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El Khalfi R, Maupoint E, Chiavassa-Gandois H, Goumarre C, Filliole A, Lapègue F, Fabry V, Acket B, Laforet A, Sans N, Cintas P, Faruch-Bilfeld M. Assessment of whole-body muscle MRI for the early diagnosis of Amyotrophic Lateral Sclerosis. Eur J Radiol 2024; 176:111481. [PMID: 38703513 DOI: 10.1016/j.ejrad.2024.111481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/01/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES To evaluate muscle signal abnormalities on whole-body muscle MRI with T2 and diffusion-weighted imaging in early ALS stages. METHODS 101 muscles were analyzed in newly diagnosed ALS patients and healthy controls on a whole-body MRI protocol including four-point T2-Dixon imaging and diffusion-weighted imaging (b0 and b800). Sensitivity and inter-observer agreement were assessed. RESULTS 15 patients (mean age, 64 +/- 12 [SD], 9 men) who met the Awaji-Shima criteria for definite, probable or possible ALS and 9 healthy controls were assessed (mean age, 53 +/- 13 [SD], 2 men). 61 % of the muscles assessed in ALS patients (62/101) showed signal hyperintensities on T2-weighted imaging, mainly in the upper and lower extremities (legs, hands and feet). ALS patients had a significantly higher number of involved muscles compared to healthy controls (p = 0,006). Diffusion-weighted imaging allowed for the detection of additional involvement in 22 muscles, thus improving the sensitivity of whole-body MRI from 60 % (using T2-weighted imaging only) up to 80 % (with the combination of T2-weighted and diffusion-weighted imaging). CONCLUSIONS ALS patients exhibited significant muscle signal abnormalities on T2-weighted and diffusion-weighted imaging in early disease stages. Whole-body MRI could be used for pre-EMG mapping of muscle involvement in order to choose suitable targets, thus improving early diagnosis.
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Affiliation(s)
- Rokia El Khalfi
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
| | - Estelle Maupoint
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Hélène Chiavassa-Gandois
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Céline Goumarre
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Antoine Filliole
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Franck Lapègue
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Vincent Fabry
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Blandine Acket
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Anne Laforet
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Nicolas Sans
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Pascal Cintas
- Service de Neurologie - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France
| | - Marie Faruch-Bilfeld
- Service d'Imagerie Médicale - Hôpital Purpan - CHU de Toulouse, Avenue du Professeur Jean Dausset, 31000 Toulouse, France.
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2
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Yuan Y, Sun J, Dong Q, Cui M. Blood-brain barrier endothelial cells in neurodegenerative diseases: Signals from the "barrier". Front Neurosci 2023; 17:1047778. [PMID: 36908787 PMCID: PMC9998532 DOI: 10.3389/fnins.2023.1047778] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023] Open
Abstract
As blood-brain barrier (BBB) disruption emerges as a common problem in the early stages of neurodegenerative diseases, the crucial roles of barrier-type brain endothelial cells (BECs), the primary part of the BBB, have been reported in the pathophysiology of neurodegenerative diseases. The mechanisms of how early vascular dysfunction contributes to the progress of neurodegeneration are still unclear, and understanding BEC functions is a promising start. Our understanding of the BBB has gone through different stages, from a passive diffusion barrier to a mediator of central-peripheral interactions. BECs serve two seemingly paradoxical roles: as a barrier to protect the delicate brain from toxins and as an interface to constantly receive and release signals, thus maintaining and regulating the homeostasis of the brain. Most previous studies about neurodegenerative diseases focus on the loss of barrier functions, and far too little attention has been paid to the active regulations of BECs. In this review, we present the current evidence of BEC dysfunction in neurodegenerative diseases and explore how BEC signals participate in the pathogenesis of neurodegenerative diseases.
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Affiliation(s)
- Yiwen Yuan
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Sun
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and Ministry of Education (MOE) Frontiers Center for Brain Science, Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Cui
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and Ministry of Education (MOE) Frontiers Center for Brain Science, Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
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3
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Bhattarai A, Chen Z, Chua P, Talman P, Mathers S, Chapman C, Howe J, Lee CMS, Lie Y, Poudel GR, Egan GF. Network diffusion model predicts neurodegeneration in limb-onset Amyotrophic Lateral Sclerosis. PLoS One 2022; 17:e0272736. [PMID: 35951510 PMCID: PMC9371353 DOI: 10.1371/journal.pone.0272736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Objective Emerging evidences suggest that the trans-neural propagation of phosphorylated 43-kDa transactive response DNA-binding protein (pTDP-43) contributes to neurodegeneration in Amyotrophic Lateral Sclerosis (ALS). We investigated whether Network Diffusion Model (NDM), a biophysical model of spread of pathology via the brain connectome, could capture the severity and progression of neurodegeneration (atrophy) in ALS. Methods We measured degeneration in limb-onset ALS patients (n = 14 at baseline, 12 at 6-months, and 9 at 12 months) and controls (n = 12 at baseline) using FreeSurfer analysis on the structural T1-weighted Magnetic Resonance Imaging (MRI) data. The NDM was simulated on the canonical structural connectome from the IIT Human Brain Atlas. To determine whether NDM could predict the atrophy pattern in ALS, the accumulation of pathology modelled by NDM was correlated against atrophy measured using MRI. In order to investigate whether network spread on the brain connectome derived from healthy individuals were significant findings, we compared our findings against network spread simulated on random networks. Results The cross-sectional analyses revealed that the network diffusion seeded from the inferior frontal gyrus (pars triangularis and pars orbitalis) significantly predicts the atrophy pattern in ALS compared to controls. Whereas, atrophy over time with-in the ALS group was best predicted by seeding the network diffusion process from the inferior temporal gyrus at 6-month and caudal middle frontal gyrus at 12-month. Network spread simulated on the random networks showed that the findings using healthy brain connectomes are significantly different from null models. Interpretation Our findings suggest the involvement of extra-motor regions in seeding the spread of pathology in ALS. Importantly, NDM was able to recapitulate the dynamics of pathological progression in ALS. Understanding the spatial shifts in the seeds of degeneration over time can potentially inform further research in the design of disease modifying therapeutic interventions in ALS.
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Affiliation(s)
- Anjan Bhattarai
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
- * E-mail:
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Phyllis Chua
- Department of Psychiatry, Monash University, Clayton, Victoria, Australia
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Paul Talman
- School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Susan Mathers
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Caron Chapman
- Neurosciences Department, University Hospital, Geelong, Victoria, Australia
| | - James Howe
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - C. M. Sarah Lee
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Yenni Lie
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Govinda R. Poudel
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
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4
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Bell LC, Fuentes AE, Healey DR, Chao R, Bakkar N, Sirianni RW, Medina DX, Bowser RP, Ladha SS, Semmineh NB, Stokes AM, Quarles CC. Longitudinal evaluation of myofiber microstructural changes in a preclinical ALS model using the transverse relaxivity at tracer equilibrium (TRATE): A preliminary study. Magn Reson Imaging 2021; 85:217-221. [PMID: 34715291 DOI: 10.1016/j.mri.2021.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/18/2022]
Abstract
T2⁎ relaxivity contrast imaging may serve as a potential imaging biomarker for amyotrophic lateral sclerosis (ALS) by noninvasively quantifying the tissue microstructure. In this preliminary longitudinal study, we investigated the Transverse Relaxivity at Tracer Equilibrium (TRATE) in three muscle groups between SOD1-G93A (ALS model) rat and a control population at two different timepoints. The control group was time matched to the ALS group such that the second timepoint was the onset of disease. We observed a statistically significant decrease in TRATE over time in the gastrocnemius, tibialis, and digital flexor muscles in the SOD1-G93A model (p-value = 0.003, 0.008, 0.005; respectively), whereas TRATE did not change over time in the control group (p-value = 0.4777, 0.6837, 0.9682; respectively). Immunofluorescent staining revealed a decrease in minimum fiber area and cell density in the SOD1-G93A model when compared to the control group (p-value = 6.043E-10 and 2.265E-10, respectively). These microstructural changes observed from histology align with the theorized biophysical properties of TRATE. We demonstrate that TRATE can longitudinally differentiate disease associated atrophy from healthy muscle and has potential to serve as a biomarker for disease progression and ultimately therapy response in patients with ALS.
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Affiliation(s)
- Laura C Bell
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Alberto E Fuentes
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Deborah R Healey
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Renee Chao
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Nadine Bakkar
- Division of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Rachael W Sirianni
- Vivian L. Smith Department of Neurosurgery, University of Texas Health Science Center, Houston, TX, United States of America
| | - David X Medina
- Division of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Robert P Bowser
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States of America; Division of Neurobiology, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Shafeeq S Ladha
- Division of Neurology, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Natenael B Semmineh
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - Ashley M Stokes
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America
| | - C Chad Quarles
- Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ, United States of America.
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5
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Mohan AB, Adithan S, Narayan S, Krishnan N, Mathews D. Evaluation of White Matter Tracts Fractional Anisotropy Using Tract-Based Spatial Statistics and Its correlation with Amyotrophic Lateral Sclerosis Functional Rating Scale Score in Patients with Motor Neuron Disease. Indian J Radiol Imaging 2021; 31:297-303. [PMID: 34556911 PMCID: PMC8448218 DOI: 10.1055/s-0041-1734337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Motor neuron diseases cause progressive degeneration of upper and lower motor neurons. No Indian studies are available on diffusion tensor imaging (DTI) findings in these patients. Aims This study was done to identify white matter tracts that have reduced fractional anisotropy (FA) in motor neuron disease (MND) patients using tract-based spatial statistics and to correlate FA values with Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score. Settings and Design A case-control study in a tertiary care hospital. Materials and Methods We did DTI sequence (20 gradient directions, b -value 1,000) in 15 MND patients (10 men and 5 women; mean age: 46.5 ± 16.5 years; 11 amyotrophic lateral sclerosis [ALS], 2 monomelic amyotrophy, 1 progressive muscular atrophy, and 1 bulbar ALS) and 15 age- and sex-matched controls. The data set from each subject was postprocessed using FSL downloaded from the FMRIB Software Library, Oxford, United Kingdom (http://www.fmrib.ox.ac.uk/fsl). Statistical Analysis The statistical permutation tool "randomize" with 5,000 permutations was used to identify voxels that were different between the patient data set and the control data set. Mean FA values of these voxels were obtained separately for each tract as per "JHU white-matter tractography atlas." SPSS was used to look to correlate tract-wise mean FA value with ALSFRS-R score. Results We found clusters of reduced FA values in multiple tracts in the brain of patients with MND. Receiver operating characteristic curves plotted for individual tracts, showed that bilateral corticospinal tract, bilateral anterior thalamic radiation, bilateral uncinate fasciculus, and right superior longitudinal fasciculus were the best discriminators (area under the curve > 0.8, p < 0.01). FA values did not correlate with ALFRS-R severity score. Conclusion In MND patients, not only the motor tracts, but several nonmotor association tracts are additionally affected, reflecting nonmotor pathological processes in ALS.
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Affiliation(s)
- Amutha Bharathi Mohan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subathra Adithan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sunil Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nagarajan Krishnan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Donna Mathews
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.,Department of Neurology, Christian Medical College (CMC), Vellore, Tamil Nadu, India
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6
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Bhattarai A, Egan GF, Talman P, Chua P, Chen Z. Magnetic Resonance Iron Imaging in Amyotrophic Lateral Sclerosis. J Magn Reson Imaging 2021; 55:1283-1300. [PMID: 33586315 DOI: 10.1002/jmri.27530] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 01/18/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) results in progressive impairment of upper and lower motor neurons. Increasing evidence from both in vivo and ex vivo studies suggest that iron accumulation in the motor cortex is a neuropathological hallmark in ALS. An in vivo neuroimaging marker of iron dysregulation in ALS would be useful in disease diagnosis and prognosis. Magnetic resonance imaging (MRI), with its unique capability to generate a variety of soft tissue contrasts, provides opportunities to image iron distribution in the human brain with millimeter to sub-millimeter anatomical resolution. Conventionally, MRI T1-weighted, T2-weighted, and T2*-weighted images have been used to investigate iron dysregulation in the brain in vivo. Susceptibility weighted imaging has enhanced contrast for para-magnetic materials that provides superior sensitivity to iron in vivo. Recently, the development of quantitative susceptibility mapping (QSM) has realized the possibility of using quantitative assessments of magnetic susceptibility measures in brain tissues as a surrogate measurement of in vivo brain iron. In this review, we provide an overview of MRI techniques that have been used to investigate iron dysregulation in ALS in vivo. The potential uses, strengths, and limitations of these techniques in clinical trials, disease diagnosis, and prognosis are presented and discussed. We recommend further longitudinal studies with appropriate cohort characterization to validate the efficacy of these techniques. We conclude that quantitative iron assessment using recent advances in MRI including QSM holds great potential to be a sensitive diagnostic and prognostic marker in ALS. The use of multimodal neuroimaging markers in combination with iron imaging may also offer improved sensitivity in ALS diagnosis and prognosis that could make a major contribution to clinical care and treatment trials. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Anjan Bhattarai
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Gary F Egan
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
| | - Paul Talman
- Department of Neuroscience, Barwon Health, Geelong, Victoria, Australia
| | - Phyllis Chua
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.,Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Melbourne, Victoria, Australia
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7
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Bhattarai A, Chen Z, Ward PGD, Talman P, Mathers S, Phan TG, Chapman C, Howe J, Lee S, Lie Y, Egan GF, Chua P. Serial assessment of iron in the motor cortex in limb-onset amyotrophic lateral sclerosis using quantitative susceptibility mapping. Quant Imaging Med Surg 2020; 10:1465-1476. [PMID: 32676365 PMCID: PMC7358415 DOI: 10.21037/qims-20-187] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dysregulation of iron in the cerebral motor areas has been hypothesized to occur in individuals with amyotrophic lateral sclerosis (ALS). There is still limited knowledge regarding iron dysregulation in the progression of ALS pathology. Our objectives were to use magnetic resonance based quantitative susceptibility mapping (QSM) to investigate the association between iron dysregulation in the motor cortex and clinical manifestations in patients with limb-onset ALS, and to examine changes in the iron concentration in the motor cortex in these patients over a 6-month period. METHODS Iron concentration was investigated using magnetic resonance based QSM in the primary motor cortex and the pre-motor area in 13 limb-onset ALS patients (including five lumbar onset, six cervical onset and two flail arm patients), and 11 age- and sex-matched control subjects. Nine ALS patients underwent follow-up scans at 6 months. RESULTS Significantly increased QSM values were observed in the left posterior primary motor area (P=0.02, Cohen's d =0.9) and right anterior primary motor area (P=0.02, Cohen's d =0.92) in the group of limb-onset ALS patients compared to that of control subjects. Increased QSM was observed in the primary motor and pre-motor area at baseline in patients with lumbar onset ALS patients, but not cervical limb-onset ALS patients, compared to control subjects. No significant change in QSM was observed at the 6-month follow-up scans in the ALS patients. CONCLUSIONS The findings suggest that iron dysregulation can be detected in the motor cortex in limb-onset ALS, which does not appreciably change over a further 6 months. Individuals with lumbar onset ALS appear to be more susceptible to motor cortex iron dysregulation compared to the individuals with cervical onset ALS. Importantly, this study highlights the potential use of QSM as a quantitative radiological indicator in early disease diagnosis in limb-onset ALS and its subtypes. Our serial scans results suggest a longer period than 6 months is needed to detect significant quantitative changes in the motor cortex.
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Affiliation(s)
- Anjan Bhattarai
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Phillip G. D. Ward
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Paul Talman
- Department of Neuroscience, Barwon Health, Geelong, Victoria, Australia
| | - Susan Mathers
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
- Department of Neurology, Monash Health, and School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Thanh G. Phan
- Department of Neurology, Monash Health, and School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Caron Chapman
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - James Howe
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Sarah Lee
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Yennie Lie
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
| | - Phyllis Chua
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Statewide Progressive Neurological Services, Calvary Health Care Bethlehem, South Caulfield, Victoria, Australia
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8
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Morello G, Spampinato AG, Conforti FL, Cavallaro S. Taxonomy Meets Neurology, the Case of Amyotrophic Lateral Sclerosis. Front Neurosci 2018; 12:673. [PMID: 30319346 PMCID: PMC6168652 DOI: 10.3389/fnins.2018.00673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/07/2018] [Indexed: 12/13/2022] Open
Abstract
Recent landmark publications from our research group outline a transformative approach to defining, studying and treating amyotrophic lateral sclerosis (ALS). Rather than approaching ALS as a single entity, we advocate targeting therapies to distinct "clusters" of patients based on their specific genomic and molecular features. Our findings point to the existence of a molecular taxonomy for ALS, bringing us a step closer to the establishment of a precision medicine approach in neurology practice.
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Affiliation(s)
- Giovanna Morello
- Institute of Neurological Sciences, Italian National Research Council, Catania, Italy
| | | | | | - Sebastiano Cavallaro
- Institute of Neurological Sciences, Italian National Research Council, Catania, Italy
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9
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Weerasekera A, Sima DM, Dresselaers T, Van Huffel S, Van Damme P, Himmelreich U. Non-invasive assessment of disease progression and neuroprotective effects of dietary coconut oil supplementation in the ALS SOD1 G93A mouse model: A 1H-magnetic resonance spectroscopic study. NEUROIMAGE-CLINICAL 2018; 20:1092-1105. [PMID: 30368196 PMCID: PMC6202692 DOI: 10.1016/j.nicl.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/28/2018] [Accepted: 09/16/2018] [Indexed: 12/12/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is an incurable neurodegenerative disease primarily characterized by progressive degeneration of motor neurons in the motor cortex, brainstem and spinal cord. Due to relatively fast progression of ALS, early diagnosis is essential for possible therapeutic intervention and disease management. To identify potential diagnostic markers, we investigated age-dependent effects of disease onset and progression on regional neurochemistry in the SOD1G93A ALS mouse model using localized in vivo magnetic resonance spectroscopy (MRS). We focused mainly on the brainstem region since brainstem motor nuclei are the primarily affected regions in SOD1G93A mice and ALS patients. In addition, metabolite profiles of the motor cortex were also assessed. In the brainstem, a gradual decrease in creatine levels were detected starting from the pre-symptomatic age of 70 days postpartum. During the early symptomatic phase (day 90), a significant increase in the levels of the inhibitory neurotransmitter γ- aminobutyric acid (GABA) was measured. At later time points, alterations in the form of decreased NAA, glutamate, glutamine and increased myo-inositol were observed. Also, decreased glutamate, NAA and increased taurine levels were seen at late stages in the motor cortex. A proof-of-concept (PoC) study was conducted to assess the effects of coconut oil supplementation in SODG93A mice. The PoC revealed that the coconut oil supplementation together with the regular diet delayed disease symptoms, enhanced motor performance, and prolonged survival in the SOD1G93A mouse model. Furthermore, MRS data showed stable metabolic profile at day 120 in the coconut oil diet group compared to the group receiving a standard diet without coconut oil supplementation. In addition, a positive correlation between survival and the neuronal marker NAA was found. To the best of our knowledge, this is the first study that reports metabolic changes in the brainstem using in vivo MRS and effects of coconut oil supplementation as a prophylactic treatment in SOD1G93A mice.
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Affiliation(s)
- A Weerasekera
- Biomedical MRI Unit/MoSAIC, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - D M Sima
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; icometrix, R&D department, Leuven, Belgium
| | - T Dresselaers
- Radiology, Department of Imaging and Pathology, UZ Leuven, Leuven, Belgium
| | - S Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - P Van Damme
- Department of Neurology, University Hospitals Leuven, Laboratory of Neurobiology, Leuven, Belgium; Department of Neurosciences, KU Leuven, Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - U Himmelreich
- Biomedical MRI Unit/MoSAIC, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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10
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Zubair AS, Mustafa R, Amrami KK, Crum BA. Case of Early Amyotrophic Lateral Sclerosis With Prominent Magnetic Resonance Imaging Plexus Abnormalities. J Clin Neuromuscul Dis 2018; 20:41-44. [PMID: 30124559 DOI: 10.1097/cnd.0000000000000206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disorder, which is characterized by progressive upper and lower motor neuron signs and symptoms, resulting in progressive muscle weakness. There are very rare reports of magnetic resonance imaging (MRI) abnormalities within the nerve roots or plexus reported in amyotrophic lateral sclerosis. Here, we report a patient who presented with progressive left arm weakness and was found to have bilateral MRI plexus abnormalities. This report illustrates that MRI plexus abnormalities can be seen in amyotrophic lateral sclerosis, possibly before symptoms, and may have clinical value in the diagnostic process.
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Affiliation(s)
| | - Rafid Mustafa
- Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Kimberly K Amrami
- Division of Musculoskeletal Radiology, Departments of Radiology and Neurologic Surgery, Mayo Clinic College of Medicine & Science, Rochester, MN
| | - Brian A Crum
- Department of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN
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11
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Bao Y, Yang L, Chen Y, Zhang B, Li H, Tang W, Geng D, Li Y. Radial diffusivity as an imaging biomarker for early diagnosis of non-demented amyotrophic lateral sclerosis. Eur Radiol 2018; 28:4940-4948. [PMID: 29948064 DOI: 10.1007/s00330-018-5506-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/09/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To explore the sensitivity of potential DTI-based biomarkers in detecting microstructural changes for whole-brain white matter in early stage amyotrophic lateral sclerosis (ALS), analyze the relationship between the DTI indices and disease status, and further clarify potential brain regions for disease monitoring and clinical assessment. METHODS Thirty-three non-demented ALS patients and 32 age- and gender-matched subjects participated in this study. DTI data were acquired via 3.0T MRI scanner. Maps of diffusion-related indices including fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were obtained. Tract-based spatial statistics (TBSS) were used to investigate whole-brain white matter changes of each index. Correlation analyses between both brain-wide and volume-of-interest (VOI)-wide white matter alterations and clinical factors including ALSFRS-R scores, disease duration, and progression rate were performed. RESULTS Compared to healthy subjects, ALS patients showed significantly increased RD, MD and reduced FA, mainly along the corticospinal tract (CST) and the body of corpus callosum (CC). Increases in RD were broader than decreases in FA, in CST of both hemispheres. Meanwhile, involvement of several extra-motor regions was also revealed by RD. Significant positive correlation between ALSFRS-R scores and FA, negative correlation between ALSFRS-R and RD were found in left CST. CONCLUSIONS RD may be the most sensitive biomarker for the detection of early demyelination of white matter. Both RD and FA may serve as objective biomarkers for disease severity assessment. CST may be the most affected brain region in non-demented ALS. KEY POINTS • Changes in RD were broader than those in FA in bilateral CST. • Involvement of extra-motor regions was uncovered by RD. • FA and RD in CST were related to ALSFRS-R scores.
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Affiliation(s)
- Yifang Bao
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Liqin Yang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Yan Chen
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Biyun Zhang
- Department of Radiotherapy, Affiliated Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China. .,Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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12
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Melhem ER. MR Imaging Biomarkers in Amyotrophic Lateral Sclerosis. Acad Radiol 2017; 24:1185-1186. [PMID: 28822630 DOI: 10.1016/j.acra.2017.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Elias R Melhem
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201.
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13
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Multimodal assessment of white matter tracts in amyotrophic lateral sclerosis. PLoS One 2017; 12:e0178371. [PMID: 28575122 PMCID: PMC5456080 DOI: 10.1371/journal.pone.0178371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
Several quantitative magnetic resonance imaging (MRI) techniques have been proposed to investigate microstructural tissue changes in amyotrophic lateral sclerosis (ALS) including diffusion tensor imaging (DTI), magnetization transfer imaging, and R2* mapping. Here, in this study, we compared these techniques with regard to their capability for detecting ALS related white matter (WM) changes in the brain and their association with clinical findings. We examined 27 ALS patients and 35 age-matched healthy controls. MRI was performed at 3T, after which we analyzed the diffusion properties, the magnetization transfer ratio (MTR), and the effective transversal relaxation rate R2* in 18 WM tracts that were obtained by a fully automated segmentation technique. ALS patients, especially with a bulbar onset, showed a bilateral increase in radial and mean diffusivity, as well as a reduction in fractional anisotropy of the corticospinal tract (CST), and diffusion changes in the parietal and temporal superior longitudinal fasciculus. A reduction of the MTR was found in both CSTs and an R2* reduction was seen only in the left CST. Tract-specific diffusion properties were not related to clinical status in a cross-sectional manner but demonstrated some association with disease progression over three subsequent months. DTI reveals more widespread WM tissue changes than MTR and R2*. These changes are not restricted to the CST, but affect also other WM tracts (especially in patients with bulbar onset), and are associated with the short term course of the disease.
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Atassi N, Xu M, Triantafyllou C, Keil B, Lawson R, Cernasov P, Ratti E, Long CJ, Paganoni S, Murphy A, Salibi N, Seethamraju R, Rosen B, Ratai EM. Ultra high-field (7tesla) magnetic resonance spectroscopy in Amyotrophic Lateral Sclerosis. PLoS One 2017; 12:e0177680. [PMID: 28498852 PMCID: PMC5428977 DOI: 10.1371/journal.pone.0177680] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/01/2017] [Indexed: 12/11/2022] Open
Abstract
The main objective of this study was to utilize high field (7T) in vivo proton magnetic resonance imaging to increase the ability to detect metabolite changes in people with ALS, specifically, to quantify levels of glutamine and glutamine separately. The second objective of this study was to correlate metabolic markers with clinical outcomes of disease progression. 13 ALS participants and 12 age-matched healthy controls (HC) underwent 7 Tesla MRI and MRS. Single voxel MR spectra were acquired from the left precentral gyrus using a very short echo time (TE = 5 ms) STEAM sequence. MRS data was quantified using LCModel and correlated to clinical outcome markers. N-acetylaspartate (NAA) and total NAA (tNA, NAA + NAAG) were decreased by 17% in people with ALS compared to HC (P = 0.004 and P = 0.005, respectively) indicating neuronal injury and/or loss in the precentral gyrus. tNA correlated with disease progression as measured by forced vital capacity (FVC) (P = 0.014; Rρ = 0.66) and tNA/tCr correlated with overall functional decline as measured by worsening of the ALS Functional Rating Scale-Revised (ALSFRS-R) (P = 0.004; Rρ = -0.74). These findings underscore the importance of NAA as a reliable biomarker for neuronal injury and disease progression in ALS. Glutamate (Glu) was 15% decreased in people with ALS compared to HC (P = 0.02) while glutamine (Gln) concentrations were similar between the two groups. Furthermore, the decrease in Glu correlated with the decrease in FVC (P = 0.013; Rρ = 0.66), a clinical marker of disease progression. The decrease in Glu is most likely driven by intracellular Glu loss due to neuronal loss and degeneration. Neither choline containing components (Cho), a marker for cell membrane turnover, nor myo-Inositol (mI), a suspected marker for neuroinflammation, showed significant differences between the two groups. However, mI/tNA was correlated with upper motor neuron burden (P = 0.004, Rρ = 0.74), which may reflect a relative increase of activated microglia around motor neurons. In summary, 7T 1H MRS is a powerful non-invasive imaging technique to study molecular changes related to neuronal injury and/or loss in people with ALS.
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Grants
- Harvard NeuroDiscovery Center, Muscular Dystrophy Association Clinical Research Training Grant, Research fellowship from the American Academy of Neurology, and the Anne B. Young neuroscience translational medicine fellowship
- Harvard NeuroDiscovery Center
- Siemens Healthcare GmbH provided support in the form of salaries for author CT, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript
- Siemens Healthcare GmbH provided support in the form of salaries for author NS, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript
- Siemens Healthcare GmbH provided support in the form of salaries for author RS, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript
- Biogen provided support in the form of salaries for author ER, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript
- Harvard NeuroDiscovery Center and the Amyotrophic Lateral Sclerosis Association (ALSA), National Institute of Neurological Disorders and Stroke (NINDS), R25NS065743, title: Neuroscience resident research program, and the Dr. Anne B. Young Neuroscience Translational Medicine Fellowship (Massachusetts General Hospital Neurology and Biogen).
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Affiliation(s)
- Nazem Atassi
- Neurological Clinical Research Institute (NCRI), Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maosheng Xu
- Department of Radiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, P.R. China
| | - Christina Triantafyllou
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, and Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Boris Keil
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, and Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Robert Lawson
- Neurological Clinical Research Institute (NCRI), Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul Cernasov
- Neurological Clinical Research Institute (NCRI), Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Elena Ratti
- Neurological Clinical Research Institute (NCRI), Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Christopher J. Long
- Massachusetts Institute of Technology, Sloan School of Management, Cambridge, Massachusetts, United States of America
| | - Sabrina Paganoni
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Alyssa Murphy
- Neurological Clinical Research Institute (NCRI), Department of Neurology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Nouha Salibi
- Siemens Healthineers, MR R&D, Siemens, Auburn, Alabama, United States of America
| | - Ravi Seethamraju
- Siemens Healthineers, MR R&D, Siemens, Charlestown, Massachusetts, United States of America
| | - Bruce Rosen
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, and Harvard Medical School, Charlestown, Massachusetts, United States of America
| | - Eva-Maria Ratai
- Department of Radiology, Massachusetts General Hospital, Athinoula A. Martinos Center for Biomedical Imaging, and Harvard Medical School, Charlestown, Massachusetts, United States of America
- * E-mail:
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Bontempi P, Busato A, Bonafede R, Schiaffino L, Scambi I, Sbarbati A, Mariotti R, Marzola P. MRI reveals therapeutical efficacy of stem cells: An experimental study on the SOD1(G93A) animal model. Magn Reson Med 2017; 79:459-469. [PMID: 28370153 DOI: 10.1002/mrm.26685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/25/2017] [Accepted: 03/03/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The first part of the experiment identifies and validates MRI biomarkers distinctive of the disease progression in the transgenic superoxide dismutase gene (SOD1(G93A)) animal model. The second part assesses the efficacy of a mesenchymal stem cell-based therapy through the MRI biomarkers previously defined. METHODS The first part identifies MRI differences between SOD1(G93A) and healthy mice. The second part of the experiment follows the disease evolution of stem cell-treated and non-stem-cell treated SOD1(G93A) mice. The analysis focused on voxel-based morphometry and T2 mapping on the brain tissues, and T2-weighted imaging and diffusion tensor imaging (DTI) on the hind limbs. RESULTS Comparing diseased mice to healthy control revealed gray matter alterations in the brainstem area, accompanied by increased T2 relaxation time. Differences in muscle volume, muscle signal intensity, fractional anisotropy, axial diffusivity, and radial diffusivity were measured in the hind limbs. In the comparison between stem cell-treated mice and nontreated ones, differences in muscle volume, muscle signal intensity, and DTI-derived maps were found. CONCLUSION MRI-derived biomarkers can be used to identify differences between stem cell-treated and nontreated SOD1(G93A) mice. Magn Reson Med 79:459-469, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Pietro Bontempi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Alice Busato
- Department of Computer Science, University of Verona, Verona, Italy
| | - Roberta Bonafede
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Schiaffino
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilaria Scambi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raffaella Mariotti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pasquina Marzola
- Department of Computer Science, University of Verona, Verona, Italy
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16
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Busato A, Fumene Feruglio P, Parnigotto PP, Marzola P, Sbarbati A. In vivo imaging techniques: a new era for histochemical analysis. Eur J Histochem 2016; 60:2725. [PMID: 28076937 PMCID: PMC5159782 DOI: 10.4081/ejh.2016.2725] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 01/15/2023] Open
Abstract
In vivo imaging techniques can be integrated with classical histochemistry to create an actual histochemistry of water. In particular, Magnetic Resonance Imaging (MRI), an imaging technique primarily used as diagnostic tool in clinical/preclinical research, has excellent anatomical resolution, unlimited penetration depth and intrinsic soft tissue contrast. Thanks to the technological development, MRI is not only capable to provide morphological information but also and more interestingly functional, biophysical and molecular. In this paper we describe the main features of several advanced imaging techniques, such as MRI microscopy, Magnetic Resonance Spectroscopy, functional MRI, Diffusion Tensor Imaging and MRI with contrast agent as a useful support to classical histochemistry.
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Affiliation(s)
- A Busato
- University of Verona, Department of Computer Science.
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17
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Budrewicz S, Szewczyk P, Bladowska J, Podemski R, Koziorowska-Gawron E, Ejma M, Słotwiński K, Koszewicz M. The possible meaning of fractional anisotropy measurement of the cervical spinal cord in correct diagnosis of amyotrophic lateral sclerosis. Neurol Sci 2015; 37:417-21. [PMID: 26590991 PMCID: PMC4789300 DOI: 10.1007/s10072-015-2418-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/03/2015] [Indexed: 12/11/2022]
Abstract
Diagnosis of amyotrophic lateral sclerosis (ALS) is based on clinical criteria and electrophysiological tests (electromyography, and transcranial magnetic stimulation). In the search for ALS biomarkers, the role of imaging procedures is currently emphasized, especially modern MR techniques. MR procedures were performed on 15 ALS patients and a sex- and age-matched control group. The MR examinations were performed with a 1.5-T MR unit, and the protocol consisted of sagittal T1-weighed images, sagittal and axial T2-weighed images, and sagittal T2-weighed FAT SAT images followed by an axial diffusion tensor imaging (DTI) sequence of the cervical spinal cord. FA values in individual segments of the cervical spinal cord were decreased in the ALS group in comparison with the control group. After comparing FA values for anterior, posterior, and lateral corticospinal columns, the greatest difference was observed between the C2 and C5 segments. Spinal cord assessment with the use of FA measurements allows for confirmation of the motor pathways lesion in ALS patients. The method, together with clinical criteria, could be helpful in ALS diagnosis, assessment of clinical course, or even the effects of new drugs. The results also confirmed the theory of the generalized character of ALS.
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Affiliation(s)
- Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Pawel Szewczyk
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Ryszard Podemski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Ewa Koziorowska-Gawron
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Słotwiński
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
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19
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Role of diffusion tensor imaging or magnetic resonance spectroscopy in the diagnosis and disability assessment of amyotrophic lateral sclerosis. J Neurol Sci 2015; 348:206-10. [DOI: 10.1016/j.jns.2014.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 12/11/2022]
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20
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Hussain A, Utz MJ, Tian W, Liu X, Ekholm S. Imaging and Diseases of the Ascending and Descending Pathways. Semin Ultrasound CT MR 2014; 35:474-86. [DOI: 10.1053/j.sult.2014.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Lessons of ALS imaging: Pitfalls and future directions - A critical review. NEUROIMAGE-CLINICAL 2014; 4:436-43. [PMID: 24624329 PMCID: PMC3950559 DOI: 10.1016/j.nicl.2014.02.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/23/2014] [Accepted: 02/23/2014] [Indexed: 12/19/2022]
Abstract
Background While neuroimaging in ALS has gained unprecedented momentum in recent years, little progress has been made in the development of viable diagnostic, prognostic and monitoring markers. Objectives To identify and discuss the common pitfalls in ALS imaging studies and to reflect on optimal study designs based on pioneering studies. Methods A “PubMed”-based literature search on ALS was performed based on neuroimaging-related keywords. Study limitations were systematically reviewed and classified so that stereotypical trends could be identified. Results Common shortcomings, such as relatively small sample sizes, statistically underpowered study designs, lack of disease controls, poorly characterised patient cohorts and a large number of conflicting studies, remain a significant challenge to the field. Imaging data of ALS continue to be interpreted at a group-level, as opposed to meaningful individual-patient inferences. Conclusions A systematic, critical review of ALS imaging has identified stereotypical shortcomings, the lessons of which should be considered in the design of future prospective MRI studies. At a time when large multicentre studies are underway a candid discussion of these factors is particularly timely. Stereotypical shortcomings can be identified in ALS neuroimaging studies. A systematic discussion of ALS study limitations is particularly timely. Individual patient data meta-analyses and multicentre studies are urgently required. The gaps identified in ALS imaging indicate exciting research opportunities.
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Key Words
- AD, axial diffusivity
- Amyotrophic lateral sclerosis
- Biomarker
- C9orf72, chromosome 9 open reading frame 72
- DTI, diffusion tensor imaging
- FA, fractional anisotropy
- MD, mean diffusivity
- MEG, magnetoencephalography
- MRI
- MRS, magnetic resonance spectroscopy
- MUNE, motor unit number estimation
- PET
- PET, positron emission tomography
- PNS, peripheral nervous system
- RD, radial diffusivity
- ROI, region of interest
- SPECT, single photon emission computed tomography
- Spectroscopy
- TMS, transcranial magnetic stimulation
- VBM, voxel-based morphometry
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Prell T, Schenk A, Witte OW, Grosskreutz J, Günther A. Transcranial brainstem sonography as a diagnostic tool for amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:244-9. [DOI: 10.3109/21678421.2014.881499] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Les critères d’Awaji : les nouveaux critères diagnostiques de la sclérose latérale amyotrophique. Rev Neurol (Paris) 2013; 169:470-5. [DOI: 10.1016/j.neurol.2012.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 10/22/2012] [Indexed: 11/18/2022]
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Abstract
Introduction Cognitive and behavioral impairments are considered to occur frequently in amyotrophic lateral sclerosis/motor neuron disease (MND). Rarely, apraxia has been reported in MND. Orofacial, or buccofacial, apraxia is characterized by a loss of voluntary control of facial, lingual, pharyngeal and masticatory muscles in the presence of preserved reflexive and automatic functions of the same muscles. Methods We report a patient with MND who presented with spastic dysarthria and asymmetric orofacial apraxia. She progressed to frontotemporal dementia (FTD). Results Clinical and neurophysiological examinations were suggestive of bulbar-onset MND-FTD. Tractography showed a reduction of fractional anisotropy in the centrum semiovale, corona radiata, corticomedullary pathway and inferior aspect of the medulla; the changes were more severe on the left side. To our knowledge, this is the first report of an asymmetric presentation of an apraxic syndrome in MND-FTD.
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Affiliation(s)
- Patrícia Pita Lobo
- Department of Neurosciences, Centro Hospitalar Lisboa Norte-Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
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Selective attention and the three-process memory model for the interpretation of verbal free recall in amyotrophic lateral sclerosis. J Int Neuropsychol Soc 2012; 18:809-18. [PMID: 22676844 DOI: 10.1017/s1355617712000562] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present study investigates selective attention and verbal free recall in amyotrophic lateral sclerosis (ALS) and examines the contribution of selective attention, encoding, consolidation, and retrieval memory processes to patients' verbal free recall. We examined 22 non-demented patients with sporadic ALS and 22 demographically related controls using Stroop Neuropsychological Screening Test (SNST; selective attention) and Rey Auditory Verbal Learning Test (RAVLT; immediate & delayed verbal free recall). The item-specific deficit approach (ISDA) was applied to RAVLT to evaluate encoding, consolidation, and retrieval difficulties. ALS patients performed worse than controls on SNST (p < .001) and RAVLT immediate and delayed recall (p < .001) and showed deficient encoding (p = .001) and consolidation (p = .002) but not retrieval (p = .405). Hierarchical regression analysis revealed that SNST and ISDA indices accounted for: (a) 91.1% of the variance in RAVLT immediate recall, with encoding (p = .016), consolidation (p < .001), and retrieval (p = .032) significantly contributing to the overall model and the SNST alone accounting for 41.6%; and (b) 85.2% of the variance in RAVLT delayed recall, with consolidation (p < .001) and retrieval (p = .008) significantly contributing to the overall model and the SNST alone accounting for 39.8%. Thus, selective attention, encoding, and consolidation, and to a lesser extent of retrieval, influenced both immediate and delayed verbal free recall. Concluding, selective attention and the memory processes of encoding, consolidation, and retrieval should be considered while interpreting patients' impaired free recall. (JINS, 2012, 18, 1-10).
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Magnetic resonance imaging in amyotrophic lateral sclerosis. Neurol Res Int 2012; 2012:608501. [PMID: 22848820 PMCID: PMC3400399 DOI: 10.1155/2012/608501] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 06/05/2012] [Indexed: 11/17/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disorder which is incurable to date. As there are many ongoing studies with therapeutic candidates, it is of major interest to develop biomarkers not only to facilitate early diagnosis but also as a monitoring tool to predict disease progression and to enable correct randomization of patients in clinical trials. Magnetic resonance imaging (MRI) has made substantial progress over the last three decades and is a practical, noninvasive method to gain insights into the pathology of the disease. Disease-specific MRI changes therefore represent potential biomarkers for ALS. In this paper we give an overview of structural and functional MRI alterations in ALS with the focus on task-free resting-state investigations to detect cortical network failures.
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27
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Rocha AJD, Maia Júnior ACM. Is magnetic resonance imaging a plausible biomarker for upper motor neuron degeneration in amyotrophic lateral sclerosis/primary lateral sclerosis or merely a useful paraclinical tool to exclude mimic syndromes? A critical review of imaging applicability in clinical routine. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 70:532-9. [DOI: 10.1590/s0004-282x2012000700012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 03/02/2012] [Indexed: 11/22/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that affects motor neurons in the cerebral cortex, brainstem, and spinal cord, brain regions in which conventional magnetic resonance imaging is often uninformative. Although the mean time from symptom onset to diagnosis is estimated to be about one year, the current criteria only prescribe magnetic resonance imaging to exclude "ALS mimic syndromes". Extensive application of non-conventional magnetic resonance imaging (MRI) to the study of ALS has improved our understanding of the in vivo pathological mechanisms involved in the disease. These modern imaging techniques have recently been added to the list of potential ALS biomarkers to aid in both diagnosis and monitoring of disease progression. This article provides a comprehensive review of the clinical applicability of the neuroimaging progress that has been made over the past two decades towards establishing suitable diagnostic tools for upper motor neuron (UMN) degeneration in ALS.
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