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However, APT imaging in the human breast is affected by the ubiquitous fat signal preventing a straightforward application of existing acquisition protocols. Although the spectral region of the APT signal does not coincide with fat resonances, the fat signal leads to an incorrect normalization of the <jats:italic>Z<\/jats:italic>\u2010spectrum, and therefore to distorted APT effects. In this study, we propose a novel normalization for APT\u2010CEST MRI that corrects for fat signal\u2013induced artifacts in the postprocessing without the need for application of fat saturation schemes or water\u2013fat separation approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The novel normalization uses the residual signal at the spectral position of the direct water saturation to estimate the fat contribution. A comprehensive theoretical description of the normalization for an arbitrary phase relation of the water and fat signal is provided. Functionality and applicability of the proposed normalization was demonstrated by in vitro and in vivo experiments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In vitro, an underestimation of the conventional APT contrast of approximately \u22121.2% per 1% fat fraction was observed. The novel normalization yielded an APT contrast independent of the fat contribution, which was also independent of the water\u2010fat phase relation. This allowed APT imaging in patients with mamma carcinoma corrected for fat signal contribution, field inhomogeneities, spillover dilution, and water relaxation effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The proposed normalization increases the specificity of APT imaging in tissues with varying fat content and represents a time\u2010efficient and specific absorption rate\u2013efficient alternative to fat saturation and water\u2013fat separation approaches.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mrm.27983","type":"journal-article","created":{"date-parts":[[2019,9,18]],"date-time":"2019-09-18T09:45:26Z","timestamp":1568799926000},"page":"920-934","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["A novel normalization for amide proton transfer CEST MRI to correct for fat signal\u2013induced artifacts: application to human breast cancer 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