Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Neuroradiology. 2021 Mar;63(3):363-372. doi: 10.1007/s00234-020-02542-5. Epub 2020 Sep 2.
To evaluate the incremental value of amide proton transfer (APT) imaging to diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) imaging, and dynamic contrast-enhanced (DCE) imaging in differentiating recurrent diffuse gliomas (World Health Organization grade II-IV) from treatment-induced change after concurrent chemoradiotherapy or radiotherapy.
This study included 36 patients (25 patients with recurrent gliomas and 11 with treatment-induced changes) with post-treatment gliomas. The mean values of apparent diffusion coefficient (ADC), fractional anisotropy (FA), normalized cerebral blood volume (nCBV), normalized cerebral blood flow, volume transfer constant, rate transfer coefficient, extravascular extracellular volume fraction, plasma volume fraction, and APT asymmetry index were assessed. Independent quantitative parameters were investigated to predict recurrent glioma using multivariable logistic regression. The incremental value of APT signal to other parameters was assessed by the increase of the area under the curve, net reclassification index, and integrated discrimination improvement.
Univariable analysis showed that lower ADC (p = 0.018), higher FA (p = 0.031), higher nCBV (p = 0.021), and higher APT signal (p = 0.009) were associated with recurrent gliomas. In multivariable logistic regression, the diagnostic performance of the model with ADC, FA, and nCBV significantly increased when APT signal was added, with areas under the curve of 0.87 and 0.92, respectively (net reclassification index of 0.77 and integrated discrimination improvement of 0.13).
APT imaging may be a useful imaging biomarker that adds value to DTI, DCE, and DSC parameters for distinguishing between recurrent gliomas and treatment-induced changes.
评估酰胺质子转移（APT）成像对弥散张量成像（DTI）、动态对比增强磁共振成像（DCE）和动态磁化率对比成像（DSC）在鉴别同步放化疗或放疗后复发性弥漫性神经胶质瘤（世界卫生组织[WHO] 分级 II-IV 级）与治疗后改变中的作用。
本研究纳入了 36 例治疗后出现神经胶质瘤的患者（25 例复发性胶质瘤，11 例治疗后改变）。评估表观弥散系数（ADC）、各向异性分数（FA）、标准化脑血容量（nCBV）、标准化脑血流量、容积转移常数、速率转移系数、细胞外间隙容积比、血浆容积比和 APT 不对称指数的平均值。使用多变量逻辑回归分析独立的定量参数，以预测复发性神经胶质瘤。通过曲线下面积、净重新分类指数和综合判别改善评估 APT 信号对其他参数的增量价值。
单变量分析显示，较低的 ADC（p = 0.018）、较高的 FA（p = 0.031）、较高的 nCBV（p = 0.021）和较高的 APT 信号（p = 0.009）与复发性神经胶质瘤相关。在多变量逻辑回归中，当加入 APT 信号时，包含 ADC、FA 和 nCBV 的模型的诊断性能显著提高，曲线下面积分别为 0.87 和 0.92（净重新分类指数为 0.77，综合判别改善为 0.13）。
APT 成像可能是一种有用的影像学生物标志物，可增加 DTI、DCE 和 DSC 参数在鉴别复发性神经胶质瘤与治疗后改变中的价值。
