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Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study
BACKGROUND: Hemodynamic changes after intracranial artery stenosis (ICAS) or occlusion are important causes of metabolic alterations in tissue. This study aimed to explore the feasibility of using amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI) to diagnose patients with sympto...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622450/ https://www.ncbi.nlm.nih.gov/pubmed/36330191 http://dx.doi.org/10.21037/qims-21-1063 |
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author | Chen, Kunjian Dou, Weiqiang Mao, Huimin Wang, Xinyu Wang, Xinyi Guo, Yu Zhang, Chao |
author_facet | Chen, Kunjian Dou, Weiqiang Mao, Huimin Wang, Xinyu Wang, Xinyi Guo, Yu Zhang, Chao |
author_sort | Chen, Kunjian |
collection | PubMed |
description | BACKGROUND: Hemodynamic changes after intracranial artery stenosis (ICAS) or occlusion are important causes of metabolic alterations in tissue. This study aimed to explore the feasibility of using amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI) to diagnose patients with symptomatic chronic ICAS based on pH variations caused by metabolite damage. METHODS: Sixty-seven patients with clinically confirmed unilateral anterior circulation ICAS (≥70% arterial narrowing) and 20 healthy volunteers were recruited for the study. Each patient underwent an MRI examination including a T2 fluid-attenuated inversion recovery (T2-FLAIR) sequence, spin-echo echo-planar diffusion-weighted imaging (DWI), three-dimensional pseudo-continuous arterial spin labeling (pcASL), and an APTw sequence. Areas with abnormal perfusion and APTw effects were defined as perfusion/pH matched areas; areas with abnormal perfusion but normal APTw effects were defined as perfusion/pH unmatched areas; the contralateral mirror areas were defined as the normal areas. Regions of interest (ROIs) were selected within these three areas, and the corresponding apparent diffusion coefficient (ADC), cerebral blood flow (CBF), and magnetization transfer ratio asymmetry (MTR(asym)) were measured. RESULTS: High intraclass correlation coefficient (ICC) values (0.78≤ ICCs ≤0.97; P<0.05) were observed between the two radiologists who independently performed the data analysis. Significant differences were found in CBF and MTR(asym) between the perfusion/pH matched, perfusion/pH unmatched, and normal areas [F((2,64))=288.5, 163.5; both P<0.05], but the ADC values were comparable between the three [F((2,64))=2.11; P>0.05]. Spearman correlation analysis revealed no significant correlation between changes in MTR(asym) and CBF (P>0.05). Finally, APTw showed a robust performance in diagnosing symptomatic chronic ICAS, with an area under the receiver operating characteristic curve (ROC) of 0.953 (sensitivity 97.01%; specificity 85.07%; cut-off value 1.005%). CONCLUSIONS: The present study has demonstrated that metabolic alterations are present in patients with symptomatic chronic ICAS. Our findings illustrate that APTw imaging could potentially serve as an effective method to provide a robust clinical diagnosis for patients with symptomatic chronic ICAS. |
format | Online Article Text |
id | pubmed-9622450 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-96224502022-11-02 Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study Chen, Kunjian Dou, Weiqiang Mao, Huimin Wang, Xinyu Wang, Xinyi Guo, Yu Zhang, Chao Quant Imaging Med Surg Original Article BACKGROUND: Hemodynamic changes after intracranial artery stenosis (ICAS) or occlusion are important causes of metabolic alterations in tissue. This study aimed to explore the feasibility of using amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI) to diagnose patients with symptomatic chronic ICAS based on pH variations caused by metabolite damage. METHODS: Sixty-seven patients with clinically confirmed unilateral anterior circulation ICAS (≥70% arterial narrowing) and 20 healthy volunteers were recruited for the study. Each patient underwent an MRI examination including a T2 fluid-attenuated inversion recovery (T2-FLAIR) sequence, spin-echo echo-planar diffusion-weighted imaging (DWI), three-dimensional pseudo-continuous arterial spin labeling (pcASL), and an APTw sequence. Areas with abnormal perfusion and APTw effects were defined as perfusion/pH matched areas; areas with abnormal perfusion but normal APTw effects were defined as perfusion/pH unmatched areas; the contralateral mirror areas were defined as the normal areas. Regions of interest (ROIs) were selected within these three areas, and the corresponding apparent diffusion coefficient (ADC), cerebral blood flow (CBF), and magnetization transfer ratio asymmetry (MTR(asym)) were measured. RESULTS: High intraclass correlation coefficient (ICC) values (0.78≤ ICCs ≤0.97; P<0.05) were observed between the two radiologists who independently performed the data analysis. Significant differences were found in CBF and MTR(asym) between the perfusion/pH matched, perfusion/pH unmatched, and normal areas [F((2,64))=288.5, 163.5; both P<0.05], but the ADC values were comparable between the three [F((2,64))=2.11; P>0.05]. Spearman correlation analysis revealed no significant correlation between changes in MTR(asym) and CBF (P>0.05). Finally, APTw showed a robust performance in diagnosing symptomatic chronic ICAS, with an area under the receiver operating characteristic curve (ROC) of 0.953 (sensitivity 97.01%; specificity 85.07%; cut-off value 1.005%). CONCLUSIONS: The present study has demonstrated that metabolic alterations are present in patients with symptomatic chronic ICAS. Our findings illustrate that APTw imaging could potentially serve as an effective method to provide a robust clinical diagnosis for patients with symptomatic chronic ICAS. AME Publishing Company 2022-11 /pmc/articles/PMC9622450/ /pubmed/36330191 http://dx.doi.org/10.21037/qims-21-1063 Text en 2022 Quantitative Imaging in Medicine and Surgery. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Chen, Kunjian Dou, Weiqiang Mao, Huimin Wang, Xinyu Wang, Xinyi Guo, Yu Zhang, Chao Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
title | Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
title_full | Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
title_fullStr | Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
title_full_unstemmed | Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
title_short | Amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
title_sort | amide proton transfer-weighted magnetic resonance imaging for the diagnosis of symptomatic chronic intracranial artery stenosis: a feasibility study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622450/ https://www.ncbi.nlm.nih.gov/pubmed/36330191 http://dx.doi.org/10.21037/qims-21-1063 |
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