title: Applying amide proton transfer-weighted MRI to distinguish pseudoprogression from true progression in malignant gliomas.
abstract: To assess amide proton transfer-weighted (APTW) imaging features in patients with malignant gliomas after chemoradiation and the diagnostic performance of APT imaging for distinguishing true progression from pseudoprogression.
  
  
  
  After approval by the Institutional Review Board, 32 patients with clinically suspected tumor progression in the first 3 months after chemoradiation were enrolled and scanned at 3T. Longitudinal routine magnetic resonance imaging (MRI) changes and medical records were assessed to confirm true progression versus pseudoprogression. True progression was defined as lesions progressing on serial imaging over 6 months, and pseudoprogression was defined as lesions stabilizing or regressing without intervention. The APTWmean and APTWmax signals were obtained from three to five regions of interests for each patient and compared between the true progression and pseudoprogression groups. The diagnostic performance was assessed with receiver operating characteristic curve analysis.
  
  
  
  The true progression was associated with APTW hyperintensity (APTWmean  = 2.75% ± 0.42%), while pseudoprogression was associated with APTW isointensity to mild hyperintensity (APTWmean  = 1.56% ± 0.42%). The APTW signal intensities were significantly higher in the true progression group (n = 20) than in the pseudoprogression group (P < 0.001; n = 12). The cutoff APTWmean and APTWmax intensity values to distinguish between true progression and pseudoprogression were 2.42% (with a sensitivity of 85.0% and a specificity of 100%) and 2.54% (with a sensitivity of 95.0% and a specificity of 91.7%), respectively.
  
  
  
  The APTW-MRI signal is a valuable imaging biomarker for distinguishing pseudoprogression from true progression in glioma patients. J. Magn. Reson. Imaging 2016;44:456-462.
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.|Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.|Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, PR China.
authors.forename: Bo
authors.initials: B
authors.lastname: Ma
authors.affiliation: Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jaishri O
authors.initials: JO
authors.lastname: Blakeley
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Hong
authors.affiliation: Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Shanshan
authors.initials: S
authors.lastname: Jiang
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.|Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Blair
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Heo
authors.affiliation: Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
authors.forename: Mingzhi
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.|F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA.
authors.forename: Peter C M
authors.initials: PC
authors.lastname: van Zijl
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.|F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA.
authors.forename: Jinyuan
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000378:metabolism; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011522:Protons; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted
chemical_list: D000577:Amides; D011522:Protons
keywords: MRI; amide proton transfer; glioma; pseudoprogression; treatment effect; true progression