Editorial for "Amide Proton Transfer MRI Could Be Used to Evaluate the Pathophysiological Status of White Matter Hyperintensities"

Background The pathophysiology of white matter hyperintensities (WMH) remains unclear, investigations of amide proton transfer (APT) signals in WMH disease may provide relevant pathophysiological information. Purpose To evaluate the APT signals differences and heterogeneity of WMH and adjacent normal-appearing white matter (NAWM) at different Fazekas grades and different locations. Study type Prospective. Population In all, 180 WMH patients (age, 40-76; male/female, 77/103) and 59 healthy controls (age, 42-70; male/female, 23/36). Field Strength/Sequence A 3 T; 3D fluid-attenuated inversion recovery (FLAIR), 3D APT-weighted (APTw). Assessment The mean APTw values (APTw(mean)) and the APTw signals heterogeneity (APTw(max-min)) among different grades WMH and NAWM and the APTw(mean) of the same grade deep WMH (DWMH) and paraventricular WMH (PWMH) were calculated and compared. Regions of interests were delineated on WMH lesions, NAWM and healthy white matter. Statistical Tests One-way analysis of variance (ANOVA); independent sample t test; Chi-square test. Significance level: P < 0.05. Results APTw(mean) among different grade WMH (from grade 0 to 3, 0.58 +/- 0.14% vs. 0.29 +/- 0.23% vs. 0.37 +/- 0.24% vs. 0.61 +/- 0.22%, respectively) were significantly different except between grade 1 and 2 (P = 0.27) and between grade 0 and 3 (P = 0.97). The differences in APTw(mean) between WMH and NAWM were significant (WMH vs. NAWM from grade 1 to 3, 0.29% +/- 0.23% vs. 0.55% +/- 0.27%; 0.37% +/- 0.24% vs. 0.59% +/- 0.22%; 0.61% +/- 0.22% vs. 0.42% +/- 0.24%, respectively). Lower APTw(mean) values were found only in grade 3 NAWM than other grades NAWM and controls. The APTw(max-min) values of grade 1-3 WMH (0.38% +/- 0.27% vs. 0.51% +/- 0.31% vs. 0.67% +/- 0.34%, respectively) were significantly different. Higher APT(mean) values were found only in grade 2 PWMH (0.47% +/- 0.22% vs. 0.32% +/- 0.24%). Data Conclusion Significant differences of APT signals were found in WMH of different Fazekas grades and different locations. Evidence Level 2 Technical Efficacy Stage 3