title: Amide proton transfer imaging to discriminate between low- and high-grade gliomas: added value to apparent diffusion coefficient and relative cerebral blood volume.
abstract: OBJECTIVE
  To evaluate the added value of amide proton transfer (APT) imaging to the apparent diffusion coefficient (ADC) from diffusion tensor imaging (DTI) and the relative cerebral blood volume (rCBV) from perfusion magnetic resonance imaging (MRI) for discriminating between high- and low-grade gliomas.
  
  
  METHODS
  Forty-six consecutive adult patients with diffuse gliomas who underwent preoperative APT imaging, DTI and perfusion MRI were enrolled. APT signals were compared according to the World Health Organization grade. The diagnostic ability and added value of the APT signal to the ADC and rCBV for discriminating between low- and high-grade gliomas were evaluated using receiver operating characteristic (ROC) analyses and integrated discrimination improvement.
  
  
  RESULTS
  The APT signal increased as the glioma grade increased. The discrimination abilities of the APT, ADC and rCBV values were not significantly different. Using both the APT signal and ADC significantly improved discrimination vs. the ADC alone (area under the ROC curve [AUC], 0.888 vs. 0.910; P = 0.007), whereas using both the APT signal and rCBV did not improve discrimination vs. the rCBV alone (AUC, 0.927 vs. 0.923; P = 0.222).
  
  
  CONCLUSIONS
  APT imaging may be a useful imaging biomarker that adds value to the ADC for discriminating between low- and high-grade gliomas.
  
  
  CONCLUSIONS
  • Higher APT values were correlated with higher glioma grades. • Adding the APT signal to the ADC improved glioma grading. • Adding the APT signal to rCBV did not improve glioma grading. • APT is a useful adjunct to the ADC for glioma grading.
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Yoon Seong
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. SUNGSOO@yuhs.ac.
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Ahn
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
authors.forename: Seung-Koo
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seok-Gu
authors.initials: SG
authors.lastname: Kang
authors.affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Se Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jinyuan
authors.initials: J
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D000071937:Cerebral Blood Volume; D056324:Diffusion Tensor Imaging; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading / Q000379:methods; D059906:Neuroimaging / Q000379:methods; D011522:Protons; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D000577:Amides; D011522:Protons
keywords: Amide proton transfer imaging; Brain tumour; Chemical exchange saturation transfer; Glioma; Magnetic resonance imaging