Diagnostic performance between MR amide proton transfer (APT) and diffusion kurtosis imaging (DKI) in glioma grading and IDH mutation status prediction at 3 T

Purpose: Accurate glioma grading and IDH mutation status prediction are critically essential for individualized preoperative treatment decisions. This study aims to compare the diagnostic performance of magnetic resonance (MR) amide proton transfer (APT) and diffusion kurtosis imaging (DKI) in glioma grading and IDH mutation status prediction. Method: Fifty-one glioma patients without treatment were retrospectively included. APT-weighted (APTw) effect and DKI indices, including mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis (MK), and kurtosis FA (KFA) were obtained from APT and diffusion-weighted images, respectively. DKI indices in tumors were normalized to that in contralateral normal appearing white matter (CNAWM) and the APTw difference (Delta APTw) between the two regions was calculated. Student's t-test, one-way ANOVA and ROC analyses were conducted. Results: Among the enrolled 51 patients, 13 had glioma-II, 17 had glioma-III and 21 had glioma-IV. 25 patients were diagnosed as IDH-mutant, and 26 as IDH-wild type. MD and MK differed significantly between glioma-IV and glioma II/III (P < 0.05), but not between glioma-II and glioma-III. FA and KFA showed no significant difference among the three groups (P > 0.05). IDH-mutant group exhibited significantly higher MD and lower FA, MK and Delta APTw than IDH-wild type (P < 0.05), whereas the two groups showed comparable KFA values. In contrast, Delta APTw differed significantly across tumor grades and IDH mutation status (P < 0.05), with consistently better discriminatory performance than DKI indices in glioma grading and IDH mutation status prediction. Conclusions: APT imaging was superior to DKI in glioma grading and IDH mutation status prediction, benefiting accurate diagnoses and treatment decisions.