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Differentiation of recurrent diffuse glioma from treatment-induced change using amide proton transfer imaging: incremental value to diffusion and perfusion parameters

  • Diagnostic Neuroradiology
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Abstract

Purpose

To evaluate the incremental value of amide proton transfer (APT) imaging to diffusion tensor imaging (DTI), dynamic susceptibility contrast (DSC) imaging, and dynamic contrast-enhanced (DCE) imaging in differentiating recurrent diffuse gliomas (World Health Organization grade II-IV) from treatment-induced change after concurrent chemoradiotherapy or radiotherapy.

Methods

This study included 36 patients (25 patients with recurrent gliomas and 11 with treatment-induced changes) with post-treatment gliomas. The mean values of apparent diffusion coefficient (ADC), fractional anisotropy (FA), normalized cerebral blood volume (nCBV), normalized cerebral blood flow, volume transfer constant, rate transfer coefficient, extravascular extracellular volume fraction, plasma volume fraction, and APT asymmetry index were assessed. Independent quantitative parameters were investigated to predict recurrent glioma using multivariable logistic regression. The incremental value of APT signal to other parameters was assessed by the increase of the area under the curve, net reclassification index, and integrated discrimination improvement.

Results

Univariable analysis showed that lower ADC (p = 0.018), higher FA (p = 0.031), higher nCBV (p = 0.021), and higher APT signal (p = 0.009) were associated with recurrent gliomas. In multivariable logistic regression, the diagnostic performance of the model with ADC, FA, and nCBV significantly increased when APT signal was added, with areas under the curve of 0.87 and 0.92, respectively (net reclassification index of 0.77 and integrated discrimination improvement of 0.13).

Conclusion

APT imaging may be a useful imaging biomarker that adds value to DTI, DCE, and DSC parameters for distinguishing between recurrent gliomas and treatment-induced changes.

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Data availability

Our anonymized data can be obtained by any qualified investigator for the purposes of replicating procedures and results after ethics clearance and approval by all authors.

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Funding

This research received funding from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, Information and Communication Technologies and Future Planning (2014R1A1A1002716, 2020R1A2C1003886). This research was also supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2020R1I1A1A01071648).

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Yae Won Park, Sung Soo Ahn & Seung-Koo Lee

  2. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

    Eui Hyun Kim, Seok-Gu Kang & Jong Hee Chang

  3. Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

    Se Hoon Kim

  4. Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jinyuan Zhou

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  1. Yae Won Park
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Correspondence to Sung Soo Ahn.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent was not required.

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As this is a retrospective study, the institutional review board waived the need for obtaining informed patient consent.

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The Matlab (MathWorks, Natick, MA) code for amide proton transfer image processing can be obtained by any qualified investigator for the purposes of replicating procedures and results after approval by all authors.

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Park, Y.W., Ahn, S.S., Kim, E.H. et al. Differentiation of recurrent diffuse glioma from treatment-induced change using amide proton transfer imaging: incremental value to diffusion and perfusion parameters. Neuroradiology 63, 363–372 (2021). https://doi.org/10.1007/s00234-020-02542-5

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