Amide proton transfer weighted (APTw) imaging for identifying treatment-induced MRI changes in IDH-wildtype glioblastoma at 3 Tesla

Motivation: Treatment-induced MRI changes in glioblastoma are common and, using standard techniques, are often difficult to distinguish from true tumor progression. Goal(s): To evaluate the diagnostic potential of amide proton transfer weighted (APTw) imaging, an FDA-approved and non-invasive tool, to distinguish pseudoprogression from true progression in molecularly defined glioblastomas. Approach: The mean APTw signal in contrast-enhancing lesions was compared between confirmed progression and treatment-induced MRI changes. Results: The APTw signal is significantly higher in confirmed progression compared to treatment-induced MRI changes and shows high sensitivity (>90%) in identifying pseudoprogression. Impact: APTw imaging shows promise for clinical use in glioblastoma assessment, particularly for identifying treatment-induced MRI changes. Future prospective studies should evaluate the combination of APTw imaging with other techniques (e.g., DWI and/or perfusion MRI) to further enhance diagnostic accuracy.