Histogram Analysis of Amide Proton Transfer Imaging to Identify Contrast-enhancing Low-Grade Brain Tumor That Mimics High-Grade Tumor: Increased Accuracy of MR Perfusion

Published Online:https://doi.org/10.1148/radiol.2015142347

The histogram analysis of amide proton transfer imaging provides increased accuracy of MR perfusion imaging for the identification of contrast-enhancing low-grade brain tumor that mimics high-grade tumor, with excellent interobserver agreement.

Purpose

To determine whether histogram analysis of amide proton transfer (APT) imaging provides increased accuracy of magnetic resonance (MR) perfusion imaging for the identification of contrast material–enhancing low-grade tumor (World Health Organization grades 1 and 2) that mimics high-grade tumor (World Health Organization grades 3 and 4).

Materials and Methods

This retrospective study was approved by the institutional review board. Forty-five patients with pathologically proven, solitary, contrast-enhancing tumors were enrolled in this study. APT-derived signal intensity from the calculated APT asymmetry at the offset frequency of 3.5 ppm and normalized cerebral blood volume (nCBV) were measured on solid portions of the tumor by using a 90% histogram cutoff (denoted as APT90 and nCBV90, respectively). The diagnostic performance of the imaging parameters was determined with leave-one-out cross validation. Interobserver agreement was assessed by using the intraclass correlation coefficient.

Results

APT90 demonstrated a significant difference between contrast-enhancing low-grade and high-grade tumors for both readers (P < .001 for both readers). Compared with nCBV90, adding APT90 significantly improved the area under the receiver operating characteristic curve (AUC) for the identification of contrast-enhancing low-grade tumor from 0.80 to 0.97 for reader 1 (P = .023) and from 0.82 to 0.97 for reader 2 (P = .035), respectively. By using leave-one-out cross-validation, the cross-validated AUC of the combination of nCBV90 and APT90 was 0.95 for reader 1 and 0.96 for reader 2. The intraclass correlation coefficient for the APT90 calculations was 0.89.

Conclusion

Histogram analysis of APT imaging provided increased accuracy of MR perfusion imaging for the identification of contrast-enhancing low-grade tumor that mimics high-grade tumor.

© RSNA, 2015

Online supplemental material is available for this article.

References

  • 1. Singhal T, Narayanan TK, Jain V, Mukherjee J, Mantil J. 11C-L-methionine positron emission tomography in the clinical management of cerebral gliomas. Mol Imaging Biol 2008;10(1):1–18. Crossref, MedlineGoogle Scholar
  • 2. Tropine A, Vucurevic G, Delani P, et al. Contribution of diffusion tensor imaging to delineation of gliomas and glioblastomas. J Magn Reson Imaging 2004;20(6):905–912. Crossref, MedlineGoogle Scholar
  • 3. Zonari P, Baraldi P, Crisi G. Multimodal MRI in the characterization of glial neoplasms: the combined role of single-voxel MR spectroscopy, diffusion imaging and echo-planar perfusion imaging. Neuroradiology 2007;49(10):795–803. Crossref, MedlineGoogle Scholar
  • 4. Hobbs SK, Shi G, Homer R, Harsh G, Atlas SW, Bednarski MD. Magnetic resonance image-guided proteomics of human glioblastoma multiforme. J Magn Reson Imaging 2003;18(5):530–536. Crossref, MedlineGoogle Scholar
  • 5. Howe FA, Barton SJ, Cudlip SA, et al. Metabolic profiles of human brain tumors using quantitative in vivo 1H magnetic resonance spectroscopy. Magn Reson Med 2003;49(2):223–232. Crossref, MedlineGoogle Scholar
  • 6. Jones CK, Schlosser MJ, van Zijl PC, Pomper MG, Golay X, Zhou J. Amide proton transfer imaging of human brain tumors at 3T. Magn Reson Med 2006;56(3):585–592. Crossref, MedlineGoogle Scholar
  • 7. Zhou J, Lal B, Wilson DA, Laterra J, van Zijl PC. Amide proton transfer (APT) contrast for imaging of brain tumors. Magn Reson Med 2003;50(6):1120–1126. Crossref, MedlineGoogle Scholar
  • 8. Zhao X, Wen Z, Zhang G, et al. Three-dimensional turbo-spin-echo amide proton transfer MR imaging at 3-Tesla and its application to high-grade human brain tumors. Mol Imaging Biol 2013;15(1):114–122. Crossref, MedlineGoogle Scholar
  • 9. Zhou J, Blakeley JO, Hua J, et al. Practical data acquisition method for human brain tumor amide proton transfer (APT) imaging. Magn Reson Med 2008;60(4):842–849. Crossref, MedlineGoogle Scholar
  • 10. Zaiss M, Schmitt B, Bachert P. Quantitative separation of CEST effect from magnetization transfer and spillover effects by Lorentzian-line-fit analysis of z-spectra. J Magn Reson 2011;211(2):149–155. Crossref, MedlineGoogle Scholar
  • 11. Emblem KE, Nedregaard B, Nome T, et al. Glioma grading by using histogram analysis of blood volume heterogeneity from MR-derived cerebral blood volume maps. Radiology 2008;247(3):808–817. LinkGoogle Scholar
  • 12. Law M, Young R, Babb J, Pollack E, Johnson G. Histogram analysis versus region of interest analysis of dynamic susceptibility contrast perfusion MR imaging data in the grading of cerebral gliomas. AJNR Am J Neuroradiol 2007;28(4):761–766. MedlineGoogle Scholar
  • 13. Chung WJ, Kim HS, Kim N, Choi CG, Kim SJ. Recurrent glioblastoma: optimum area under the curve method derived from dynamic contrast-enhanced T1-weighted perfusion MR imaging. Radiology 2013;269(2):561–568. LinkGoogle Scholar
  • 14. Kim HS, Suh CH, Kim N, Choi CG, Kim SJ. Histogram analysis of intravoxel incoherent motion for differentiating recurrent tumor from treatment effect in patients with glioblastoma: initial clinical experience. AJNR Am J Neuroradiol 2014;35(3):490–497. Crossref, MedlineGoogle Scholar
  • 15. Sagiyama K, Mashimo T, Togao O, et al. In vivo chemical exchange saturation transfer imaging allows early detection of a therapeutic response in glioblastoma. Proc Natl Acad Sci U S A 2014;111(12):4542–4547. Crossref, MedlineGoogle Scholar
  • 16. Cairns RA, Harris IS, Mak TW. Regulation of cancer cell metabolism. Nat Rev Cancer 2011;11(2):85–95. Crossref, MedlineGoogle Scholar
  • 17. van Zijl PC, Zhou J, Mori N, Payen JF, Wilson D, Mori S. Mechanism of magnetization transfer during on-resonance water saturation. A new approach to detect mobile proteins, peptides, and lipids. Magn Reson Med 2003;49(3):440–449. Crossref, MedlineGoogle Scholar
  • 18. Salhotra A, Lal B, Laterra J, Sun PZ, van Zijl PC, Zhou J. Amide proton transfer imaging of 9L gliosarcoma and human glioblastoma xenografts. NMR Biomed 2008;21(5):489–497. Crossref, MedlineGoogle Scholar
  • 19. Scheidegger R, Wong ET, Alsop DC. Contributors to contrast between glioma and brain tissue in chemical exchange saturation transfer sensitive imaging at 3 Tesla. Neuroimage 2014;99:256–268. Crossref, MedlineGoogle Scholar
  • 20. van Zijl PC, Yadav NN. Chemical exchange saturation transfer (CEST): what is in a name and what isn’t? Magn Reson Med 2011;65(4):927–948. Crossref, MedlineGoogle Scholar
  • 21. Zhou J, Payen JF, Wilson DA, Traystman RJ, van Zijl PCM. Using the amide proton signals of intracellular proteins and peptides to detect pH effects in MRI. Nat Med 2003;9(8):1085–1090. Crossref, MedlineGoogle Scholar

Article History

Received October 6, 2014; revision requested November 25; revision received January 3, 2015; accepted January 29; final version accepted February 11.
Published online: Apr 24 2015
Published in print: Oct 2015