Baolin Wu,1,* Fei Jia,2,* Xuekun Li,2 Meng Zhang,2 Dongming Han,2 Zhiyun Jia1,3 1Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People’s Republic of China; 2Department of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, People’s Republic of China; 3Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Dongming HanDepartment of MR, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, Henan, People’s Republic of ChinaTel +86 13849369537Email 625492590@qq.comZhiyun JiaDepartment of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People’s Republic of ChinaTel + 86-13408419087Fax + 86 28 85423503Email zhiyunjia@hotmail.comBackground: To investigate the value of amide proton transfer (APT) imaging in predicting the histological grade of hepatocellular carcinoma (HCC), compared with diffusion kurtosis imaging (DKI).Methods: A total of 88 patients with HCC were enrolled and divided into four groups (G1, G2, G3, and G4) based on histologic grades. Preoperative APT signal intensity (SI), mean diffusivity (MD), mean kurtosis (MK) of HCC were measured and compared. Those quantitative magnetic resonance imaging (qMRI) parameters were compared using an analysis of variance. The correlations between the qMRI parameters and the histological grades were determined using Spearman’s rank analysis. In addition, the predictive performance for differentiating low- (G1 and G2) from high-grade (G3 and G4) HCC was evaluated using receiver operating characteristic (ROC) curve analysis.Results: Significant differences were found in APT SIs, MD, and MK among the four groups (P< 0.05). Moderate to good relationships were found between the histologic grade of HCC and APT SI and MK (r=0.679, P< 0.001 and r=0.539, P< 0.001, respectively). The area under the ROC curves (AUCs) of APT SI, MK, and MD for differentiating low- from high-grade HCC were 0.890 (95%CI: 0.805– 0.947), 0.765 (95%CI: 0.662– 0.849) and 0.717 (95%CI: 0.611– 0.808), respectively. Comparison of ROC curves showed a significantly higher AUC of APT SI compared with those of the DKI-derived parameters (P < 0.05).Conclusion: The APT imaging may be more accurate than DKI for predicting the histological grade of HCC.Keywords: hepatocellular carcinoma, amide proton transfer, diffusion kurtosis imaging, histological grade
