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Pasquini J, Firbank MJ, Ceravolo R, Silani V, Pavese N. Diffusion Magnetic Resonance Imaging Microstructural Abnormalities in Multiple System Atrophy: A Comprehensive Review. Mov Disord 2022; 37:1963-1984. [PMID: 36036378 DOI: 10.1002/mds.29195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023] Open
Abstract
Multiple system atrophy (MSA) is a neurodegenerative disease characterized by autonomic failure, ataxia, and/or parkinsonism. Its prominent pathological alterations can be investigated using diffusion magnetic resonance imaging (dMRI), a technique that exploits the characteristics of water random motion inside brain tissue. The aim of this report was to review currently available literature on the application of dMRI in MSA and to describe microstructural abnormalities, diagnostic applications, and pathophysiological correlates. Sixty-four published studies involving microstructural investigation using dMRI in MSA were included. Widespread microstructural abnormalities of white matter were described, especially in the middle cerebellar peduncle, corticospinal tract, and hemispheric fibers. Gray matter degeneration was identified as well, with diffuse involvement of subcortical structures, especially in the putamina. Diagnostic applications of dMRI were mostly explored for the differential diagnosis between MSA parkinsonism and Parkinson's disease. Recently, machine learning algorithms for image processing and disease classification have demonstrated high diagnostic accuracy, showing potential for translation into clinical practice. To a lesser extent, clinical correlates of microstructural abnormalities have also been investigated, and abnormalities related to motor, ocular, and cognitive impairments were described. dMRI in MSA has contributed to in vivo identification of known pathological abnormalities. Translation into clinical practice of the latest advancements for the differential diagnosis between MSA and other forms of parkinsonism seems feasible. Current limitations involve the possibility of correctly diagnosing MSA in the very early stages, when the clinical diagnosis is most uncertain. Furthermore, pathophysiological correlates of microstructural abnormalities remain understudied. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jacopo Pasquini
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michael J Firbank
- Positron Emission Tomography Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Roberto Ceravolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Neurodegenerative Diseases Center, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation, Dino Ferrari Center, Università degli Studi di Milano, Milan, Italy
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, United Kingdom.,Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark
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Hara K, Watanabe H, Bagarinao E, Kawabata K, Yoneyama N, Ohdake R, Imai K, Masuda M, Yokoi T, Ogura A, Tsuboi T, Ito M, Atsuta N, Niwa H, Taoka T, Maesawa S, Naganawa S, Katsuno M, Sobue G. Corpus callosal involvement is correlated with cognitive impairment in multiple system atrophy. J Neurol 2018; 265:2079-2087. [PMID: 29974207 DOI: 10.1007/s00415-018-8923-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/28/2018] [Accepted: 06/01/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We examined the anatomical involvement related to cognitive impairment in patients with multiple system atrophy (MSA). METHODS We examined 30 patients with probable MSA and 15 healthy controls. All MSA patients were assessed by the Unified MSA-Rating scale and Addenbrooke's Cognitive Examination-Revised (ACE-R). We classified 15 MSA patients with ACE-R scores > 88 as having normal cognition (MSA-NC) and 15 with scores ≤ 88 as having cognitive impairment (MSA-CI). All subjects underwent 3 T MRI scanning and were investigated using voxel-based morphometry and diffusion tensor imaging. RESULTS Both the MSA-NC and MSA-CI patients exhibited cerebellar but not cerebral atrophy in voxel-based morphometry compared to controls. In contrast, tract-based spatial statistics revealed widespread and significantly decreased fractional anisotropy (FA) values, as well as increased mean diffusivity, radial diffusivity, and axial diffusivity in both the cerebrum and cerebellum in MSA-CI patients compared to controls. MSA-NC patients also exhibited similar involvement of the cerebellum but less extensive involvement of the cerebrum compared with the MSA-CI patients. In particular, FA values in MSA-CI patients were significantly decreased in the anterior part of the left corpus callosum compared with those in MSA-NC patients. The mean FA values in the left anterior part of the corpus callosum were significantly correlated with total ACE-R scores and subscores (memory, fluency, and language) in MSA patients. CONCLUSIONS Decreased FA values in the anterior corpus callosum showed a significant correlation with cognitive impairment in MSA.
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Affiliation(s)
- Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan. .,Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan.
| | - Epifanio Bagarinao
- Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan
| | - Kazuya Kawabata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Noritaka Yoneyama
- Department of Neurology, Handa City Hospital, 475-8559, Handa, Japan
| | - Reiko Ohdake
- Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan
| | - Kazunori Imai
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Takamasa Yokoi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Aya Ogura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Mizuki Ito
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Naoki Atsuta
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, 448-8505, Kariya, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nagoya University Graduate School of Medicine, 466-8550, Nagoya, Japan
| | - Satoshi Maesawa
- Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan.,Department of Neurosurgery, Nagoya University Graduate School of Medicine, 466-8550, Nagoya, Japan
| | - Shinji Naganawa
- Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan.,Department of Radiology, Nagoya University Graduate School of Medicine, 466-8550, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.,Brain and Mind Research Center, Nagoya University, 466-8550, Nagoya, Japan
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Zanigni S, Evangelisti S, Testa C, Manners DN, Calandra-Buonaura G, Guarino M, Gabellini A, Gramegna LL, Giannini G, Sambati L, Cortelli P, Lodi R, Tonon C. White matter and cortical changes in atypical parkinsonisms: A multimodal quantitative MR study. Parkinsonism Relat Disord 2017; 39:44-51. [DOI: 10.1016/j.parkreldis.2017.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/05/2017] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
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Kim HJ, Jeon B, Fung VSC. Role of Magnetic Resonance Imaging in the Diagnosis of Multiple System Atrophy. Mov Disord Clin Pract 2016; 4:12-20. [PMID: 30363358 DOI: 10.1002/mdc3.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/04/2016] [Indexed: 12/14/2022] Open
Abstract
Background Multiple system atrophy (MSA) is a rapidly progressing neurodegenerative disorder without effective disease-modifying therapies. Because of a lack of reliable diagnostic biomarkers, there has been increasing interest in using magnetic resonance imaging (MRI) to improve the diagnostic accuracy of MSA. Methods This review summarizes recent literatures on the role of MRI in the diagnosis of MSA. Results Several MRI abnormalities on conventional MRI already are included in the current diagnostic criteria for MSA. Other features on conventional MRI are also used to make a diagnosis of MSA or to rule out alternative diagnoses. On the other hand, some of the MRI findings that were previously considered suggestive of a diagnosis of MSA are now being challenged, because it turned out that they were not as specific to MSA as previously thought. More advanced MRI modalities, including susceptibility-weighted imaging, diffusion-weighted imaging, diffusion tensor imaging, voxel-based morphometry, and cortical thickness analysis, are now used to study the changes in the brains of patients with MSA. Furthermore, studies have produced promising results demonstrating the use of MRI as a tool for monitoring and assessing disease progression in MSA. Conclusions MRI is useful and indispensable in the diagnosis of MSA and also possibly for monitoring disease progression. In this regard, well-designed, long-term, prospective studies on large numbers of patients are needed.
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Affiliation(s)
- Han-Joon Kim
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center Parkinson Study Group, and Neuroscience Research Institute College of Medicine Seoul National University Seoul Korea
| | - Victor S C Fung
- Movement Disorders Unit Department of Neurology Westmead Hospital and Sydney Medical School Sydney Australia
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Rulseh AM, Keller J, Rusz J, Syka M, Brozova H, Rusina R, Havrankova P, Zarubova K, Malikova H, Jech R, Vymazal J. Diffusion tensor imaging in the characterization of multiple system atrophy. Neuropsychiatr Dis Treat 2016; 12:2181-7. [PMID: 27616888 PMCID: PMC5008640 DOI: 10.2147/ndt.s109094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Multiple system atrophy (MSA) is a rare neurodegenerative disease that remains poorly understood, and the diagnosis of MSA continues to be challenging. We endeavored to improve the diagnostic process and understanding of in vivo characteristics of MSA by diffusion tensor imaging (DTI). MATERIALS AND METHODS Twenty MSA subjects, ten parkinsonian dominant (MSA-P), ten cerebellar dominant (MSA-C), and 20 healthy volunteer subjects were recruited. Fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps were processed using tract-based spatial statistics. Diffusion data were additionally evaluated in the basal ganglia. A support vector machine was used to assess diagnostic utility, leave-one-out cross-validation in the evaluation of classification schemes, and receiver operating characteristic analyses to determine cutoff values. RESULTS We detected widespread changes in the brain white matter of MSA subjects; however, no group-wise differences were found between MSA-C and MSA-P subgroups. Altered DTI metrics in the putamen and middle cerebellar peduncles were associated with a positive parkinsonian and cerebellar phenotype, respectively. Concerning clinical applicability, we achieved high classification performance on mean diffusivity data in the combined bilateral putamen and middle cerebellar peduncle (accuracy 90.3%±9%, sensitivity 86.5%±11%, and specificity 99.3%±4%). CONCLUSION DTI in the middle cerebellar peduncle and putamen may be used in the diagnosis of MSA with a high degree of accuracy.
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Affiliation(s)
- Aaron Michael Rulseh
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic; Department of Radiology, 1st Faculty of Medicine, General University Hospital, Charles University in Prague, Prague, Czech Republic; National Institute of Mental Health, Klecany, Czech Republic
| | - Jiri Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic; 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic; Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Michael Syka
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Hana Brozova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Robert Rusina
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Thomayer Hospital, Prague, Czech Republic
| | - Petra Havrankova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Katerina Zarubova
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Josef Vymazal
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
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Rozenfeld MN, Nemeth AJ, Walker MT, Mohan P, Wang X, Parrish TB, Opal P. An investigation of diffusion imaging techniques in the evaluation of spinocerebellar ataxia and multisystem atrophy. J Clin Neurosci 2014; 22:166-72. [PMID: 25439745 DOI: 10.1016/j.jocn.2014.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 08/30/2014] [Indexed: 12/14/2022]
Abstract
Multisystem system atrophy and spinocerebellar ataxia are rare neurodegenerative ataxias that can be difficult to diagnose, with important prognostic and treatment implications. The purpose of this study is to evaluate various methods of diffusion imaging and tractography in their effectiveness at differentiating these diseases from control subjects. Our secondary aim is determining whether diffusion abnormalities correspond with clinical disease severity. Diffusion imaging and tractography were performed on five patients and seven age-matched controls. Fractional anisotropy, generalized fractional anisotropy, and apparent diffusion coefficient values and corticospinal tract volumes were measured within various diffusion and probabilistic tractography models, including standard diffusion tensor and Q-ball tractography. Standard diffusion based fractional anisotropy and apparent diffusion coefficient values were significantly altered in patients versus controls in the middle cerebellar peduncles and central pons. Tractography based fractional anisotropy and generalized fractional anisotropy values were significantly lower in patients versus controls when corticospinal tracts were drawn in a craniocaudal direction (bilaterally using Q-ball imaging, only on the right using diffusion tensor imaging). The right corticospinal tract volume was significantly smaller in patients versus controls when created using Q-ball imaging in a caudocranial direction. There was no correlation between diffusion alteration and clinical symptomatology. In conclusion, various diffusion-based techniques can be effective in differentiating ataxic patients from control subjects, although the selection of diffusion algorithm and tract growth technique and direction is non-trivial.
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Affiliation(s)
- Michael N Rozenfeld
- Department of Radiology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
| | - Alexander J Nemeth
- Department of Radiology, Northwestern University, Chicago, IL, USA; Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Matthew T Walker
- Northshore University Health Systems, Department of Radiology, Evanston, IL, USA
| | - Prasoon Mohan
- St. Francis Hospital, Department of Radiology, Evanston, IL, USA
| | - Xue Wang
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Todd B Parrish
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Puneet Opal
- Ken and Ruth Davee Department of Neurology, Northwestern University, Chicago, IL, USA.
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7
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Yang H, Wang X, Liao W, Zhou G, Li L, Ouyang L. Application of diffusion tensor imaging in multiple system atrophy: the involvement of pontine transverse and longitudinal fibers. Int J Neurosci 2014; 125:18-24. [PMID: 24555517 DOI: 10.3109/00207454.2014.896914] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Many studies have demonstrated the degeneration of pontine transverse and longitudinal tracts in multiple system atrophy (MSA). One purpose of this study was to assess whether diffusion tensor imaging (DTI) can show microstructural abnormalities in these tracts in patients with MSA cerebellar type (MSA-C). Another purpose was to determine the correlation between cross sign progress and pontine fiber degeneration in these patients. MATERIALS AND METHODS Thirty patients with MSA-C and 30 healthy volunteers underwent conventional magnetic resonance imaging (MRI) and DTI. Regions of interest were placed in both cerebral peduncles, the posterior limbs of the internal capsule and the pontine crossing tract of each subject. Quantitative indexes such as fractional anisotropy (FA) and mean diffusivity (MD) were compared between groups by analysis of variance. Cross sign was divided into three grades as follows: 0, no cross sign; 1, vertical line only; 2, clear cross sign. Spearman rank correlation analysis was used between FA, MD, and the cross grade in patients with MSA-C. RESULTS FA and MD in the MSA-C group, and each cross grade, showed statistically significant differences compared to control groups. There was a close correlation between all measures. FA decreased and MD increased, and cross grade formed gradually in the patients. CONCLUSION DTI can identify microstructural abnormalities in pontine transverse and longitudinal fibers even in patients without abnormalities on conventional MRI. Along with pontine transverse tract degeneration, the cross sign develops accompanied by the start of longitudinal tract degeneration, ultimately resulting in the complete formation of a cross sign.
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Affiliation(s)
- Haixia Yang
- Department of Radiology, Xiangya Hospital, Central South University , Changsha, Hunan , China
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Watanabe H, Senda J, Ito M, Atsuta N, Haram K, Watanabe H, Nakamura R, Tsuboi T, Yoshida M, Naganawa S, Sobue G. [Cutting-edge MRI techniques for studying neurological diseases focusing on spinocerebellar degeneration]. Rinsho Shinkeigaku 2013; 53:1087-90. [PMID: 24291887 DOI: 10.5692/clinicalneurol.53.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This symposium discusses the utility of the different MR techniques in the diagnosis and management of spinocerebellar degeneration (SCD). Conventional MRI is widely used and can show characteristic signal abnormalities such as putaminal hyperintensity, hyperintense putaminal rim, putaminal hypointensity, hot cross bun sign in the pontine base, and hyperintensity in the middle cerebellar peduncles strengthening a diagnosis of multiple system atrophy (MSA). However, the diagnostic utility of these signal abnormalities in early MSA remains restricted. In addition, it should be considered that different magnetic field strengths and sequences could be influenced on the findings resulting false negative. On the other hand, proton magnetic resonance spectroscopy, diffusion weighted imaging (DWI), diffusion tensor imaging (DTI) and voxel based morphometry (VBM) in the pontine base, cerebellum, and putamen will be informative in the early diagnosis of MSA and other SCD prior to conventional MRI changes and even before any clinical manifestation of symptoms. Particularly, DWI, DTI, and VBM are expected to have potential as surrogate markers of disease progression. Further prospective and large studies including earlier disease stages will be needed to clarify whether these novel MR techniques will aid in the future sets of diagnostic criteria and therapeutic trials.
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Affiliation(s)
- Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine
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Ishihara T, Ito M, Niimi Y, Tsujimoto M, Senda J, Kawai Y, Watanabe H, Ishigami M, Ito T, Kamei H, Onishi Y, Nakamura T, Goto H, Naganawa S, Kiuchi T, Sobue G. Clinical and radiological impact of liver transplantation for brain in cirrhosis patients without hepatic encephalopathy. Clin Neurol Neurosurg 2013; 115:2341-7. [DOI: 10.1016/j.clineuro.2013.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 08/08/2013] [Accepted: 08/12/2013] [Indexed: 12/14/2022]
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Diagnostic accuracy using diffusion tensor imaging in the diagnosis of ALS: a meta-analysis. Acad Radiol 2012; 19:1075-86. [PMID: 22749050 DOI: 10.1016/j.acra.2012.04.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/05/2012] [Accepted: 04/06/2012] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES A number of studies have reported decreases in fractional anistropy (FA) in amyotrophic lateral sclerosis using diffusion tensor imaging (DTI). The purpose of this study was to perform a meta-analysis in order to estimate the diagnostic test accuracy measures of DTI for the diagnosis of amyotrophic lateral sclerosis (ALS). MATERIALS AND METHODS We searched MEDLINE (1966-April 2011), EMBASE (1999-April 2011), CINAHL (1999-April 2011), and Cochrane (2005-April 2011) databases to identify studies that measured FA in ALS subjects. Human, single-center studies using a DTI region of interest (ROI) or tractography techniques were used to compare FA values along the brain corticospinal tracts between ALS subjects and healthy controls. There were no language restrictions. Independent extraction of articles by 2 authors using predefined data fields including study quality indicators. We identified 30 case-control studies that used region of interest or tractography DTI techniques. We applied binormal receiver operative characteristic (ROC) curve analysis to assign specificity and sensitivity for each study. We applied the bivariate mixed-effects regression model using the Markov Chain Monte Carlo Simulation to calculate summary estimates for the sensitivity and specificity. We used the metan module in Stata, version 11.0, to calculate the area under the ROC curve, diagnostic odds ratio and the test effectiveness summary estimates. RESULTS The pooled sensitivity was 0.65 (95% CI 0.61-0.69); the pooled specificity, 0.67 (95% CI 0.63-0.72); the pooled diagnostic odds ratio, 1.88 (95% CI 1.46-2.30); the pooled test effectiveness, 1.04 (95% CI 0.81-1.27); and the pooled area under the ROC curve, 0.76 (95% CI 0.71-0.81). Subanalyses comparing magnetic resonance imaging (MRI) field strength (1.5T vs. 3.0T) and brain location (corticospinal tract average vs. internal capsule) revealed no significant differences in the test accuracy measures. Reference standard used for the diagnosis of ALS was the El Escorial criteria. There was at least moderate heterogeneity between the studies. True study quality is uncertain. CONCLUSION The discriminatory capability of DTI to make a diagnosis of ALS is only modest. There were no significant differences in the diagnostic test accuracy summary estimates with respect to MRI field strength or brain location.
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Makino T, Ito S, Kuwabara S. Involvement of pontine transverse and longitudinal fibers in multiple system atrophy: a tractography-based study. J Neurol Sci 2011; 303:61-6. [PMID: 21310434 DOI: 10.1016/j.jns.2011.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/28/2010] [Accepted: 01/13/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Pathological studies showed both pontine transverse (cortico-ponto-cerebellar) and longitudinal (corticospinal) fibers degenerate in MSA. The objective was to investigate the association between the development of cross sign, degenerations of pontine fibers, and the frequency of pyramidal signs in MSA. METHODS Patients with MSA (n=26) and healthy subjects (n=27) were enrolled in this study. Whole pontine transverse and longitudinal fibers were individually traced by diffusion tensor tractography. FA was calculated along each entire tractography. Cross sign was graded as: 0, no cross sign; 1, anterior-posterior line only; and 2, complete cross sign. T2-hyperintense MCPs was graded as: 0, no change; 1, slight signal change; and 2, severe signal change. FA of pontine fibers in MSA patients and that in healthy subjects was statistically evaluated by ANOVA with an overall statistical significance level of 0.05. The frequency of pyramidal signs in MSA was compared between each cross and MCP grade. RESULTS FA of pontine transverse fibers in MSA patients decreased with the development of cross sign. FA of Cross 2 was significantly lower than that of healthy subjects (p=0.003). As regards pontine longitudinal fibers, FA decreased when cross sign was completed. The frequency of pyramidal signs in MCP 2 and 1 was higher than that in MCP 0. CONCLUSION Pontine transverse fibers degenerate as cross sign develop, and degenerations of pontine longitudinal fibers begin, or even accelerate when cross sign becomes apparent. Pyramidal signs are frequently present when T2-hyperintense MCPs are clearly observed.
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Affiliation(s)
- Takahiro Makino
- Department of Neurology, Graduate School of Medicine, Chiba University, Japan
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