Amide proton transfer in detecting intracerebral hemorrhage

Amide Proton Transfer (APT) is a kind of chemical exchange-dependent saturation transfer (CEST) imaging which can detect peptides and endogenous mobile proteins. We aimed to explore the value of non-invasive APT in early detecting intracerebral hemorrhage (ICH) at different stages by comparing it to susceptibility weighted imaging (SWI), the most sensitive tool for detecting ICH. Routine MRI, SWI and APT imaging were performed in 39 patients with ICH at different stages on a 3.0 T. The MRI findings were evaluated, the signal values of SWI and APT in the hemorrhage lesions were measured and compared with the contralateral normal brain tissue. Paired-sample t-test was used for statistical evaluation. SWI showed hypointense signal in 15 cases and heterogeneous signal intensity in the other 14 cases. However, all the ICH lesions were hyperintense on the APT-weighted images. Both the mean values of APT and SWI were higher in the hemorrhagic lesions than in the contralateral normal brain tissue (P<0.01). Routine MR imaging has limitation in detecting ICH because of the various signal intensities at the different stages. SWI is more sensitive than conventional MRIs in detecting ICH. But SWI shows heterogeneous signal intensity in half of the cases with ICH because of the T2 and T1 properties in SWI. As APT can detect endogenous mobile proteins and peptides, the ICH which contains many hemoglobins always shows hyperintensity on APT. In this way, APT imaging is sensitive to detect ICH and may provide a new MRI tool as a routine imaging technique for early detecting ICH. In this way, APT imaging is sensitive to detect ICH and may provide a new MRI tool as a routine imaging technique for early detecting ICH.

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