Amide Proton Transfer Weighted MR Imaging for Predicting Meningioma Stiffness: A Feasibility Study

Background: Stiffness of meningioma is an important factor affecting the surgical resection and the prognosis of patients. Purpose: To examine the feasibility of APTw-magnetic resonance imaging (MRI) in evaluating meningioma stiffness. Study Type: Retrospective. Population: Seventy-one patient with meningiomas, 39 were male and 32 were female; the mean age was 51 ± 10 years. Field Strength/Sequence: 3.0T; Turbo-spin-echo T₁-weighted and Gd-T₁-weighted sequence; Turbo-spin-echo T₂-weighted sequence; 2D fat-suppressed, turbo-spin-echo APTw pulse sequence. Assessment: The T₁WI signal intensity score, T₂WI signal intensity score, APTw_min, APTw_max, and APTw_mean values were compared between soft, medium stiff and stiff meningiomas or non-stiff meningiomas and stiff meningiomas group. Statistical Tests: Chi-square test, one-way ANOVA analysis, independent-samples t-test, intra-class correlation coefficient, rank-sum test, receiver operating characteristic curve analysis. P < 0.05 was considered statistically significant in all tests. Results: APTw_min and APTw_mean in the stiff group were significantly lower than that in the non-stiff group (2.79% ± 0.42% vs. 1.90% ± 0.60% and 3.20% ± 0.31% vs. 2.55% ± 0.61%). APTw_min and APTw_mean in the stiff group were significantly lower than that in the medium stiff and soft groups (1.90% ± 0.60% vs. 2.69% ± 0.40% and 3.12% ± 0.32%, 2.55% ± 0.61% vs. 3.17% ± 0.33% and 3.39% ± 0.18%), APTw_min in the medium stiff group was significantly lower than in the soft group, there was no significant difference in APTw_mean between the medium stiff and soft groups (P = 0.190). APTw_min showed the best diagnostic performance for evaluating meningioma stiffness with an area under the curve of 0.913, when the APTw_min was lower than 2.4%, the meningioma was defined as a stiff tumor, the sensitivity, specificity, and accuracy were 87.1%, 87.5%, and 85.9%, respectively. Data Conclusion: APTw-MRI could be used to evaluate meningioma stiffness, with APTw_min having the best evaluative efficiency. Level of Evidence: 3. Technical Efficacy: Stage 1.