Zhu Hongquan, Liu Yufei, Li Yuanhao, Ding Yuejie, Shen Nanxi, Xie Yan, Yan Su, Fu Yan, Zhang Jiaxuan, Liu Dong, Zhang Xiaoxiao, Li Li, Zhu Wenzhen
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (H.Z., Y.L., Y.L., Y.D., N.S., Y.X., S.Y., Y.F., J.Z., D.L., L.L., W.Z.).
Department of Clinical, Philips Healthcare, Wuhan, China (X.Z.).
Acad Radiol. 2025 May;32(5):2919-2930. doi: 10.1016/j.acra.2024.12.054. Epub 2025 Jan 13.
Isocitrate dehydrogenase (IDH) status, glioma subtypes and tumor proliferation are important for glioma evaluation. We comprehensively compare the diagnostic performance of amide proton transfer-weighted (APTw) MRI and its related metrics in glioma diagnosis, in the context of the latest classification.
Totally 110 patients with adult-type diffuse gliomas underwent APTw imaging. The magnetization transfer ratio asymmetry (MTR), magnetization transfer ratio normalized by reference signal (MTR), and spillover-corrected magnetization transfer ratio yielding R (MTR), and metrics based on Lorentzian fitting (Fit-amide, Fit-MTR, and Fit-MTR) were calculated. Group differences were compared between IDH genotypes, and among three glioma subtypes. The diagnostic performances were assessed using the receiver operating characteristic (ROC) analysis and compared. The correlations with Ki-67 expression were also analyzed.
All APTw-related metrics exhibited significantly higher values in IDH-wildtype gliomas than in IDH-mutant gliomas (all p < 0.001). Fit-MTR had the best area under the curve (AUC) of 0.858. All APTw-related metrics in glioblastomas were significantly higher than oligodendrogliomas (all p < 0.01) and astrocytomas (all p < 0.001). No metrics had significant difference between oligodendrogliomas and astrocytomas. The highest AUCs was 0.870 for Fit-MTR in distinguishing astrocytomas from glioblastomas, and 0.867 for Fit-MTR in distinguishing oligodendrogliomas from glioblastomas. Besides, Fit-MTR had the highest correlation coefficient with Ki-67 expression of 0.578.
APTw-related metrics can effectively evaluate glioma IDH status, tumor subtypes and proliferation. The combination of Lorentzian fitting and the reference signal normalization could further improve the diagnostic performance, and perform better than MTR.
异柠檬酸脱氢酶（IDH）状态、胶质瘤亚型和肿瘤增殖对胶质瘤评估很重要。在最新分类的背景下，我们全面比较了酰胺质子转移加权（APTw）磁共振成像（MRI）及其相关指标在胶质瘤诊断中的诊断性能。
共110例成人型弥漫性胶质瘤患者接受了APTw成像。计算了磁化传递率不对称性（MTR）、经参考信号归一化的磁化传递率（MTR）、产生R的溢出校正磁化传递率（MTR）以及基于洛伦兹拟合的指标（拟合酰胺、拟合MTR和拟合MTR）。比较了IDH基因型之间以及三种胶质瘤亚型之间的组间差异。使用受试者操作特征（ROC）分析评估诊断性能并进行比较。还分析了与Ki-67表达的相关性。
所有与APTw相关的指标在IDH野生型胶质瘤中的值均显著高于IDH突变型胶质瘤（所有p<0.001）。拟合MTR的曲线下面积（AUC）最佳，为0.858。胶质母细胞瘤中所有与APTw相关的指标均显著高于少突胶质细胞瘤（所有p<0.01）和星形细胞瘤（所有p<0.001）。少突胶质细胞瘤和星形细胞瘤之间的指标无显著差异。拟合MTR区分星形细胞瘤与胶质母细胞瘤的最高AUC为0.870，区分少突胶质细胞瘤与胶质母细胞瘤的最高AUC为0.867。此外，拟合MTR与Ki-67表达的相关系数最高，为0.578。
与APTw相关的指标可有效评估胶质瘤的IDH状态、肿瘤亚型和增殖情况。洛伦兹拟合与参考信号归一化相结合可进一步提高诊断性能，且表现优于MTR。
