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Differentiation between glioblastomas and solid brain metastases using amide proton transfer-weighted (APTw) MRI with and without fluid suppression

Knutsson, Malte LU orcid ; Salomonsson, Tim LU orcid ; Seidemo, Anina LU orcid ; Rydelius, Anna LU ; Sarda, Xavier Saenz LU ; Liebig, Patrick ; Belting, Mattias LU ; Bengzon, Johan LU ; van Zijl, Peter C M and Knutsson, Linda LU orcid , et al. (2026) In Magma (New York, N.Y.)
Abstract

OBJECT: Accurate differentiation between glioblastomas (GBM) and solitary brain metastases (MET) is crucial for treatment planning. This study evaluated the ability of amide proton transfer-weighted (APTw) MRI with and without fluid suppression (FS) to distinguish between GBM and MET.

METHOD: Thirty-two patients with histopathologically confirmed GBM (n = 24) or MET (n = 8) were included. Post-processing included creation of APTw maps without FS, with patient-specific FS based on the patient's white matter values and with a fixed-factor FS. Regions of interest (ROIs) were segmented in the contrast-enhanced tumour, peritumoural oedema, necrosis and the normal-appearing white matter (NAWM). The min, max and mean signals were... (More)

OBJECT: Accurate differentiation between glioblastomas (GBM) and solitary brain metastases (MET) is crucial for treatment planning. This study evaluated the ability of amide proton transfer-weighted (APTw) MRI with and without fluid suppression (FS) to distinguish between GBM and MET.

METHOD: Thirty-two patients with histopathologically confirmed GBM (n = 24) or MET (n = 8) were included. Post-processing included creation of APTw maps without FS, with patient-specific FS based on the patient's white matter values and with a fixed-factor FS. Regions of interest (ROIs) were segmented in the contrast-enhanced tumour, peritumoural oedema, necrosis and the normal-appearing white matter (NAWM). The min, max and mean signals were extracted for each ROI and normalised to NAWM, creating normalised APTw (nAPTw) values. Group differences were determined with t test and Mann-Whitney U test. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.

RESULTS: Both FS methods significantly reduced nAPTw values in tumour regions. Patient-specific FS showed highest performance in distinguishing GBM from MET in the necrotic (AUC 0.921) and oedematous regions (AUC 0.698). Fixed FS provided minor to intermediate improvements.

CONCLUSION: Patient-specific fluid suppression increased the diagnostic performance of APTw imaging in differentiating GBM from MET, particularly in oedematous and necrotic regions.

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Contribution to journal
publication status
epub
subject
in
Magma (New York, N.Y.)
publisher
Springer
external identifiers
  • scopus:105046261734
  • pmid:42530745
ISSN
1352-8661
DOI
10.1007/s10334-026-01389-w
language
English
LU publication?
yes
additional info
© 2026. The Author(s).
id
d708a6a1-0ef9-4596-be9a-02eb590fccaa
date added to LUP
2026-08-05 16:28:41
date last changed
2026-08-25 04:01:13
@article{d708a6a1-0ef9-4596-be9a-02eb590fccaa,
  abstract     = {{<p>OBJECT: Accurate differentiation between glioblastomas (GBM) and solitary brain metastases (MET) is crucial for treatment planning. This study evaluated the ability of amide proton transfer-weighted (APTw) MRI with and without fluid suppression (FS) to distinguish between GBM and MET.</p><p>METHOD: Thirty-two patients with histopathologically confirmed GBM (n = 24) or MET (n = 8) were included. Post-processing included creation of APTw maps without FS, with patient-specific FS based on the patient's white matter values and with a fixed-factor FS. Regions of interest (ROIs) were segmented in the contrast-enhanced tumour, peritumoural oedema, necrosis and the normal-appearing white matter (NAWM). The min, max and mean signals were extracted for each ROI and normalised to NAWM, creating normalised APTw (nAPTw) values. Group differences were determined with t test and Mann-Whitney U test. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.</p><p>RESULTS: Both FS methods significantly reduced nAPTw values in tumour regions. Patient-specific FS showed highest performance in distinguishing GBM from MET in the necrotic (AUC 0.921) and oedematous regions (AUC 0.698). Fixed FS provided minor to intermediate improvements.</p><p>CONCLUSION: Patient-specific fluid suppression increased the diagnostic performance of APTw imaging in differentiating GBM from MET, particularly in oedematous and necrotic regions.</p>}},
  author       = {{Knutsson, Malte and Salomonsson, Tim and Seidemo, Anina and Rydelius, Anna and Sarda, Xavier Saenz and Liebig, Patrick and Belting, Mattias and Bengzon, Johan and van Zijl, Peter C M and Knutsson, Linda and Sundgren, Pia C}},
  issn         = {{1352-8661}},
  language     = {{eng}},
  month        = {{07}},
  publisher    = {{Springer}},
  series       = {{Magma (New York, N.Y.)}},
  title        = {{Differentiation between glioblastomas and solid brain metastases using amide proton transfer-weighted (APTw) MRI with and without fluid suppression}},
  url          = {{http://dx.doi.org/10.1007/s10334-026-01389-w}},
  doi          = {{10.1007/s10334-026-01389-w}},
  year         = {{2026}},
}