Molecular MRI differentiation between primary central nervous system lymphomas and high-grade gliomas using endogenous protein-based amide proton transfer MR imaging at 3 Tesla.
OBJECTIVE
To show the ability of using the amide proton transfer-weighted (APTW) MRI signals as imaging biomarkers to differentiate primary central nervous system lymphomas (PCNSLs) from high-grade gliomas (HGGs).


METHODS
Eleven patients with lymphomas and 21 patients with HGGs were examined. Magnetization-transfer (MT) spectra over an offset range of ± 6 ppm and the conventional MT ratio (MTR) at 15.6 ppm were acquired. The APTW signals, total chemical-exchange-saturation-transfer signal (integral between 0 and 5 ppm, CEST total), and MTR signal were obtained and compared between PCNSLs and HGGs. The diagnostic performance was assessed with the receiver operating characteristic (ROC) curve analysis.


RESULTS
The PCNSLs usually showed more homogeneous APTW hyperintensity (spatially compared to normal brain tissue) than the HGGs. The APTW max, APTW max-min and CEST total signal intensities were significantly lower (P < 0.05, 0.001 and 0.05, respectively), while the APTW min and MTR were significantly higher (both P < 0.01) in PCNSL lesions than in HGG lesions. The APTW values in peritumoral oedema were significantly lower for PCNSLs than for HGGs (P < 0.01). APTW max-min had the highest area under the ROC curve (0.963) and accuracy (94.1 %) in differentiating PCNSLs from HGGs.


CONCLUSIONS
The protein-based APTW signal would be a valuable MRI biomarker by which to identify PCNSLs and HGGs presurgically.


CONCLUSIONS
PCNSLs overall showed more homogeneous APTW hyperintensity than HGGs. Maximum APTW signals were lower in PCNSL lesions than in HGG lesions. MTR signals were higher in PCNSLs than in HGGs. APTW heterogeneity had the highest accuracy in differentiating PCNSLs from HGGs.
Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China.|Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Shanshan
S
Jiang
Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China.
Hao
H
Yu
Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China.
Xianlong
X
Wang
Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China.
Shilong
S
Lu
Department of Pathology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China.
Yufa
Y
Li
Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China.
Lyujin
L
Feng
Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Yi
Y
Zhang
Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Hye-Young
HY
Heo
Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
Dong-Hoon
DH
Lee
Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. jzhou@mri.jhu.edu.
Jinyuan
J
Zhou
Department of Radiology, Zhujiang Hospital, Southern Medical University, 253 Middle Gongye Road, Guangzhou, Guangdong, 510282, China. zhibowen@163.com.
Zhibo
Z
Wen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides; D001921:Brain / Q000473:pathology; D001932:Brain Neoplasms / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000473:pathology*; D006801:Humans; D008223:Lymphoma / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods; D011522:Protons; D012372:ROC Curve; D012189:Retrospective Studies
D000577:Amides; D011522:Protons
APT imaging; Glioma; Lymphoma; Magnetization transfer; PCNSL