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Objective:To evaluate the application of amide proton transfer weighted (APTw) magnetic resonance imaging(MRI) for grading of brainstem glioma (BSG) in children.Methods:Twenty-five children (16 males and 9 females) aged 0.7-12.4(5.6±3.3)years were diagnosed as BSG by surgery or biopsy in Beijing Children′s Hospital from December 2019 to March 2022, including 13 cases of low-grade BSG and 12 cases of high-grade BSG. APTw imaging and conventional MRI were performed on a 3.0 T MRI scanner. The differences in gender distribution, age, conventional MRI appearance, APTw signal intensity and apparent diffusion coefficient (ADC) between children with high and low grade BSG were analyzed. Receiver operating characteristic (ROC) curve was used to analyze the efficacy of APTw signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold. Pearson′s correlation coefficient analysis was used to evaluate the correlation between APTw signal intensity and Ki-67 expression.Results:There was no significant difference in age and gender distribution between high-grade and low-grade BSG patients. The maximum diameter of high-grade BSG was significantly larger than that of low-grade BSG [(4.7±0.9) vs. (3.1±1.7)cm; t=-2.94, P=0.007]; the maximum signal intensity of APTw (APTw max) in high-grade BSG was significantly higher than that in low-grade BSG [(4.9±0.6)% vs. (3.0±1.2)%; t=-5.14, P<0.001]; the average signal intensity of APTw (APTw mean) in high-grade BSG was significantly higher than that in low-grade BSG[(3.6±0.4%) vs. (2.7±1.1)%; t=-2.66, P=0.014].The area under the curve(AUC)of APTw max in distinguishing high-and low-grade BSG was 0.897; with 4.07% as the optimal diagnostic threshold of APTw max, the sensitivity for the diagnosis of high-grade BSG was 0.917 and specificity was 0.846. The AUC of APTw mean in distinguishing high-and low-grade BSG was 0.769; with 2.85% as the optimal diagnostic threshold of APTw mean, the sensitivity for the diagnosis of high-grade BSG was 0.917 and specificity was 0.692. There was a positive correlation between the value of APTw max and Ki-67 expression( r=0.453, P=0.023). Conclusion:APTw imaging is helpful to distinguish high-grade and low-grade BSG in children. APTw max value can be used to effectively evaluate the proliferative activity of BSG in children.
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Objective:To investigate the diagnostic value of three-dimensional amide proton transfer-weighted imaging (APTWI) and its combination with diffusion weighted imaging (DWI) for differentiating breast benign from malignant lesions.Methods:This was a prospective study. From July to December 2020, 226 patients with breast lesions confirmed by surgery or puncture pathology in the First Affiliated Hospital of Zhengzhou University were collected. All patients underwent MR T 1-weighted imaging, T 2-weighted imaging, DWI, APTWI, and dynamic contrast-enhanced MRI, and the apparent diffusion coefficient (ADC) value and the magnetization transfer ratio asymmetry at an offset of 3.5 ppm [MTRasym(3.5 ppm)] were obtained from DWI and APTWI respectively. Mann-Whitney U test was used for the comparison of DWI and APTWI parameters between breast benign and malignant lesions. Receiver operating characteristic (ROC) curve was used to evaluate the differences of diagnostic efficacy between DWI, APTWI, and their combination. Results:There were 226 patients with 226 breast lesions, including 124 malignant and 102 benign lesions. The ADC values of patients with malignant breast lesions [1.03 (0.93, 1.13)×10 -3 mm 2/s] and MTRasym (3.5 ppm) [1.95% (1.10%, 2.88%)] were lower than those of benign breast lesions [1.38 (1.11, 1.55)×10 -3 mm 2/s, 3.30% (2.20%, 4.20%), respectively], and the differences were statistically significant ( Z=-8.19, -6.51, P<0.05). The area under the ROC curves (AUC) of DWI, APTWI, and its combination in the differential diagnosis of benign and malignant breast lesions were 0.817, 0.752, and 0.868, respectively. The AUC of the combination of DWI and APTWI was higher than that of DWI and APTWI ( Z=4.00, 2.93, P<0.05), and there was no significant difference in the AUC between DWI and APTWI diagnoses ( Z=1.58, P>0.05). Taking 1.25×10 -3 mm 2/s as the optimal cut-off value for ADC values, the sensitivity, specificity, and accuracy in differentiating benign from malignant breast lesions were 94.4% (117/124), 62.7% (64/102), and 80.1% (181/226), respectively; Taking 2.70% as the optimal cut-off value for MTRasym (3.5 ppm), the sensitivity, specificity, and accuracy in differentiating benign from malignant breast lesions were 73.4% (91/124), 64.7% (66/102), and 69.5% (157/226), respectively, and the sensitivity, specificity, and accuracy of DWI combined with APTWI in differentiating benign from malignant breast lesions were 82.3% (102/124), 79.4% (81/102), and 81.0% (183/226), respectively. Conclusion:APTWI can be used for the differential diagnosis of benign and malignant breast lesions, and the combination of APTWI and DWI can obtain the better diagnostic performance than the single method.
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Objective:To evaluate the clinical application value of MR amide proton transfer weighted imaging (APTWI) in predicting the pathological grade of brainstem glioma (BSG).Methods:The data of 41 BSG patients in Beijing Tiantan Hospital, Capital Medical University from August 2019 to June 2020 who underwent both MRI and APTWI 2 weeks before surgery and had pathological grading results were retrospectively analyzed. According to the pathological results, 41 patients were classified into high-grade BSG (20 patients) and low-grade BSG (21 patients). Combined with conventional MR images, the signal intensity (%) of amide proton transfer (APT) in the parenchymal area of the tumor was obtained on APTWI images. χ 2 test or independent sample t-test was used to analyze the differences in gender distribution, age and APT signal intensity between patients with high and low grade BSG. Receiver operating characteristic (ROC) curve was drawn to predict the efficacy of APT signal intensity in the differential diagnosis of high and low grade BSG, and Youden index was calculated to obtain the optimal diagnostic threshold; the predictive ability of APT signal intensity was analyzed in combination with Hosmer-Lemeshow goodness of fit test. Results:There was no significant difference in age [(23±18) years, (20±17) years, t=0.97, P=0.340] and gender distribution (9/11, 9/12 for males/females, χ 2=0.02, P=0.890) between high-grade and low-grade BSG patients. The APT signal intensity of high-grade BSG [(3.9±0.9)%] was significantly higher than that of low-grade BSG [(2.8±0.9)%], and the difference had statistical significance ( t=4.16, P<0.001). The area under the ROC curve of APT signal intensity to distinguish high-grade and low grade BSG was 0.836, and with 2.85% as the optimal diagnostic threshold of APT signal intensity, its sensitivity for the diagnosis of high-grade BSG was 90.0% and specificity was 71.4%. The Hosmer-Lemeshow test showed that APTWI had a good predictive ability for BSG grade (χ 2=13.33, P=0.101). Conclusion:APTWI can be applied in distinguishing high grade BSG from low grade BSG, and has clinical value in predicting glioma grading.
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Objective: To observe the value of amide proton transfer weighted (APTw) imaging in predicting isocitrate dehydrogenase (IDH) wild type and IDH mutant of high-grade gliomas. Methods: Twenty-five patients with pathologically confirmed high-grade gliomas were enrolled. All patients underwent preoperative MR scanning, including routine sequences, T1WI enhancement and APTw scanning. According to the pathology, the patients were divided into IDH wild type group and IDH mutant group. ROIs were placed on FLAIR images of all tumor layers to select the solid components of the tumor, and APT values of each layer were obtained to get the mean value. Differences of APT values were analyzed between groups using independent sample t test, and ROC curve analysis was performed to evaluate the diagnostic efficacy of APT values in assessing the gene status of IDH. Results: Among 25 patients of high-grade gliomas, 9 cases were IDH mutant and 16 cases were IDH wild type. APT value of IDH wild type group ([3.21±0.82]%) was significantly higher than that of IDH mutant group ([2.23±0.72]%; t=2.89, P<0.05), and the AUC was 0.84 (P<0.05). The sensitivity and specificity of IDH wild type diagnosis was 93.8% and 66.7%, respectively. Conclusion: APTw imaging can be used to predict gene status of IDH in high-grade gliomas.