Differentiating the histologic grades of gliomas preoperatively using amide proton transfer-weighted (APTW) and intravoxel incoherent motion MRI

Abstract

<p class="first" id="P1">The purpose of this work was to investigate the diagnostic performance of amide proton transfer-weighted (APTW) and intravoxel incoherent motion (IVIM) MRI in the preoperative grading of gliomas. Fifty-one patients with suspected gliomas were recruited and underwent a preoperative MRI exam that included APTW and IVIM sequences. All cases were confirmed by postsurgical histopathology. APTW signal intensity, true diffusion coefficient (D), perfusion fraction (f), and pseudo-diffusion coefficient (D*) were applied to assess the solid tumor component and contralateral normal-appearing white matter. Relative APTW signal intensity (rAPTW) was also used. Independent-samples and paired-samples <i>t</i>-tests were used to compare differences in MRI parameters between low-grade gliomas (LGGs) and high-grade gliomas (HGGs) groups. The diagnostic performance was assessed with receiver operating characteristic curve. 26 patients were pathologically diagnosed as LGG, and 25 diagnosed as HGG. APTW, rAPTW, and f values were significantly larger (all <i>p</i> &lt; 0.001), while D was significantly lower ( <i>p</i> &lt; 0.001) in the HGG group than in the LGG group. There was no significant difference between D* values for the two groups. rAPTW had an area under the curve (AUC) of 0.957, with a sensitivity of 100% and a specificity of 84.6%, followed by APTW, f, D and D*. The combined use of APTW and IVIM had the best diagnostic performance, with an AUC of 0.986. In conclusion, APTW and IVIM, as two promising supplementary sequences for routine MR imaging, could be valuable in differentiating LGGs from HGGs. </p><p id="P2">APTW imaging can generate image contrast mainly related to endogenous cellular proteins in tissue, and IVIM MR imaging can separate water molecular diffusion from microcirculation. 51 glioma patients were recruited to investigate the diagnostic performance of APT and IVIM MR imaging. Our results show that these supplementary MRI methods are valuable in differentiating low- from high-grade gliomas. </p><p id="P3"> <div class="figure-container so-text-align-c"> <img alt="" class="figure" src="/document_file/13e22ab0-99a3-4c46-a3e3-0a0a31514508/PubMedCentral/image/nihms931214u1.jpg"/> </div> </p>