DOI: 10.1093/bjs/znad258.003 ISSN:

677 Amide Proton Transfer-Weighted Imaging Versus Diffusion-Weighted Imaging for Monitoring Treatment Response in Glioma Patients: A Systematic Review and Meta-Analysis

A Chansiriwongs, A Welch
  • Surgery



Monitoring treatment response in glioma (GM) patients remains a challenge, as tumour recurrence (TR) and treatment-related injury (TRI) both appear similarly on standard magnetic resonance imaging (MRI). Although diffusion-weighted MRI (DWI) is gold standard, equivocal patients still undergo invasive biopsies for diagnosis. Amide proton transfer-weighted MRI (APTw) may more accurately differentiate TR from TRI, reducing surgical intervention rates. Hence, this systematic review and meta-analysis aimed to determine how APTw compares to DWI in the identification of TR from TRI.


A search strategy was used to select studies investigating the diagnostic ability of DWI or APTw in detecting TR from Ovid MEDLINE ®, Ovid Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Thai Clinical Trials Registry. Selection criteria were applied to retrieve studies and methodologies critically appraised according to the QUADAS-2 tool. Conclusions from studies were synthesised, and the sensitivity and specificity for TR detection pooled.


18 studies were included in the analysis (11 DWI, 6 APTw, 1 both). For TR, APTw signal measured significantly higher, whereas apparent diffusion coefficients derived from DWI images were significantly lower. In DWI studies, combined sensitivity and specificity for TR was 84.4% (95% CI, 72.5%-91.7%) and 81.2% (95% CI, 67.9%-89.8%) accordingly. Meta-analysis was not performed for APTw due to limited study numbers. In general, studies had low methodological quality and were associated with a risk of bias.


Overall, though comparisons between DWI and APTw in monitoring GM treatment were inconclusive, this study supports the potential use of APTw in neurosurgery.

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