Relaxation-compensated amide proton transfer (APT) MRI signal intensity is 
associated with survival and progression in high-grade glioma patients

Paech, D; Dreher, C; Regnery, S; Meissner, JE; Goerke, S; Windschuh, J; Oberhollenzer, J; Schultheiss, M; Deike-Hofmann, K; Bickelhaupt, S; Radbruch, A; Zaiss, M; Unterberg , A; Wick, W; Bendszus, M; Bachert, P; Ladd, ME; Schlemmer, HP

doi:10.1007/s00330-019-06066-2

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Relaxation-compensated amide proton transfer (APT) MRI signal intensity is associated with survival and progression in high-grade glioma patients

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Zaiss, M
Department High-Field Magnetic Resonance, Max Planck Institute for Biological Cybernetics, Max Planck Society;
Max Planck Institute for Biological Cybernetics, Max Planck Society;

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Citation

Paech, D., Dreher, C., Regnery, S., Meissner, J., Goerke, S., Windschuh, J., et al. (2019). Relaxation-compensated amide proton transfer (APT) MRI signal intensity is associated with survival and progression in high-grade glioma patients. European Radiology, 29(9), 4957-4967. doi:10.1007/s00330-019-06066-2.

Cite as: https://hdl.handle.net/21.11116/0000-0003-152D-4

Abstract

Objectives
The purpose of this study was to investigate the association of relaxation-compensated chemical exchange saturation transfer (CEST) MRI with overall survival (OS) and progression-free survival (PFS) in newly diagnosed high-grade glioma (HGG) patients.
Methods
Twenty-six patients with newly diagnosed high-grade glioma (WHO grades III–IV) were included in this prospective IRB-approved study. CEST MRI was performed on a 7.0-T whole-body scanner. Association of patient OS/PFS with relaxation-compensated CEST MRI (amide proton transfer (APT), relayed nuclear Overhauser effect (rNOE)/NOE, downfield-rNOE-suppressed APT (dns-APT)) and diffusion-weighted imaging (apparent diffusion coefficient) were assessed using the univariate Cox proportional hazards regression model. Hazard ratios (HRs) and corresponding 95% confidence intervals were calculated. Furthermore, OS/PFS association with clinical parameters (age, gender, O6-methylguanine-DNA methyltransferase (MGMT) promotor methylation status, and therapy: biopsy + radio-chemotherapy vs. debulking surgery + radio-chemotherapy) were tested accordingly.
Results
Relaxation-compensated APT MRI was significantly correlated with patient OS (HR = 3.15, p = 0.02) and PFS (HR = 1.83, p = 0.009). The strongest association with PFS was found for the dns-APT metric (HR = 2.61, p = 0.002). These results still stand for the relaxation-compensated APT contrasts in a homogenous subcohort of n = 22 glioblastoma patients with isocitrate dehydrogenase (IDH) wild-type status. Among the tested clinical parameters, patient age (HR = 1.1, p = 0.001) and therapy (HR = 3.68, p = 0.026) were significant for OS; age additionally for PFS (HR = 1.04, p = 0.048).
Conclusion
Relaxation-compensated APT MRI signal intensity is associated with overall survival and progression-free survival in newly diagnosed, previously untreated glioma patients and may, therefore, help to customize treatment and response monitoring in the future.