T1w 图像增强边缘在 APTw 图像上始终呈高信号。在 8 例病毒性脑炎患者中，3 例患者显示轻度斑点状钆增强，而 APTw 图像也显示轻度斑点状高信号。其中 5 例患者 Gd-T1w 无增强，APTw 图像等信号。在 11 例脑膜炎患者中，增强的 APTw 信号强度在增强的脑膜中清晰可见。60 个感染性病变（71%）在 Gd-T1w 图像上显示增强。APTw 的灵敏度和特异性分别为 93.3%（56/60）和 91.7%（22/24）。APTw 与 Gd-T1w 的一致性非常好（=0.83），在检测感染性病变方面无显著差异（=0.69）。
这些初步数据表明，APTw MRI 是一种用于检测和评估颅内感染性病变的无创技术。APTw MRI 可以与 Gd-T1w 相似地检测感染性病变，并且可能为评估颅内感染提供一种无注射的方法。
