评估酰胺质子转移 (APT) 成像用于评估膀胱癌 (BC) 中的 Ki-67、p53 和 PD-L1 状态，并将其与扩散加权成像 (DWI) 的诊断效果进行比较。连续招募了疑似 BC 的患者用于术前多参数 MRI。 APT 信号通过不对称磁化转移比 (MTRasym) 进行量化。 MTRasym 和表观扩散系数 (ADC) 由两名放射科医生测量，并评估观察者间的一致性。 Spearman 相关分析了 MTRasym 值和分子标记。 Whitney U 测试根据分子标记状态评估 MTRasym 和 ADC 变异。使用曲线下面积 (AUC) 分析确定最佳截止点。对 88 名 BC 患者（72 ± 10 岁；77 名男性）进行了研究。 MTRasym 值与 Ki-67、p53 和 PD-L1 水平显着相关 (P < 0.05)。在高 Ki-67 表达 BC 中发现了较高的 MTRasym 值（1.89% [0.73%] vs. 1.23% ± 0.26%；P < 0.001），高 p53 表达 BC（1.63% [0.56%] vs. 1.24% [0.56%] ]；P < 0.001）和阳性 PD-L1 表达 BC（2.02% [0.81%] vs. 1.48% [0.38%]；P < 0.001）。在高 Ki-67 表达 BC 中发现较低的 ADC（1.06 ×10-3 mm2/s [0.32 ×10-3 mm2/s] 与 1.38 ×10-3 mm2/s [0.39 ×10-3 mm2/s] P<0.001）。对于 p53 状态，MTRasym 阈值为 1.27%，敏感性为 95%，特异性为 60%，AUC 为 0.781。对于 PD-L1 状态，1.90% 的阈值具有 88% 的敏感性、92% 的特异性，AUC 为 0.859。APT 可以显着增强 BC 侵袭性的术前评估，并为靶向免疫治疗决策提供信息，其性能优于 DWI。版权所有 © 2024大学放射科医生协会。由爱思唯尔公司出版。保留所有权利。

To evaluate amide proton transfer (APT) imaging for assessing Ki-67, p53 and PD-L1 status in bladder cancer (BC) and compare its diagnostic efficacy with that of diffusion-weighted imaging (DWI).Consecutive patients suspected of BC were recruited for preoperative multiparametric MRI. APT signal was quantified by asymmetric magnetization transfer ratio (MTRasym). MTRasym and apparent diffusion coefficient (ADC) were measured by two radiologists, with interobserver agreement assessed. Spearman's correlation analyzed MTRasym values and molecular markers. The Whitney U test evaluated MTRasym and ADC variation based on molecular marker status. Optimal cutoff points were determined using area under the curve (AUC) analysis.88 patients (72 ± 10 years; 77 men) with BC were studied. MTRasym values were significantly correlated with Ki-67, p53 and PD-L1 levels (P < 0.05). Higher MTRasym values were found in high Ki-67 expression BCs (1.89% [0.73%] vs. 1.23% ± 0.26%; P < 0.001), high p53 expression BCs (1.63% [0.56%] vs. 1.24% [0.56%]; P < 0.001) and positive PD-L1 expression BCs (2.02% [0.81%] vs. 1.48% [0.38%]; P < 0.001). Lower ADCs were found in high Ki-67 expression BCs (1.06 ×10-3 mm2/s [0.32 ×10-3 mm2/s] vs. 1.38 ×10-3 mm2/s [0.39 ×10-3 mm2/s]; P < 0.001). For p53 status, an MTRasym threshold of 1.27% had 95% sensitivity, 60% specificity, and AUC of 0.781. For PD-L1 status, a 1.90% threshold had 88% sensitivity, 92% specificity, and AUC of 0.859.APT may significantly enhance the preoperative assessment of BC aggressiveness and inform targeted immunotherapy decisions, with performance superior to DWI.Copyright © 2024 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.