Amide Proton Transfer-weighted (APTw) imaging is a molecular MRI technique used to quantify protein concentrations in gliomas, which have heterogeneous components with varying cellularity and metabolic activity. This study aimed to assess the correlation between the component-specific APT signal of the neoplasm and WHO grade, molecular profile and survival status. Sixty-one patients with adult-type diffuse gliomas were retrospectively analyzed. APT values were semi-automatically extracted from tumor solid and, whenever present, necrotic components. APT values were compared between groups stratified by WHO grade, IDH-mutation, MGMT promoter methylation and 1- and 2-year survival status using Wilcoxon rank-sum test, adjusting for multiple comparisons. Overall survival (OS) was analyzed in the subgroup of 48 patients with grade 4 tumors using Cox proportional-hazards models. Random-effects models were used to assess inter-subject heterogeneity of the mean APT values in each tumor component. APT values of the solid component significantly differed between patients with grades 2–3 and 4 tumors (mean 1.58 ± 0.50 vs. 2.04 ± 0.56,p= 0.028) and correlated with OS after 1 year (1.81 ± 0.58 in survivors vs. 2.17 ± 0.51 in deceased patients,p= 0.030). APT values did not differ by IDH-mutation, MGMT methylation, and 2-year survival status. Within grade 4 glioma patients, higher APT kurtosis of the solid component was a negative prognostic factor (hazard ratio = 1.60,p= 0.040). Mean APT values of the necrosis showed high inter-subject variability, although most necrotic tumors were grade 4 and IDH wildtype. In conclusion, APTw imaging in the solid component provided metrics associated with glioma grade and survival status but showed weak correlation with IDH-mutation and MGMT promoter methylation status, in contrast to previous works. Further research is needed to understand APT signal variability within the necrotic component of high-grade gliomas.
酰胺质子转移加权（APTw）成像是一种用于量化胶质瘤中蛋白质浓度的分子磁共振成像技术，胶质瘤具有异质性成分，其细胞密度和代谢活性各不相同。本研究旨在评估肿瘤特定成分的APT信号与WHO分级、分子特征及生存状态之间的相关性。研究回顾性分析了61例成人型弥漫性胶质瘤患者。通过半自动方法从肿瘤实性成分及坏死成分（若存在）中提取APT值。采用Wilcoxon秩和检验比较按WHO分级、IDH突变状态、MGMT启动子甲基化状态以及1年和2年生存状态分组的APT值，并对多重比较进行校正。在48例4级肿瘤患者亚组中，使用Cox比例风险模型分析总生存期（OS）。采用随机效应模型评估各肿瘤成分平均APT值的受试者间异质性。实性成分的APT值在2-3级与4级肿瘤患者间存在显著差异（平均值1.58 ± 0.50 vs. 2.04 ± 0.56，p=0.028），并与1年生存状态相关（生存者1.81 ± 0.58 vs. 死亡患者2.17 ± 0.51，p=0.030）。APT值在IDH突变状态、MGMT甲基化状态及2年生存状态分组间无显著差异。在4级胶质瘤患者中，实性成分较高的APT峰度是预后不良因素（风险比=1.60，p=0.040）。坏死成分的平均APT值显示出较高的受试者间变异性，尽管大多数坏死性肿瘤为4级且IDH野生型。总之，实性成分的APTw成像提供了与胶质瘤分级和生存状态相关的指标，但与既往研究不同，其与IDH突变和MGMT启动子甲基化状态的相关性较弱。需要进一步研究以理解高级别胶质瘤坏死成分内APT信号的变异性。
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