Differentiating glioma recurrence and pseudoprogression by APTw CEST MRI

Motivation: Recurrent gliomas are treatment-resistant due to metabolic and molecular heterogeneity, posing challenges for accurate monitoring with conventional MRI. Goal(s): This study aims to evaluate Amide Proton Transfer weighted (APTw) CEST MRI as an imaging biomarker to better assess glioma heterogeneity and differentiate progression from pseudoprogression (PsPD). Approach: A prospective, single-center trial of 371 glioma patients identified 30 with recurrence and 12 with PsPD. Standard MRI sequences and APTw imaging were performed, with semi-automated segmentation and quantitative analysis. Results: APTw values distinguished progressive disease from PsPD, revealed metabolic hotspots, and detected resection cavity changes at recurrence, underscoring APTw's clinical utility in neuro-oncological monitoring. Impact: This study highlights APTw-CEST MRI's value as an imaging biomarker, aiding clinicians in differentiating progression from pseudoprogression. It enables targeted treatment strategies and opens new research into metabolic imaging for personalized glioma management, enhancing patient care and guiding therapy decisions.