Visual evaluation of amide proton transfer weighted images as an assessment criterion of the malignancy of a glial tumors

Aim. To determine the possibilities of visual evaluation of images weighted by amide proton transfer in evaluation of malignancy of glial brain tumors.

Methods: The study included 47 patients with histologically confirmed supratentorial gliomas who underwent surgical treatment at the university clinic of the FSBEI HE PRMU MOH from 2023 to 2024. The study was performed on a Philips Ingenia Elite X 3T magnetic resonance imaging machine (the Netherlands). The study protocol consisted of a standard protocol and images weighted by amide proton transfer (APT-WI). A visual assessment of APT-weighted images was performed in the Vidar Viewer 3.3 (Russia).  

Results. When visually evaluating images weighted by amide proton transfer, three evaluation parameters were identified: signal intensity, heterogeneity, correspondence of the volume of the modified signal and the T2-FLAIR-positive region. The signal characteristics of each tumor studied were evaluated on a scale from 1 to 3 points for signal intensity, from 1 to 2 points for heterogeneity, and from 1 to 3 points for length. Low grade gliomas (100%) were characterized by a weak homogeneous and heterogeneous type. Gliomas with a high degree of malignancy were characterized mainly by a high heterogeneous type – in 28 cases out of 40 (70%). The volume of the altered signal on APT-WI was smaller than in T2-FLAIR images in most gliomas of low malignancy (71%), in gliomas of high malignancy, 45% of all cases showed volume equality, and in 37.5% the tumor size on APT-WI exceeded the size on T2-FLAIR. According to the total score, a comparison was made between the groups of tumors according to the degree of malignancy. Statistically significant differences were found between low and high grade gliomas and 3[3;4] and 7 [6.25; 7.75] respectively (p = 0.001, Mann–Whitney test). Grade 4 gliomas had a higher score (7 [7; 8]) compared to grade 3 (5 [3; 7]), p = 0.006, Mann–Whitney test and grade 2 (3 [3; 4]), p = 0.001, Mann–Whitney test.

Conclusion. The use of the technique of visual assessment of images weighted by amide proton transfer increases the effectiveness of preoperative MR diagnostics in the differential analysis of glial tumors.

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