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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Risk stratification of abdominal tumors in children with amide proton transfer imaging
Xuan Jia1, Wenqi Wang2, Jiawei Liang1
1Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Insights
Amide proton transfer (APT) MRI shows promise for identifying high-risk pediatric neuroblastoma, outperforming T1 and T2 mapping for risk stratification in abdominal tumors.
Area of Science:
- Radiology
- Medical Imaging
- Oncology
Background:
- Pediatric abdominal tumors require accurate risk stratification for optimal treatment.
- Molecular imaging techniques offer potential for non-invasive assessment of tumor biology.
- Amide proton transfer (APT) MRI is an emerging technique evaluating tissue composition.
Purpose of the Study:
- To assess the utility of APT MRI in predicting the risk group of pediatric abdominal tumors.
- To compare the performance of APT MRI with quantitative T1 and T2 mapping for risk stratification.
- To evaluate APT MRI as a potential imaging biomarker for neuroblastoma.
Main Methods:
- Prospective study of 133 pediatric patients with suspected abdominal tumors.
- Acquisition of APT-weighted imaging and quantitative T1/T2 mapping.
- Analysis of APTw, T1, and T2 indices within regions of interest, compared between risk groups using ROC analysis and t-tests.
Main Results:
- APT MRI demonstrated significantly higher signal in high-risk neuroblastoma (NB) compared to low-risk NB (p < .001, AUC=0.93).
- No significant difference in APTw signal was observed for Wilms' tumor (WT) or hepatoblastoma (HB) risk groups (AUCs 0.58 and 0.71, respectively).
- Quantitative T1 and T2 mapping yielded AUCs of 0.61-0.70 for risk stratification.
Conclusions:
- APT MRI serves as a potential imaging biomarker for preoperative risk stratification of pediatric neuroblastoma.
- APT MRI offers added value beyond structural MRI for neuroblastoma risk assessment.
- Further investigation is warranted for APT MRI's role in other pediatric abdominal tumors like WT and HB.
Objectives:
To evaluate the potential of molecular amide proton transfer (APT) MRI for predicting the risk group of abdominal tumors in children, and compare it with quantitative T1 and T2 mapping.
Methods:
This prospective study enrolled 133 untreated pediatric patients with suspected abdominal tumors from February 2019 to September 2020. APT-weighted (APTw) imaging and quantitative relaxation time mapping sequences were executed for each subject. The region of interest (ROI) was generated with automatic artifact detection and ROI-shrinking algorithms, within which the APTw, T1, and T2 indices were calculated and compared between different risk groups. The prediction performance of different imaging parameters was assessed with the receiver operating characteristics (ROC) analysis and Student's t-test.
Results:
Fifty-seven patients were included in the final analysis, including 24 neuroblastomas (NB), 18 Wilms' tumors (WT), and 15 hepatoblastomas (HB). The APTw signal was significantly (p < .001) higher in patients with high-risk NB than those with low-risk NB, while the difference between patients with low-risk and high-risk WT (p = .69) or HB (p = .35) was not statistically significant. The associated areas under the curve (AUC) for APT to differentiate low-risk and high-risk NB, WT, and HB were 0.93, 0.58, and 0.71, respectively. The quantitative T1 and T2 values generated AUCs of 0.61-0.70 for the risk stratification of abdominal tumors.
Conclusions:
APT MRI is a potential imaging biomarker for stratifying the risk group of pediatric neuroblastoma in the abdomen preoperatively and provides added value to structural MRI.
Key Points:
• Amide proton transfer (APT) imaging showed significantly (p < .001) higher values in pediatric patients with high-risk neuroblastoma than those with low-risk neuroblastoma, but did not demonstrate a significant difference in patients with Wilms' tumor (p = .69) or hepatoblastoma (p = .35). • The associated areas under the curve (AUC) for APT to differentiate low-risk and high-risk neuroblastoma, Wilms' tumor, and hepatoblastoma were 0.93, 0.58, and 0.71, respectively. • The quantitative T1 and T2 indices generated AUCs of 0.61-0.70 for dichotomizing the risk group of abdominal tumors.
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