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 T 1 ‐weighted and Gd‐T 1 ‐weighted sequence; Turbo‐spin‐echo T 2 ‐weighted sequence; 2D fat‐suppressed, turbo‐spin‐echo APTw pulse sequence. Assessment The T 1 WI signal intensity score, T 2 WI 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