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Li Y, El Habib Daho M, Conze PH, Zeghlache R, Le Boité H, Tadayoni R, Cochener B, Lamard M, Quellec G. A review of deep learning-based information fusion techniques for multimodal medical image classification. Comput Biol Med 2024; 177:108635. [PMID: 38796881 DOI: 10.1016/j.compbiomed.2024.108635] [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: 10/05/2023] [Revised: 03/18/2024] [Accepted: 05/18/2024] [Indexed: 05/29/2024]
Abstract
Multimodal medical imaging plays a pivotal role in clinical diagnosis and research, as it combines information from various imaging modalities to provide a more comprehensive understanding of the underlying pathology. Recently, deep learning-based multimodal fusion techniques have emerged as powerful tools for improving medical image classification. This review offers a thorough analysis of the developments in deep learning-based multimodal fusion for medical classification tasks. We explore the complementary relationships among prevalent clinical modalities and outline three main fusion schemes for multimodal classification networks: input fusion, intermediate fusion (encompassing single-level fusion, hierarchical fusion, and attention-based fusion), and output fusion. By evaluating the performance of these fusion techniques, we provide insight into the suitability of different network architectures for various multimodal fusion scenarios and application domains. Furthermore, we delve into challenges related to network architecture selection, handling incomplete multimodal data management, and the potential limitations of multimodal fusion. Finally, we spotlight the promising future of Transformer-based multimodal fusion techniques and give recommendations for future research in this rapidly evolving field.
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Affiliation(s)
- Yihao Li
- LaTIM UMR 1101, Inserm, Brest, France; University of Western Brittany, Brest, France
| | - Mostafa El Habib Daho
- LaTIM UMR 1101, Inserm, Brest, France; University of Western Brittany, Brest, France.
| | | | - Rachid Zeghlache
- LaTIM UMR 1101, Inserm, Brest, France; University of Western Brittany, Brest, France
| | - Hugo Le Boité
- Sorbonne University, Paris, France; Ophthalmology Department, Lariboisière Hospital, AP-HP, Paris, France
| | - Ramin Tadayoni
- Ophthalmology Department, Lariboisière Hospital, AP-HP, Paris, France; Paris Cité University, Paris, France
| | - Béatrice Cochener
- LaTIM UMR 1101, Inserm, Brest, France; University of Western Brittany, Brest, France; Ophthalmology Department, CHRU Brest, Brest, France
| | - Mathieu Lamard
- LaTIM UMR 1101, Inserm, Brest, France; University of Western Brittany, Brest, France
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2
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Campetella L, Villagrán-García M, Farina A, Benaiteau M, Iorio R, Calabresi P, Vogrig A, Versace S, Ciano-Petersen NL, Bicilli Brotelle E, Branger P, Verlut C, Langner-Lemercier S, Leclancher A, Duwicquet C, Charif M, Kerschen P, Capet N, Renard D, Chanson E, Rafiq M, Tyvaert L, Joubert B, Cotton F, Honnorat J, Muñiz-Castrillo S. Corticospinal tract hyperintensity in patients with LGI1-antibody encephalitis and other central nervous system disorders with neuroglial antibodies. J Neuroimmunol 2024; 390:578346. [PMID: 38648696 DOI: 10.1016/j.jneuroim.2024.578346] [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: 01/18/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
The frequency of corticospinal tract (CST) T2/FLAIR hyperintensity in disorders with neuroglial antibodies is unclear. Herein, we retrospectively reviewed brain MRIs of 101 LGI1-antibody encephalitis patients, and observed CST hyperintensity in 30/101 (30%). It was mostly bilateral (93%), not associated with upper motor neuron signs/symptoms (7%), and frequently decreased over time (39%). In a systematic review including patients with other neuroglial antibodies, CST hyperintensity was reported in 110 with neuromyelitis optica (94%), myelin oligodendrocyte glycoprotein-associated disease (2%), Ma2-antibody (3%) and GAD65-antibody paraneoplastic neurological syndrome (1%). CST hyperintensity is not an infrequent finding in LGI1-Ab encephalitis and other disorders with neuroglial antibodies.
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Affiliation(s)
- Lucia Campetella
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Neuroscience Department, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Macarena Villagrán-García
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Antonio Farina
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Viale Gaetano Pieraccini 6, 50139 Florence, Italy
| | - Marie Benaiteau
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Raffaele Iorio
- Neuroscience Department, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Clinical Neurology, Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Fondazione Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Paolo Calabresi
- Neuroscience Department, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Clinical Neurology, Department of Ageing, Neurosciences, Head-neck and Orthopaedics Sciences, Fondazione Policlinico Universitario A. Gemelli, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine (DAME), University of Udine, Piazzale Massimiliano Kolbe 4, 33100 Udine, Italy
| | - Salvatore Versace
- Clinical Neurology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine (DAME), University of Udine, Piazzale Massimiliano Kolbe 4, 33100 Udine, Italy
| | - Nicolás Lundahl Ciano-Petersen
- Neurology Service, Regional University Hospital of Málaga, Av. de Carlos Haya 84, Bailén-Miraflores 29010, Málaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, C. Severo Ochoa 35, Campanillas, 29590 Málaga, Spain; Red Andaluza de Investigación Clínica y Traslacional en Neurología (NeuroRECA), Av. de Carlos Haya 84, Bailén-Miraflores, 29010 Málaga, Spain
| | - Elodie Bicilli Brotelle
- Neurology Department, Centre Hospitalier d'Avignon, 305A Rue Raoul Follereau, 84000 Avignon, France
| | - Pierre Branger
- Neurology Department, CHU de Caen Normandie, Av. de la Côte de Nacre CS 30001, 14000 Caen, France
| | - Clotilde Verlut
- Neurology Department, CHRU de Besançon, 3 Bd Alexandre Fleming, 25030 Besançon, Cedex, France
| | | | - Alexandre Leclancher
- Department of Clinical Neurophysiology, Amiens University Medical Center, 1 Rue du Professeur Christian Cabrol, 80000 Amiens, France
| | - Coline Duwicquet
- Neurology and Clinical Neurophisiology Department, CHU Bretonneau, 2 Bd Tonnellé, 37000 Tours, France
| | - Mahmoud Charif
- Neurology Department, Multiple Sclerosis Unit, CHU Montpellier, 191 Av. du Doyen Gaston Giraud, 34295 Montpellier, France
| | - Philippe Kerschen
- Neurology Department, Luxembourg Hospital Center, L 4 Rue Nicolas Ernest Barblé, 1210 Rollengergronn-Belair-Nord Luxembourg, Luxembourg
| | - Nicolas Capet
- Neurology Department, Princesse Grace Hospital Center, 1 Av. Pasteur, 98000, Monaco; CRCSEP, Neurologie Pasteur 2, CHU de Nice, and UMR2CA (URRIS), Université Côte d'Azur, 30 Voie Romaine, 06000 Nice, France
| | - Dimitri Renard
- Neurology Department, CHU de Nîmes, 4 Rue du Professeur Robert Debré, 30900 Nîmes, France
| | - Eve Chanson
- Neurology Department, Centre Hospitalier Universitaire Gabriel Montpied, 58 Rue Montalembert, 63000 Clermont-Ferrand, France
| | - Marie Rafiq
- Neurology Department, Hôpital Pierre Paul Riquet, CHU de Toulouse, 2 Rue Charles Viguerie, 31300 Toulouse, France
| | - Louise Tyvaert
- Neurology Department, University Hospital of Nancy, Lorraine University, 29 Av. du Maréchal de Lattre de Tassigny, 54000 Nancy, France
| | - Bastien Joubert
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Neurology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 165 Chem. du Grand Revoyet, 69495 Oullins-Pierre-Bénite, France
| | - François Cotton
- Radiology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165 Chem. du Grand Revoyet, 69495 Oullins-EPierre-Bénite, France; CREATIS, INSERM U1044, CNRS UMR 5220, UCBL1, 43 Bd du 11 Novembre 1918, 69100 Villeurbanne, France
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France
| | - Sergio Muñiz-Castrillo
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, 69008 Lyon, France; Stanford Center for Sleep Sciences and Medicine, Stanford University, 3165 Porter Dr, Palo Alto, CA 94304, United States.
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Kushol R, Luk CC, Dey A, Benatar M, Briemberg H, Dionne A, Dupré N, Frayne R, Genge A, Gibson S, Graham SJ, Korngut L, Seres P, Welsh RC, Wilman AH, Zinman L, Kalra S, Yang YH. SF2Former: Amyotrophic lateral sclerosis identification from multi-center MRI data using spatial and frequency fusion transformer. Comput Med Imaging Graph 2023; 108:102279. [PMID: 37573646 DOI: 10.1016/j.compmedimag.2023.102279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a complex neurodegenerative disorder characterized by motor neuron degeneration. Significant research has begun to establish brain magnetic resonance imaging (MRI) as a potential biomarker to diagnose and monitor the state of the disease. Deep learning has emerged as a prominent class of machine learning algorithms in computer vision and has shown successful applications in various medical image analysis tasks. However, deep learning methods applied to neuroimaging have not achieved superior performance in classifying ALS patients from healthy controls due to insignificant structural changes correlated with pathological features. Thus, a critical challenge in deep models is to identify discriminative features from limited training data. To address this challenge, this study introduces a framework called SF2Former, which leverages the power of the vision transformer architecture to distinguish ALS subjects from the control group by exploiting the long-range relationships among image features. Additionally, spatial and frequency domain information is combined to enhance the network's performance, as MRI scans are initially captured in the frequency domain and then converted to the spatial domain. The proposed framework is trained using a series of consecutive coronal slices and utilizes pre-trained weights from ImageNet through transfer learning. Finally, a majority voting scheme is employed on the coronal slices of each subject to generate the final classification decision. The proposed architecture is extensively evaluated with multi-modal neuroimaging data (i.e., T1-weighted, R2*, FLAIR) using two well-organized versions of the Canadian ALS Neuroimaging Consortium (CALSNIC) multi-center datasets. The experimental results demonstrate the superiority of the proposed strategy in terms of classification accuracy compared to several popular deep learning-based techniques.
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Affiliation(s)
- Rafsanjany Kushol
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada.
| | - Collin C Luk
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Avyarthana Dey
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michael Benatar
- Department of Neurology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hannah Briemberg
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annie Dionne
- Axe Neurosciences, CHU de Québec, Université Laval, Québec, QC, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Nicolas Dupré
- Axe Neurosciences, CHU de Québec, Université Laval, Québec, QC, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Richard Frayne
- Departments of Radiology and Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Angela Genge
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Summer Gibson
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Simon J Graham
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Peter Seres
- Departments of Biomedical Engineering and Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Robert C Welsh
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Alan H Wilman
- Departments of Biomedical Engineering and Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Lorne Zinman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sanjay Kalra
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada; Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Yee-Hong Yang
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
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4
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Loftus JR, Puri S, Meyers SP. Multimodality imaging of neurodegenerative disorders with a focus on multiparametric magnetic resonance and molecular imaging. Insights Imaging 2023; 14:8. [PMID: 36645560 PMCID: PMC9842851 DOI: 10.1186/s13244-022-01358-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/13/2022] [Indexed: 01/17/2023] Open
Abstract
Neurodegenerative diseases afflict a large number of persons worldwide, with the prevalence and incidence of dementia rapidly increasing. Despite their prevalence, clinical diagnosis of dementia syndromes remains imperfect with limited specificity. Conventional structural-based imaging techniques also lack the accuracy necessary for confident diagnosis. Multiparametric magnetic resonance imaging and molecular imaging provide the promise of improving specificity and sensitivity in the diagnosis of neurodegenerative disease as well as therapeutic monitoring of monoclonal antibody therapy. This educational review will briefly focus on the epidemiology, clinical presentation, and pathologic findings of common and uncommon neurodegenerative diseases. Imaging features of each disease spanning from conventional magnetic resonance sequences to advanced multiparametric methods such as resting-state functional magnetic resonance imaging and arterial spin labeling imaging will be described in detail. Additionally, the review will explore the findings of each diagnosis on molecular imaging including single-photon emission computed tomography and positron emission tomography with a variety of clinically used and experimental radiotracers. The literature and clinical cases provided demonstrate the power of advanced magnetic resonance imaging and molecular techniques in the diagnosis of neurodegenerative diseases and areas of future and ongoing research. With the advent of combined positron emission tomography/magnetic resonance imaging scanners, hybrid protocols utilizing both techniques are an attractive option for improving the evaluation of neurodegenerative diseases.
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Affiliation(s)
- James Ryan Loftus
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| | - Savita Puri
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
| | - Steven P. Meyers
- grid.412750.50000 0004 1936 9166Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642 USA
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5
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Dominguez L, Collazo IVM, Sechi E, Bohm P, Chiriboga SL. Neurochondrin immunoglobulin G - Associated myelopathy - Ataxia syndrome. J Neurol Sci 2022; 432:120058. [PMID: 34848095 DOI: 10.1016/j.jns.2021.120058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/28/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Lisette Dominguez
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States of America
| | | | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Parker Bohm
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States of America
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Dean KE, Shen B, Askin G, Schweitzer AD, Shahbazi M, Wang Y, Lange D, Tsiouris AJ. A specific biomarker for amyotrophic lateral sclerosis: Quantitative susceptibility mapping. Clin Imaging 2021; 75:125-130. [PMID: 33548870 DOI: 10.1016/j.clinimag.2020.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/09/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Accurate and timely diagnosis of amyotrophic lateral sclerosis (ALS) is a diagnostic challenge given the lack of specific diagnostic and imaging biomarkers as well as the significant clinic overlap with mimic syndromes. We hypothesize that MR quantitative susceptibility mapping (QSM) can help differentiate ALS from mimic diagnoses. METHODS In a blinded retrospective study of MRIs with QSM from 2015 to 2018, we compared motor cortex susceptibility along the hand and face homunculi in ALS patients and patients with similar clinical presentations. Inclusion required a confirmed ALS or a mimic diagnosis. Comparative groups included age-matched patients with MRIs performed for non-motor neuron symptoms that were reported as normal or demonstrated leukoaraiosis. Quantitative susceptibility values were compared with ANOVA and Tukey-Kramer (post-hoc). ROC analysis and Youden's index were used to identify optimal cutoff values. RESULTS Fifty ALS, 35 mimic, and 70 non-motor neuron symptom patients (35 normal, 35 leukoaraiosis) were included. Hand and face homunculus mean susceptibility values were significantly higher in the ALS group compared to the mimic (p=0.001, p=0.004), leukoaraiosis (p<0.001, p=0.003), and normal (p<0.001, p<0.001) groups. ROC curve analysis comparing ALS to mimics resulted in an area under the curve of 0.71 and 0.67 for the hand and face homunculus measurements, respectively. In differentiating ALS from mimics, Youden's index showed 100% specificity and 36% sensitivity for hand homunculus measurements. CONCLUSIONS QSM has diagnostic potential in the assessment of suspected ALS patients, demonstrating very high specificity in differentiating ALS from mimic diagnoses.
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Affiliation(s)
- Kathryn E Dean
- Department of Radiology, NewYork-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA.
| | - Beiyi Shen
- Department of Radiology, Stony Brook Medicine, Stony Brook, NY, USA
| | - Gulce Askin
- Department of Healthcare Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Andrew D Schweitzer
- Department of Radiology, NewYork-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA
| | - Mona Shahbazi
- Department of Neurology, Hospital for Special Surgery, New York, NY, USA
| | - Yi Wang
- Department of Radiology, NewYork-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA
| | - Dale Lange
- Department of Neurology, Hospital for Special Surgery, New York, NY, USA
| | - Apostolos John Tsiouris
- Department of Radiology, NewYork-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, USA
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Rizzo G, Marliani AF, Battaglia S, Albini Riccioli L, De Pasqua S, Vacchiano V, Infante R, Avoni P, Donadio V, Passaretti M, Bartolomei I, Salvi F, Liguori R. Diagnostic and Prognostic Value of Conventional Brain MRI in the Clinical Work-Up of Patients with Amyotrophic Lateral Sclerosis. J Clin Med 2020; 9:jcm9082538. [PMID: 32781557 PMCID: PMC7463468 DOI: 10.3390/jcm9082538] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 12/27/2022] Open
Abstract
Clinical signs of upper motor neuron (UMN) involvement are important in the diagnosis of amyotrophic lateral sclerosis (ALS) though are often difficult to analyze. Many studies using both qualitative and quantitative evaluations have reported abnormal Magnetic Resonance Imaging (MRI) findings at the level of the pyramidal pathway in patients with ALS. Although the most interesting results were obtained by quantitative studies using advanced MR techniques, the qualitative evaluation of MRI images remains the most-used in clinical practice. We evaluated the diagnostic and prognostic contribution of conventional 3T-MRI in the clinical work-up of ALS patients. Two neuroradiologists retrospectively assessed 3T-MRI data of 93 ALS patients and 89 controls. The features of interest were corticospinal tract (CST) T2/FLAIR hyperintensity, motor cortex (MC) T2*/SWI hypointensity, and selective MC atrophy. All MRI features were significantly more prevalent in ALS patients than in controls. The simultaneous presence of CST FLAIR hyperintensity and MC SWI hypointensity was associated with the highest diagnostic accuracy (sensitivity: 70%; specificity: 81%; positive predictive value, PPV: 90%; negative predictive value, NPV: 51%; accuracy: 73%) and a shorter survival (HR: 6.56, p = 0.002). Conventional 3T-MRI can be a feasible tool to detect specific qualitative changes based on UMN involvement and to support clinical diagnosis of ALS. Importantly, CST FLAIR hyperintensity and MC SWI hypointensity are predictors of shorter survival in ALS patients.
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Affiliation(s)
- Giovanni Rizzo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
- Correspondence: ; Tel.: +39-051-496-6112
| | - Anna Federica Marliani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Stella Battaglia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Luca Albini Riccioli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Silvia De Pasqua
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Veria Vacchiano
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
| | - Rossella Infante
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
| | - Patrizia Avoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Massimiliano Passaretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
| | - Ilaria Bartolomei
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Fabrizio Salvi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via Altura 3, 40139 Bologna, Italy; (S.D.P.); (V.V.); (R.I.); (P.A.); (M.P.); (R.L.)
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura 3, 40139 Bologna, Italy; (A.F.M.); (S.B.); (L.A.R.); (V.D.); (I.B.); (F.S.)
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Dadar M, Manera AL, Zinman L, Korngut L, Genge A, Graham SJ, Frayne R, Collins DL, Kalra S. Cerebral atrophy in amyotrophic lateral sclerosis parallels the pathological distribution of TDP43. Brain Commun 2020; 2:fcaa061. [PMID: 33543125 PMCID: PMC7846188 DOI: 10.1093/braincomms/fcaa061] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/24/2020] [Indexed: 12/27/2022] Open
Abstract
Amyotrophic lateral sclerosis is a neurodegenerative disease characterized by a preferential involvement of both upper and lower motor neurons. Evidence from neuroimaging and post-mortem studies confirms additional involvement of brain regions extending beyond the motor cortex. The aim of this study was to assess the extent of cerebral disease in amyotrophic lateral sclerosis cross-sectionally and longitudinally and to compare the findings with a recently proposed disease-staging model of amyotrophic lateral sclerosis pathology. Deformation-based morphometry was used to identify the patterns of brain atrophy associated with amyotrophic lateral sclerosis and to assess their relationship with clinical symptoms. Longitudinal T1-weighted MRI data and clinical measures were acquired at baseline, 4 months and 8 months, from 66 patients and 43 age-matched controls who participated in the Canadian Amyotrophic Lateral Sclerosis Neuroimaging Consortium study. Whole brain voxel-wise mixed-effects modelling analysis showed extensive atrophy patterns differentiating patients from the normal controls. Cerebral atrophy was present in the motor cortex and corticospinal tract, involving both grey matter and white matter, and to a lesser extent in non-motor regions. More specifically, the results showed significant bilateral atrophy in the motor cortex and corticospinal tract (including the internal capsule and brainstem) and ventricular enlargement, along with significant longitudinal atrophy in precentral gyrus, frontal and parietal white matter, accompanied by ventricular and sulcal enlargement. Atrophy in the precentral gyrus was significantly associated with greater disability as quantified with the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (P < 0.0001). The pattern of atrophy observed using deformation-based morphometry was consistent with the Brettschneider’s four-stage pathological model of the disease. Deformation-based morphometry provides a sensitive indicator of atrophy in Amyotrophic lateral sclerosis and has potential as a biomarker of disease burden, in both grey matter and white matter.
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Affiliation(s)
- Mahsa Dadar
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Ana Laura Manera
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Lorne Zinman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Lawrence Korngut
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta T2N 4N1, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta T2N 4N1, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada
| | - Angela Genge
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Simon J Graham
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario M4N 3M5, Canada
| | - Richard Frayne
- Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta T2N 4N1, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta T2N 4N1, Canada.,Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada
| | - D Louis Collins
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
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9
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Harvey HB, Watson LC, Subramaniam RM, Burns J, Bykowski J, Chakraborty S, Ledbetter LN, Lee RK, Pannell JS, Pollock JM, Powers WJ, Rosenow JM, Shih RY, Slavin K, Utukuri PS, Corey AS. ACR Appropriateness Criteria® Movement Disorders and Neurodegenerative Diseases. J Am Coll Radiol 2020; 17:S175-S187. [PMID: 32370961 DOI: 10.1016/j.jacr.2020.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
Movement disorders and neurodegenerative diseases are a variety of conditions that involve progressive neuronal degeneration, injury, or death. Establishing the correct diagnosis of a movement disorder or neurodegenerative process can be difficult due to the variable features of these conditions, unusual clinical presentations, and overlapping symptoms and characteristics. MRI has an important role in the initial assessment of these patients, although a combination of imaging and laboratory and genetic tests is often needed for complete evaluation and management. This document summarizes the imaging appropriateness data for rapidly progressive dementia, chorea, Parkinsonian syndromes, suspected neurodegeneration with brain iron accumulation, and suspected motor neuron disease. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Laura C Watson
- Research Author, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada; Canadian Association of Radiologists
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Jeffrey S Pannell
- University of California San Diego Medical Center, San Diego, California
| | | | - William J Powers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina; American Academy of Neurology
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Neurosurgery expert
| | - Robert Y Shih
- Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | | | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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10
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Welton T, Maller JJ, Lebel RM, Tan ET, Rowe DB, Grieve SM. Diffusion kurtosis and quantitative susceptibility mapping MRI are sensitive to structural abnormalities in amyotrophic lateral sclerosis. NEUROIMAGE-CLINICAL 2019; 24:101953. [PMID: 31357149 PMCID: PMC6664242 DOI: 10.1016/j.nicl.2019.101953] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/24/2019] [Accepted: 07/19/2019] [Indexed: 12/11/2022]
Abstract
Objective To construct a clinical diagnostic biomarker using state-of-the-art microstructural MRI in the motor cortex of people with amyotrophic lateral sclerosis (ALS). Methods Clinical and MRI data were obtained from 21 ALS patients (aged 54 ± 14 years, 33% female) and 63 age- and gender-matched controls (aged 48 ± 18 years, 43% female). MRI was acquired at 3T and included T1-weighted scan (for volumetrics), arterial spin labelling (for cerebral blood flow), susceptibility-weighted angiography (for iron deposition) and multiband diffusion kurtosis imaging (for tissue microstructure). Group differences in imaging measures in the motor cortex were tested by general linear model and relationships to clinical variables by linear regression. Results The ALS group had mild-to-moderate impairment (disease duration: 1.8 ± 0.8 years; ALS functional rating scale 40.2 ± 6.0; forced vital capacity 83% ± 22%). No age or gender differences were present between groups. We found significant group differences in diffusion kurtosis metrics (apparent, mean, radial and axial kurtosis: p < .01) and iron deposition in the motor cortex (p = .03). Within the ALS group, we found significant relationships between motor cortex volume, apparent diffusion and disease duration (adjusted R2 = 0.27, p = .011); and between the apparent and radial kurtosis metrics and ALS functional rating scale (adjusted R2 = 0.25, p = .033). A composite imaging biomarker comprising kurtosis and iron deposition measures yielded a maximal diagnostic accuracy of 83% (81% sensitivity, 85% specificity) and an area-under-the-curve of 0.86. Conclusion Diffusion kurtosis is sensitive to early changes present in the motor region in ALS. We propose a composite imaging biomarker reflecting tissue microstructural changes in early ALS that may provide clinically valuable diagnostic information. A biomarker based on diffusion kurtosis imaging achieved an accuracy of 83%. Kurtosis-based measures were more abnormal in ALS than tensor-based measures. Motor cortex in the symptomatic hemisphere was smaller and had greater iron concentration. There was a 1 mL volume loss per year in ALS motor cortex.
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Affiliation(s)
- Thomas Welton
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia.
| | - Jerome J Maller
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia; GE Healthcare, Richmond, Victoria, Australia.
| | | | - Ek T Tan
- GE Global Research, Niskayuna, NY, USA.
| | - Dominic B Rowe
- MND Research Centre, Faculty of Medicine and Health Sciences, Macquarie University, NSW, Australia; Macquarie University Hospital, Macquarie, Australia
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Australia; Macquarie University Hospital, Macquarie, Australia; Department of Radiology, Royal Prince Alfred Hospital, Sydney, Australia.
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11
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Verber NS, Shepheard SR, Sassani M, McDonough HE, Moore SA, Alix JJP, Wilkinson ID, Jenkins TM, Shaw PJ. Biomarkers in Motor Neuron Disease: A State of the Art Review. Front Neurol 2019; 10:291. [PMID: 31001186 PMCID: PMC6456669 DOI: 10.3389/fneur.2019.00291] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data.
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Affiliation(s)
- Nick S Verber
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Stephanie R Shepheard
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Harry E McDonough
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Sophie A Moore
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - James J P Alix
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Iain D Wilkinson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Tom M Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
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12
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Wirth AM, Johannesen S, Khomenko A, Baldaranov D, Bruun TH, Wendl C, Schuierer G, Greenlee MW, Bogdahn U. Value of fluid-attenuated inversion recovery MRI data analyzed by the lesion segmentation toolbox in amyotrophic lateral sclerosis. J Magn Reson Imaging 2018; 50:552-559. [PMID: 30569457 PMCID: PMC6767504 DOI: 10.1002/jmri.26577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background MRI fluid‐attenuated inversion recovery (FLAIR) studies reported hyperintensity in the corticospinal tract and corpus callosum of patients with amyotrophic lateral sclerosis (ALS). Purpose To evaluate the lesion segmentation toolbox (LST) for the objective quantification of FLAIR lesions in ALS patients. Study Type Retrospective. Population Twenty‐eight ALS patients (eight females, mean age: 50 range: 24–73, mean ALSFRS‐R sum score: 36) were compared with 31 age‐matched healthy controls (12 females, mean age: 45, range: 25–67). ALS patients were treated with riluzole and additional G‐CSF (granulocyte‐colony stimulating factor) on a named patient basis. Field Strength/Sequence 1.5 T, FLAIR, T1‐weighted MRI. Assessment The lesion prediction algorithm (LPA) of the LST enabled the extraction of individual binary lesion maps, total lesion volume (TLV), and number (TLN). Location and overlap of FLAIR lesions across patients were investigated by registration to FLAIR average space and an atlas. ALS‐specific functional rating scale revised (ALSFRS‐R), disease progression, and survival since diagnosis served as clinical correlates. Statistical Tests Univariate analysis of variance (ANOVA), repeated‐measures ANOVA, t‐test, Bravais‐Pearson correlation, Chi‐square test of independence, Kaplan–Meier analysis, Cox‐regression analysis. Results Both ALS patients and healthy controls exhibited FLAIR alterations. TLN significantly depended on age (F(1,54) = 24.659, P < 0.001) and sex (F(1,54) = 5.720, P = 0.020). ALS patients showed higher TLN than healthy controls depending on sex (F(1, 54) = 5.076, P = 0.028). FLAIR lesions were small and most pronounced in male ALS patients. FLAIR alterations were predominantly detected in the superior and posterior corona radiata, anterior capsula interna, and posterior thalamic radiation. Patients with pyramidal tract (PT) lesions exhibited significantly inferior survival than patients without PT lesions (P = 0.013). Covariate age exhibited strong prognostic value for survival (P = 0.015). Data Conclusion LST enables the objective quantification of FLAIR alterations and is a potential prognostic biomarker for ALS. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:552–559.
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Affiliation(s)
- Anna M Wirth
- Department of Neurology, University Hospital of Regensburg, Germany.,Department of Experimental Psychology, University of Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Andrei Khomenko
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Dobri Baldaranov
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital of Regensburg, Germany
| | - Christina Wendl
- Center of Neuroradiology, University Hospital and District Medical Hospital of Regensburg, Germany
| | - Gerhard Schuierer
- Center of Neuroradiology, University Hospital and District Medical Hospital of Regensburg, Germany
| | - Mark W Greenlee
- Department of Experimental Psychology, University of Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital of Regensburg, Germany
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13
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Ishaque A, Mah D, Seres P, Luk C, Johnston W, Chenji S, Beaulieu C, Yang YH, Kalra S. Corticospinal tract degeneration in ALS unmasked in T1-weighted images using texture analysis. Hum Brain Mapp 2018; 40:1174-1183. [PMID: 30367724 DOI: 10.1002/hbm.24437] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/20/2018] [Accepted: 10/12/2018] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to investigate whether textures computed from T1-weighted (T1W) images of the corticospinal tract (CST) in amyotrophic lateral sclerosis (ALS) are associated with degenerative changes evaluated by diffusion tensor imaging (DTI). Nineteen patients with ALS and 14 controls were prospectively recruited and underwent T1W and diffusion-weighted magnetic resonance imaging. Three-dimensional texture maps were computed from T1W images and correlated with the DTI metrics within the CST. Significantly correlated textures were selected and compared within the CST for group differences between patients and controls using voxel-wise analysis. Textures were correlated with the patients' clinical upper motor neuron (UMN) signs and their diagnostic accuracy was evaluated. Voxel-wise analysis of textures and their diagnostic performance were then assessed in an independent cohort with 26 patients and 13 controls. Results showed that textures autocorrelation, energy, and inverse difference normalized significantly correlated with DTI metrics (p < .05) and these textures were selected for further analyses. The textures demonstrated significant voxel-wise differences between patients and controls in the centrum semiovale and the posterior limb of the internal capsule bilaterally (p < .05). Autocorrelation and energy significantly correlated with UMN burden in patients (p < .05) and classified patients and controls with 97% accuracy (100% sensitivity, 92.9% specificity). In the independent cohort, the selected textures demonstrated similar regional differences between patients and controls and classified participants with 94.9% accuracy. These results provide evidence that T1-based textures are associated with degenerative changes in the CST.
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Affiliation(s)
- Abdullah Ishaque
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Dennell Mah
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Peter Seres
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Collin Luk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Wendy Johnston
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Sneha Chenji
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Yee-Hong Yang
- Department of Computing Sciences, University of Alberta, Edmonton, Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada.,Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada.,Department of Biomedical Engineering, University of Alberta, Edmonton, Canada.,Department of Computing Sciences, University of Alberta, Edmonton, Canada
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14
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Mazón M, Vázquez Costa JF, Ten-Esteve A, Martí-Bonmatí L. Imaging Biomarkers for the Diagnosis and Prognosis of Neurodegenerative Diseases. The Example of Amyotrophic Lateral Sclerosis. Front Neurosci 2018; 12:784. [PMID: 30410433 PMCID: PMC6209630 DOI: 10.3389/fnins.2018.00784] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/10/2018] [Indexed: 12/17/2022] Open
Abstract
The term amyotrophic lateral sclerosis (ALS) comprises a heterogeneous group of fatal neurodegenerative disorders of largely unknown etiology characterized by the upper motor neurons (UMN) and/or lower motor neurons (LMN) degeneration. The development of brain imaging biomarkers is essential to advance in the diagnosis, stratification and monitoring of ALS, both in the clinical practice and clinical trials. In this review, the characteristics of an optimal imaging biomarker and common pitfalls in biomarkers evaluation will be discussed. Moreover, the development and application of the most promising brain magnetic resonance (MR) imaging biomarkers will be reviewed. Finally, the integration of both qualitative and quantitative multimodal brain MR biomarkers in a structured report will be proposed as a support tool for ALS diagnosis and stratification.
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Affiliation(s)
- Miguel Mazón
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia, Spain
| | - Juan Francisco Vázquez Costa
- Neuromuscular Research Unit, Instituto de Investigación Sanitaria la Fe (IIS La Fe), Valencia, Spain
- ALS Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Amadeo Ten-Esteve
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia, Spain
| | - Luis Martí-Bonmatí
- Radiology and Biomedical Imaging Research Group (GIBI230), La Fe University and Polytechnic Hospital and La Fe Health Research Institute, Valencia, Spain
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15
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Ishaque A, Mah D, Seres P, Luk C, Eurich D, Johnston W, Yang YH, Kalra S. Evaluating the cerebral correlates of survival in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2018; 5:1350-1361. [PMID: 30480029 PMCID: PMC6243384 DOI: 10.1002/acn3.655] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/17/2023] Open
Abstract
Objective To evaluate cerebral degenerative changes in ALS and their correlates with survival using 3D texture analysis. Methods A total of 157 participants were included in this analysis from four neuroimaging studies. Voxel-wise texture analysis on T1-weighted brain magnetic resonance images (MRIs) was conducted between patients and controls. Patients were divided into long- and short-survivors using the median survival of the cohort. Neuroanatomical differences between the two survival groups were also investigated. Results Whole-brain analysis revealed significant changes in image texture (FDR P < 0.05) bilaterally in the motor cortex, corticospinal tract (CST), insula, basal ganglia, hippocampus, and frontal regions including subcortical white matter. The texture of the CST correlated (P < 0.05) with finger- and foot-tapping rate, measures of upper motor neuron function. Patients with a survival below the media of 19.5 months demonstrated texture change (FDR P < 0.05) in the motor cortex, CST, basal ganglia, and the hippocampus, a distribution which corresponds to stage 4 of the distribution TDP-43 pathology in ALS. Patients with longer survival exhibited texture changes restricted to motor regions, including the motor cortex and the CST. Interpretation Widespread gray and white matter pathology is evident in ALS, as revealed by texture analysis of conventional T1-weighted MRI. Length of survival in patients with ALS is associated with the spatial extent of cerebral degeneration.
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Affiliation(s)
- Abdullah Ishaque
- Faculty of Medicine and Dentistry University of Alberta Edmonton Canada.,Neuroscience and Mental Health Institute University of Alberta Edmonton Canada
| | - Dennell Mah
- Division of Neurology Department of Medicine University of Alberta Edmonton Canada
| | - Peter Seres
- Department of Biomedical Engineering University of Alberta Edmonton Canada
| | - Collin Luk
- Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Dean Eurich
- School of Public Health University of Alberta Edmonton Canada
| | - Wendy Johnston
- Division of Neurology Department of Medicine University of Alberta Edmonton Canada
| | - Yee-Hong Yang
- Department of Computing Sciences University of Alberta Edmonton Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute University of Alberta Edmonton Canada.,Division of Neurology Department of Medicine University of Alberta Edmonton Canada.,Department of Biomedical Engineering University of Alberta Edmonton Canada.,Department of Computing Sciences University of Alberta Edmonton Canada
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16
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Obusez EC, Lowe M, Oh SH, Wang I, Jennifer Bullen, Ruggieri P, Hill V, Lockwood D, Emch T, Moon D, Loy G, Lee J, Kiczek M, Manoj Massand, Statsevych V, Stultz T, Jones SE. 7T MR of intracranial pathology: Preliminary observations and comparisons to 3T and 1.5T. Neuroimage 2018; 168:459-476. [DOI: 10.1016/j.neuroimage.2016.11.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 10/26/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022] Open
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17
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Vázquez‐Costa JF, Mazón M, Carreres‐Polo J, Hervás D, Pérez‐Tur J, Martí‐Bonmatí L, Sevilla T. Brain signal intensity changes as biomarkers in amyotrophic lateral sclerosis. Acta Neurol Scand 2018; 137:262-271. [PMID: 29082510 DOI: 10.1111/ane.12863] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate the contribution of the demographical, clinical, analytical and genetic factors to brain signal intensity changes in T2-weighted MR images in amyotrophic lateral sclerosis (ALS) patients and controls. METHODS Susceptibility-weighted and FLAIR sequences were obtained in a 3T MR scanner. Iron-related hypointensities in the motor cortex (IRhMC) and hyperintensities of the corticospinal tract (HCT) were qualitatively scored. Age, gender, family history and clinical variables were recorded. Baseline levels of ferritin were measured. C9orf72 was tested in all patients and SOD1 only in familial ALS patients not carrying a C9orf72 expansion. Patients who carried a mutation were categorized as genetic. Associations of these variables with visual scores were assessed with multivariable analysis. RESULTS A total of 102 ALS patients (92 non-genetic and 10 genetic) and 48 controls (28 ALS mimics and 20 healthy controls) were recruited. In controls, IRhMC associated with age, but HCT did not. In ALS patients, both HTC and IRhMC strongly associated with clinical UMN impairment and bulbar onset. The intensity/extent of IRhMC in the different motor homunculus regions (lower limbs, upper limbs and bulbar) were linked to the symptoms onset site. Between genetic and sporadic patients, no difference in IRhMC and HCT was found. CONCLUSIONS IRhMC and HCT are reliable markers of UMN degeneration in ALS patients and are more frequent in bulbar onset patients, independently of the mutation status. Age should be considered when evaluating IRhMC. The regional measurement of IRhMC following the motor homunculus could be used as a measure of disease progression.
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Affiliation(s)
- Juan F. Vázquez‐Costa
- Neuromuscular Research Unit Instituto de Investigación Sanitaria la Fe Valencia Spain
- ALS Unit Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Valencia Spain
| | - Miguel Mazón
- Department of Radiology and Biomedical Imaging Research Group GIBI2 Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - Joan Carreres‐Polo
- Department of Radiology and Biomedical Imaging Research Group GIBI2 Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - David Hervás
- Biostatistics Unit Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - Jordi Pérez‐Tur
- Laboratory of Molecular Genetics Institut de Biomedicina de València‐CSIC Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED) Valencia Spain
- Unidad mixta de Neurología y Genética Instituto de Investigación Sanitaria la Fe (IIS La Fe) Valencia Spain
| | - Luis Martí‐Bonmatí
- Department of Radiology and Biomedical Imaging Research Group GIBI2 Hospital Universitario y Politécnico La Fe and Instituto de Investigación Sanitaria la Fe Valencia Spain
| | - Teresa Sevilla
- Neuromuscular Research Unit Instituto de Investigación Sanitaria la Fe Valencia Spain
- ALS Unit Department of Neurology Hospital Universitario y Politécnico La Fe Valencia Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Valencia Spain
- Department of Medicine University of Valencia Valencia Spain
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18
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Quantitative FLAIR MRI in Amyotrophic Lateral Sclerosis. Acad Radiol 2017; 24:1187-1194. [PMID: 28572001 PMCID: PMC5605225 DOI: 10.1016/j.acra.2017.04.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/14/2017] [Accepted: 04/24/2017] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES T2-weighted magnetic resonance imaging (MRI) hyperintensity assessed visually in the corticospinal tract (CST) lacks sensitivity for a diagnosis of amyotrophic lateral sclerosis (ALS). We sought to explore a quantitative approach to fluid-attenuated inversion recovery (FLAIR) MRI intensity across a range of ALS phenotypes. MATERIALS AND METHODS Thirty-three classical ALS patients, 10 with a flail arm presentation, and six with primary lateral sclerosis underwent MRI at 3 Tesla. Comparisons of quantitative FLAIR intensity in the CST and corpus callosum were made between 21 healthy controls and within patient phenotypic subgroups, some of whom were studied longitudinally. RESULTS Mean FLAIR intensity was greater in patient groups. The cerebral peduncle intensity provided the strongest subgroup classification. FLAIR intensity increased longitudinally. The rate of change of FLAIR within CST correlated with rate of decline in executive function and ALS functional rating score. CONCLUSIONS FLAIR MRI encodes quantifiable information of potential diagnostic, stratification, and monitoring value.
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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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Jin J, Hu F, Zhang Q, Jia R, Dang J. Hyperintensity of the corticospinal tract on FLAIR: A simple and sensitive objective upper motor neuron degeneration marker in clinically verified amyotrophic lateral sclerosis. J Neurol Sci 2016; 367:177-83. [PMID: 27423585 DOI: 10.1016/j.jns.2016.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/19/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The involvement of upper motor neuron (UMN) degeneration is crucial to the diagnosis of amyotrophic lateral sclerosis (ALS). However, it is difficult to detect in the early stages, and particularly with predominantly lower motor neuron (LMN) dysfunction. Thus, objective and sensitive UMN degeneration markers are needed for an accurate and early diagnosis. Several studies have investigated the abnormal signal changes in brain MRI for patients with ALS, so we hope to develop a neuroimaging diagnosis method in brain MRI that can evaluate UMN degeneration. MATERIALS AND METHODS We investigated corticospinal tract (CST) hyperintensity on MRI-fluid attenuated inversion recovery (FLAIR) images for 82 clinically verified ALS patients and 38 age-and gender-matched control subjects. Visual evaluation of the FLAIR images was analyzed independently by 3 observers. The clinical examination was implemented by an experienced neurological physician. RESULTS The three observers' views were identical regarding CST hyperintensity on FLAIR images in subcortical precentral gyrus, centrum emiovale, internal capsule, and cerebral peduncles levels (p>0.05). The frequency of CST hyperintensity is significantly higher for the ALS group than the control group in subcortical precentral gyrus, centrum semiovale, posterior limbs of internal capsule and cerebral peduncles levels. (p<0.01). The mean areas under the receiver operating characteristic curves (AUC) values were not different among clinical examinations, CST hyperintensity and mixed-examination (CST hyperintensity and clinical examination groups) in subcortical precentral gyrus, centrum semiovale, internal capsule, and cerebral peduncles levels (p>0.05), although AUC values of CST hyperintensity was slightly higher than clinical examination in centrum semiovale level. There was no statistically significant correlation between CST hyperintensity and age of onset, gender, disease duration, region of onset, and clinical UMN manifestation. (p>0.05). CONCLUSION CST hyperintensity was found more frequently in patients with ALS compared to the matched control group. It can be used to evaluate UMN degeneration effectively in subcortical precentral gyrus, centrum semiovale and cerebral peduncles levels. Combining CST hyperintensity and clinical examination can improve the sensitivity of diagnostic performance for UMN degeneration in ALS.
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Affiliation(s)
- Jiaoting Jin
- Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Fangfang Hu
- Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Qiuli Zhang
- Department of Medical Imaging, First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Rui Jia
- Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China
| | - Jingxia Dang
- Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
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Hirayanagi K, Sato M, Furuta N, Makioka K, Ikeda Y. Juvenile-onset Sporadic Amyotrophic Lateral Sclerosis with a Frameshift FUS Gene Mutation Presenting Unique Neuroradiological Findings and Cognitive Impairment. Intern Med 2016; 55:689-93. [PMID: 26984092 DOI: 10.2169/internalmedicine.55.5569] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 24-year-old Japanese woman developed anterocollis, weakness of the proximal arms, and subsequent cognitive impairment. A neurological examination revealed amyotrophic lateral sclerosis (ALS) without a family history. Systemic muscle atrophy progressed rapidly. Cerebral MRI clearly exhibited high signal intensities along the bilateral pyramidal tracts. An analysis of the FUS gene revealed a heterozygous two-base pair deletion, c.1507-1508delAG (p.G504WfsX515). A subset of juvenile-onset familial/sporadic ALS cases with FUS gene mutations reportedly demonstrates mental retardation or learning difficulty. Our study emphasizes the importance of conducting a FUS gene analysis in juvenile-onset ALS cases, even when no family occurrence is confirmed.
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Sheelakumari R, Madhusoodanan M, Radhakrishnan A, Ranjith G, Thomas B. A Potential Biomarker in Amyotrophic Lateral Sclerosis: Can Assessment of Brain Iron Deposition with SWI and Corticospinal Tract Degeneration with DTI Help? AJNR Am J Neuroradiol 2015; 37:252-8. [PMID: 26494694 DOI: 10.3174/ajnr.a4524] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/09/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Iron-mediated oxidative stress plays a pivotal role in the pathogenesis of amyotrophic lateral sclerosis. This study aimed to assess iron deposition qualitatively and quantitatively by using SWI and microstructural changes in the corticospinal tract by using DTI in patients with amyotrophic lateral sclerosis. MATERIALS AND METHODS Seventeen patients with amyotrophic lateral sclerosis and 15 age- and sex-matched controls underwent brain MR imaging with SWI and DTI. SWI was analyzed for both signal-intensity scoring and quantitative estimation of iron deposition in the anterior and posterior banks of the motor and sensory cortices and deep gray nuclei. The diffusion measurements along the corticospinal tract at the level of pons and medulla were obtained by ROI analysis. RESULTS Patients with amyotrophic lateral sclerosis showed reduced signal-intensity grades in the posterior bank of the motor cortex bilaterally. Quantitative analysis confirmed significantly higher iron content in the posterior bank of the motor cortex in patients with amyotrophic lateral sclerosis. In contrast, no significant differences were noted for the anterior bank of the motor cortex, anterior and posterior banks of the sensory cortex, and deep nuclei. Receiver operating characteristic comparison showed a cutoff of 35μg Fe/g of tissue with an area under the curve of 0.78 (P = .008) for the posterior bank of the motor cortex in discriminating patients with amyotrophic lateral sclerosis from controls. Fractional anisotropy was lower in the pyramidal tracts of patients with amyotrophic lateral sclerosis at the pons and medulla on either side, along with higher directionally averaged mean diffusivity values. The combination of SWI and DTI revealed an area under the curve of 0.784 for differentiating patients with amyotrophic lateral sclerosis from controls. CONCLUSIONS Measurements of motor cortex iron deposition and diffusion tensor parameters of the corticospinal tract may be useful biomarkers for the diagnosis of clinically suspected amyotrophic lateral sclerosis.
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Affiliation(s)
| | | | | | - G Ranjith
- Devices Testing Laboratory, Biomedical Technology Wing (G.R.)
| | - B Thomas
- Department of Imaging Sciences and Interventional Radiology (B.T.), Sree Chitra Thirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India.
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Van Wyck DW, Diaz JR, Loh Y. Magnetic Resonance Imaging Corticospinal Tract Hyperintensities in Progressive Supranuclear Palsy. Neurohospitalist 2015; 5:89-90. [DOI: 10.1177/1941874414554302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- David W. Van Wyck
- Department of Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Jonathan R. Diaz
- Department of Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Yince Loh
- Department of Medicine, Madigan Army Medical Center, Tacoma, WA, USA
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Cervo A, Cocozza S, Saccà F, Giorgio SMDA, Morra VB, Tedeschi E, Marsili A, Vacca G, Palma V, Brunetti A, Quarantelli M. The combined use of conventional MRI and MR spectroscopic imaging increases the diagnostic accuracy in amyotrophic lateral sclerosis. Eur J Radiol 2014; 84:151-157. [PMID: 25466774 DOI: 10.1016/j.ejrad.2014.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/21/2014] [Accepted: 10/28/2014] [Indexed: 12/11/2022]
Abstract
PURPOSE We aimed to assess, in amyotrophic lateral sclerosis (ALS), the diagnostic accuracy of the combined use of conventional MRI signal changes (namely, hypointensity of the precentral cortex and hyperintensity of the corticospinal tracts on T2-weighted images), and N-Acetyl-Aspartate (NAA) reduction in the motor cortex at Magnetic Resonance Spectroscopy (MRS), which are affected by limited diagnostic accuracy when used separately. METHODS T2-hypointensity and NAA/(Choline+Creatine) ratio of the precentral gyrus and T2-hyperintensity of the corticospinal tracts were measured in 84 ALS patients and 28 healthy controls, using a Region-of-Interest approach. Sensitivity and specificity values were calculated using Fisher stepwise discriminant analysis, and cross-validated using the leave-one-out method. RESULTS Precentral gyrus T2 signal intensity (p<10(-4)) and NAA peak (p<10(-6)) were significantly reduced in patients, and their values did not correlate significantly to each other both in patients and controls, while no significant differences were obtained in terms of T2-hyperintensity of the corticospinal tract. Sensitivity and specificity of the two discriminant variables, taken alone, were 71.4% and 75.0%, for NAA peak, and 63.1% and 71.4% for T2-hypointensity, respectively. When using these two variables in combination, a significant increase in sensitivity (78.6%) and specificity (82.1%) was achieved. CONCLUSIONS Precentral gyrus T2-hypointensity and NAA peak are not significantly correlated in ALS patients, suggesting that they reflect relatively independent phenomena. The combined use of these measures improves the diagnostic accuracy of MRI in ALS diagnosis.
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Affiliation(s)
- Amedeo Cervo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Francesco Saccà
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Sara M D A Giorgio
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Enrico Tedeschi
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Angela Marsili
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Giovanni Vacca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University "Federico II", Naples, Italy
| | - Vincenzo Palma
- U.O.C. Neurofisiopatologia, PO S. Gennaro ASL Napoli 1, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Mario Quarantelli
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
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Kono Y, Sengoku R, Mitsumura H, Bono K, Sakuta K, Yamasaki M, Mochio S, Iguchi Y. Clinical characteristics associated with corticospinal tract hyperintensity on magnetic resonance imaging in patients with amyotrophic lateral sclerosis. Clin Neurol Neurosurg 2014; 127:1-4. [PMID: 25306412 DOI: 10.1016/j.clineuro.2014.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 08/22/2014] [Accepted: 09/19/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The usefulness of conventional magnetic resonance imaging (C-MRI) for diagnosing amyotrophic lateral sclerosis (ALS) remains controversial. The aim of this study was to investigate the utility of C-MRI in identifying ALS, specifically the association between corticospinal tract (CST) hyperintensity on C-MRI and clinical characteristics in patients with ALS. METHODS Between June 2008 and April 2012, we retrospectively enrolled consecutive patients diagnosed with sporadic ALS who underwent C-MRI. Patients with ALS were classified as definite-phase ALS (D-ALS) and indefinite-phase ALS (ID-ALS). We focused on the hyperintensity of T2-weighted images in the CST in patients with ALS. Based on the MRI results, we divided patients into two groups: a positive CST group showing CST hyperintensity; and a negative CST group with no such findings. Clinical characteristics of the two groups were compared. RESULTS Seventeen patients (median age, 62 years; 8 women, 9 men) were enrolled in this study, with D-ALS in eight (47%) and ID-ALS in nine (53%). Eight patients (47%) showed CST positivity. The rate of CST positivity was higher in patients with D-ALS (75%) than in patients with ID-ALS (22%, p=0.03). CONCLUSIONS CST positivity appears significantly increased in D-ALS patients. C-MRI can play an important role in diagnosing ALS.
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Affiliation(s)
- Yu Kono
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Renpei Sengoku
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hidetaka Mitsumura
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiko Bono
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Sakuta
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mikihito Yamasaki
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Mochio
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan
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Neuroimaging to investigate multisystem involvement and provide biomarkers in amyotrophic lateral sclerosis. BIOMED RESEARCH INTERNATIONAL 2014; 2014:467560. [PMID: 24949452 PMCID: PMC4052676 DOI: 10.1155/2014/467560] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/25/2014] [Indexed: 12/11/2022]
Abstract
Neuroimaging allows investigating the extent of neurological systems degeneration in amyotrophic lateral sclerosis (ALS). Advanced MRI methods can detect changes related to the degeneration of upper motor neurons but have also demonstrated the participation of other systems such as the sensory system or basal ganglia, demonstrating in vivo that ALS is a multisystem disorder. Structural and functional imaging also allows studying dysfunction of brain areas associated with cognitive signs. From a biomarker perspective, numerous studies using diffusion tensor imaging showed a decrease of fractional anisotropy in the intracranial portion of the corticospinal tract but its diagnostic value at the individual level remains limited. A multiparametric approach will be required to use MRI in the diagnostic workup of ALS. A promising avenue is the new methodological developments of spinal cord imaging that has the advantage to investigate the two motor system components that are involved in ALS, that is, the lower and upper motor neuron. For all neuroimaging modalities, due to the intrinsic heterogeneity of ALS, larger pooled banks of images with standardized image acquisition and analysis procedures are needed. In this paper, we will review the main findings obtained with MRI, PET, SPECT, and nuclear magnetic resonance spectroscopy in ALS.
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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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Abstract
BACKGROUND There is currently no definite neuroimaging test to detect amyotrophic lateral sclerosis (ALS), which leads to significant delay in diagnosis, particularly if one takes into account the rapidity of disease evolution. Hyperintensity of the corticospinal tracts (CST) on T2 or fluid-attenuated inversion recovery (FLAIR) weighted magnetic resonance imaging (MRI) has been well described, but data on sensitivity and specificity in larger series is lacking to help guide its application to clinical care. METHODS We analyzed clinical and MRI data from 64 patients with a definite retrospective diagnosis of ALS. In this case-control study, two experienced blinded neuroradiologists systematically assessed defined rostrocaudal segments of the intracranial course of the CST. RESULTS The overall sensitivity and specificity of conventional MRI for the diagnosis of ALS were 48% and 76% respectively. Highest specificities for CST hyperintensity were noted for the subcortical white matter (92%), centrum semiovale (88%) and medullary pyramids (92%). The lowest specificities were found for the cerebral peduncle (36%) and internal capsule (32%). We did not find a correlation with the rate of clinical progression, age of onset or the presence of upper motor neuron signs on examination. CONCLUSION Conventional MRI was not found to be a reliable diagnostic tool for ALS and it did not help predict clinical characteristics such as speed of evolution or prominence of upper motor neuron signs. Its main role in the setting of ALS should remain to help exclude alternative diagnostic considerations. A multimodal approach relying on newer functional and structural MRI techniques still needs to be developed and validated. Précision de l'IRM conventionnelle dans la SLA.
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Blasco H, Corcia P, Gordon PH, Pradat PF. Biological and neuroimaging biomarkers for amyotrophic lateral sclerosis: 2013 and beyond. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
SUMMARY Amyotrophic lateral sclerosis is an idiopathic, incurable neurodegenerative disease that is fatal for most patients in less than 3 years from the time weakness first appears. Alongside identification of etiologies and stronger neuroprotective agents, the development of biomarkers is a main research priority. Since the original description, diagnosis and progression measurement in amyotrophic lateral sclerosis has been clinical. The time from symptom onset to diagnosis is usually more than a year, and clinical research studies utilize clinical end points that have low sensitivity. Few eligible patients and inefficient trials mean that just one or a few new therapies can be tested each year. Biological markers are needed not only to improve the sensitivity of clinical assessments, but also to better examine disease pathophysiology in vivo.
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Affiliation(s)
- Hélène Blasco
- UMR INSERM U930, Université François-Rabelais de Tours, Tours, France
- Laboratoire de Biochimie & de Biologie Moléculaire, Hôpital Bretonneau, CHRU de Tours, France
| | - Philippe Corcia
- Centre SLA, Service de Neurologie & Neurophysiologie Clinique, CHRU de Tours, France
| | - Paul H Gordon
- Départment des Maladies du Système Nerveux, Assistance Publique-Hôpitaux de Paris, Hôpital de la Salpêtrière, 75013, Paris, France
| | - Pierre-François Pradat
- Départment des Maladies du Système Nerveux, Assistance Publique-Hôpitaux de Paris, Hôpital de la Salpêtrière, 75013, Paris, France
- UMR-678, INSERM-UPMC, Hôpital de la Salpêtrière, 75013, Paris, France
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Jenkins TM, Burness C, Connolly DJ, Rao DG, Hoggard N, Mawson S, McDermott CJ, Wilkinson ID, Shaw PJ. A prospective pilot study measuring muscle volumetric change in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:414-23. [PMID: 23705876 DOI: 10.3109/21678421.2013.795597] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to investigate the potential of muscle volume, measured with magnetic resonance (MR), as a biomarker to quantify disease progression in patients with amyotrophic lateral sclerosis (ALS). In this longitudinal pilot study, we first sought to determine the stability of volumetric muscle MR measurements in 11 control subjects at two time-points. We assessed feasibility of detecting atrophy in four patients with ALS, followed at three-month intervals for 12 months. Muscle power and MR volume were measured in thenar eminence (TEm), first dorsal interosseous (1DIO), tibialis anterior (TA) and tongue. Changes over time were assessed using linear regression models and t-tests. Results demonstrated that, in controls, no volumetric MR changes were seen (mean volume variation in all muscles < 5%, p > 0.1). In patients, between-subject heterogeneity was identified. Trends for volume loss were found in TEm (mean, - 26.84%, p = 0.056) and TA (- 8.29%, p = 0.077), but not in 1DIO (- 18.47%, p = 0.121) or tongue (< 5%, p = 0.367). In conclusion, volumetric muscle MR appears a stable measure in controls, and progressive volume loss was demonstrable in individuals with ALS in whom clinical weakness progressed. In this small study, subclinical atrophy was not demonstrable using muscle MR. Clinico-radiological discordance between muscle weakness and MR atrophy could reflect a contribution of upper motor neuron pathology.
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Affiliation(s)
- Thomas M Jenkins
- Sheffield Institute for Translational Neuroscience (SITraN), 385a Glossop Road, Sheffield, UK.
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Ignjatović A, Stević Z, Lavrnić S, Daković M, Bačić G. Brain iron MRI: a biomarker for amyotrophic lateral sclerosis. J Magn Reson Imaging 2013; 38:1472-9. [PMID: 23564606 DOI: 10.1002/jmri.24121] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 02/20/2013] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the usefulness of MRI detection of hypointensity areas (iron deposits) in the brain using a dedicated MRI technique in patients with ALS in establishing this sign as a potential surrogate biomarker that correlates with the severity of disease. MATERIALS AND METHODS Forty-six ALS patients and 26 age-matched controls were examined by MRI. The ALS Functional Rating Scale (ALSFRS) score was determined before the first MRI examination. The sub-set of 25 ALS patients was re-examined around 6 months after the first MRI examination. The MRI examination consisted of routine T1W, T2W, and FLAIR sequences with the addition of a thin slice heavily T2* weighted sequence to accentuate magnetic susceptibility artifacts. RESULTS T2*W sequence is superior to any other MRI sequence in detecting hypointensities in the brain of ALS patients. Hypointensities were found only in the precentral gyruses gray matter (PGGM) and were detected in 42 patients. The extent of hypointensities was measured and scored (0-3) and correlated with ALSFRS (r = -0.545). Twenty-five patients were re-examined 6 months later, and the majority of them showed the shift toward higher MRI scores. No control subjects had hypointensities in PGGM. CONCLUSION The detection of hypointensities in PGGM appears to be a very promising surrogate MRI biomarker for ALS due to its simplicity, high sensitivity and specificity, suitability for longitudinal studies, and relationship with the pathogenesis of the disease.
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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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Carrara G, Carapelli C, Venturi F, Ferraris MM, Lequio L, Chiò A, Calvo A, Sirgiovanni S, Cistaro A, Valentini MC. A distinct MR imaging phenotype in amyotrophic lateral sclerosis: correlation between T1 magnetization transfer contrast hyperintensity along the corticospinal tract and diffusion tensor imaging analysis. AJNR Am J Neuroradiol 2012; 33:733-9. [PMID: 22194369 DOI: 10.3174/ajnr.a2855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In the search for a diagnostic marker in ALS, we focused our attention on the hyperintense signal intensity in T1 MTC MR images along the CST, detected in some patients and not found in other patients with ALS and in control subjects. The aim of this study was to investigate the relationship between the hyperintense signal intensity in T1 MTC images and white matter damage. To this purpose, we studied potential heterogeneities in DTI values within our patients by using TBSS without a priori anatomic information. MATERIALS AND METHODS In 43 patients with ALS and 43 healthy control subjects, the presence or absence of T1 MTC hyperintense signal intensity was evaluated. With a DTI analysis with a TBSS approach, differences in FA distribution between the 2 groups (patients with T1 MTC hyperintense signal intensity and patients without it) compared with each other and with control subjects were investigated. RESULTS We found regional differences in white matter FA between patients with T1 MTC hyperintense signal intensity (37.2%) and patients without it. Patients with T1 MTC abnormal signal intensity showed lower FA strictly limited to the motor network and the posterior aspect of the body of the CC without extramotor FA reductions, whereas patients without this sign showed FA reductions in several confluent regions within and outside the CST and in the whole CC. CONCLUSIONS T1 MTC hyperintense signal intensity in the CST and posterior CC, when present, is specific for ALS and represents, among patients with ALS, a possible distinct phenotype of presentation of the disease with prominent UMN involvement.
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Affiliation(s)
- G Carrara
- Neuroradiology Department of CTO Hospital, Torino, Italy.
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Ben Bashat D, Artzi M, Tarrasch R, Nefussy B, Drory VE, Aizenstein O. A potential tool for the diagnosis of ALS based on diffusion tensor imaging. ACTA ACUST UNITED AC 2011; 12:398-405. [DOI: 10.3109/17482968.2011.582646] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ding XQ, Kollewe K, Blum K, Körner S, Kehbel S, Dengler R, Lanfermann H, Petri S. Value of quantitative analysis of routine clinical MRI sequences in ALS. ACTA ACUST UNITED AC 2011; 12:406-13. [DOI: 10.3109/17482968.2011.597402] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Canu E, Agosta F, Riva N, Sala S, Prelle A, Caputo D, Perini M, Comi G, Filippi M. The topography of brain microstructural damage in amyotrophic lateral sclerosis assessed using diffusion tensor MR imaging. AJNR Am J Neuroradiol 2011; 32:1307-14. [PMID: 21680655 DOI: 10.3174/ajnr.a2469] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE ALS leads to macrostructural (ie, cortical atrophy and hyperintensities along the corticospinal tract) and microstructural (ie, gray matter intrinsic damage) central nervous system abnormalities. We used a multimodal voxelwise imaging approach to assess microstructural changes independent of macrostructural volume loss in patients with ALS compared with HCs. MATERIALS AND METHODS Twenty-three patients with ALS and 14 HCs were studied. Conventional imaging and DTI were performed. Images were processed by using SPM5 to assess measures of gray and white matter atrophy as well as microstructural damage (ie, MD and FA). DTI alterations independent of volume loss were investigated. RESULTS When we accounted for both gray and white matter atrophy, patients with ALS showed increased MD values in several gray and white matter areas mainly located in the orbitofrontal and frontotemporal regions bilaterally, in the right genu of the corpus callosum, and in the right posterior limb of the internal capsule. When we accounted for white matter volume loss, patients with ALS showed decreased FA along the corticospinal tract bilaterally and in the left inferior frontal lobe relative to HCs. The MD of the orbitofrontal regions bilaterally was associated significantly with disease duration. CONCLUSIONS In patients with ALS, DTI detects microstructural changes independent of brain tissue loss. The affected regions included both motor and extramotor areas. The extent of ALS-related DTI abnormalities was greater than that disclosed by the volumetric analysis.
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Affiliation(s)
- E Canu
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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Protogerou G, Ralli S, Tsougos I, Patramani I, Hadjigeorgiou G, Fezoulidis I, Kapsalaki EZ. T2 FLAIR Increased Signal Intensity at the Posterior Limb of the Internal Capsule: Clinical Significance in ALS Patients. Neuroradiol J 2011; 24:226-34. [PMID: 24059612 DOI: 10.1177/197140091102400210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 03/02/2011] [Indexed: 11/15/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is characterized by progressive upper and lower motor neuron degeneration. A hyperintense signal on T2-weighted images along the corticospinal tract has been reported in patients with confirmed ALS. However, the specificity of this finding is under consideration, since it is also identified in healthy controls. Moreover, the correlation of this finding with disease progression has not yet been established. The purpose of our study is to evaluate the frequency with which this high signal appears in the posterior limb of the internal capsule (PLIC), compare visual with quantitative measurements, and correlate these with the progression of the disease. Our prospective clinical study included 24 patients and 51 healthy volunteers. In the ALS patient group, the diagnosis was established according to the criteria of El Escorial in the revised form of Airlee House. All patients were neurologically examined and underwent diagnostic procedures to exclude other diseases resembling ALS. The initial MRI was performed six months to two years after the onset of symptomatology. All ALS patients were clinically examined regarding their symptoms from the upper and lower motor neurons. Follow-up MRIs were performed in nine out of 24 patients over a period of six months. Signal changes in the PLIC are visually evaluated on FLAIR images, and are classified as distinct, mild or no signal change. Fractional anisotropy (FA) measurements are performed by placing a region of interest (ROI) in the PLIC bilaterally. Both findings are being compared. Mild signal changes were visualized in the PLIC in ten volunteers and seven patients. Distinct T2 FLAIR signal changes were visualized in the PLIC in seven ALS patients. No distinct signal change was visualized in the controls. Moreover this increased T2 FLAIR signal change became more accentuated with disease progress. FA measurements in patients were lower than in age-matched healthy subjects, with a further decrease with disease progression. Our findings indicate that although mild hyperintensity of the PLIC is not pathognomonic for ALS, detection of a distinct PLIC hyperintensity that gradually accentuates might actually be a sign of progressive ALS. This finding is supported by the progressively decreasing FA measurements. Larger numbers of patients need to be included and re-evaluated to obtain statistically significant results.
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Affiliation(s)
- G Protogerou
- Department of Radiology, University Hospital of Larissa, University of Thessaly, School of Medicine; Larissa, Greece -
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Keller J, Vymazal J, Ridzoň P, Rusina R, Kulišt’ák P, Malíková H, Rulseh AM, Keller O, Jech R. Quantitative brain MR imaging in amyotrophic lateral sclerosis. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2011; 24:67-76. [DOI: 10.1007/s10334-010-0237-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 11/26/2010] [Accepted: 11/29/2010] [Indexed: 12/13/2022]
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Álvarez-Uría Tejero M, Sáiz Ayala A, Fernández Rey C, Santamarta Liébana M, Costilla García S. Diagnóstico de la esclerosis lateral amiotrófica: avances en RM. RADIOLOGIA 2011; 53:146-55. [DOI: 10.1016/j.rx.2010.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/05/2010] [Accepted: 10/13/2010] [Indexed: 11/27/2022]
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41
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Álvarez-Uría Tejero M, Sáiz Ayala A, Fernández Rey C, Santamarta Liébana M, Costilla García S. Diagnosis of amyotrophic lateral sclerosis: advances in magnetic resonance imaging. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Amyotrophic lateral sclerosis (ALS) is a motor neuron disease characterized by progressive degeneration of upper motor neurons (UMN) and lower motor neurons (LMN). While LMN dysfunction can be confirmed by electromyography (EMG) and muscle biopsy, UMN involvement is more difficult to detect, particularly in the early phase. Objective and sensitive measures of UMN dysfunction are needed for early diagnosis and monitoring of disease progression and therapeutic efficacy. Advanced magnetic resonance imaging (MRI) techniques, such as diffusion, perfusion, magnetization transfer imaging, functional MRI, and MR spectroscopy, provide insight into the pathophysiological processes of ALS and may have a role in the identification and monitoring of UMN pathology. This article provides an overview of these neuroimaging techniques and their potential roles in ALS.
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Affiliation(s)
- Sumei Wang
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Evaluation of corticospinal tract impairment in the brain of patients with amyotrophic lateral sclerosis by using diffusion tensor imaging acquisition schemes with different numbers of diffusion-weighting directions. J Comput Assist Tomogr 2010; 34:746-50. [PMID: 20861779 DOI: 10.1097/rct.0b013e3181e35129] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Amyotrophic lateral sclerosis is characterized by degeneration of upper and lower motor neurons. Diffusion tensor imaging (DTI) indexes obtained along the corticospinal tracts distinguish ALS patients and control subjects. Diffusion tensor imaging can be estimated from at least 6 diffusion-weighted images; however an acquisition scheme with a higher number of diffusion directions allows a more robust estimation of DTI indexes. The aim of the study was to establish if a higher number of diffusion encoding gradients increases the diagnostic accuracy of DTI in ALS. We studied 18 patients and 16 control subjects acquiring 2 DTI data sets with 6 and 31 gradient orientations. The mean diffusivity and fractional anisotropy values were measured along the corticospinal tract. Mean diffusivity in ALS was significantly increased (P = 0.026) with respect to control subjects in acquisition scheme with 31 but not (P = 0.214) with 6 diffusion-weighting directions. Fractional anisotropy was significantly lower in patients both with 6 (P = 0.0036) and with 31 (P = 0.0004) diffusion-weighting directions (0.538 vs 0.588 and 0.530 vs 0.594). Fractional anisotropy receiver operating characteristic curve analysis showed a higher diagnostic accuracy by using 31 diffusion-weighting direction (85.76%) with respect to 6 directions (79.86%). Diffusion tensor imaging confirms its potentials in diagnosing ALS with a good accuracy; the acquisition scheme with a higher diffusion-weighting directions seems to better discriminate between ALS patients and control subjects.
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Agosta F, Pagani E, Petrolini M, Sormani MP, Caputo D, Perini M, Prelle A, Salvi F, Filippi M. MRI predictors of long-term evolution in amyotrophic lateral sclerosis. Eur J Neurosci 2010; 32:1490-6. [DOI: 10.1111/j.1460-9568.2010.07445.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We studied two sisters with rapidly progressing ALS starting at the ages of 46 and 48 years and leading to death after 14 months. Both fulfilled the El Escorial criteria for definite ALS and had marked upper motor neuron (UMN) predominance. Brain MRI, on fluid attenuation recovery (FLAIR) mode, showed outstanding hyperintensities of the precentral gyrus, centrum semiovale, corona radiata and along the corticospinal pathways in the brainstem. Screening for the SOD1 gene disclosed, at codon 140, a base substitution of adenine for thymine (GGT>CCA) known as the A140A 'silent' mutation since it does not change the amino acid (alanine) encoded for at that position. The severe UMN involvement and the fast progression of the disease may correlate with the MRI findings. It is also possible that the A140A mutation is not incidental; the mutated mRNA might be cytotoxic.
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Agosta F, Pagani E, Petrolini M, Caputo D, Perini M, Prelle A, Salvi F, Filippi M. Assessment of white matter tract damage in patients with amyotrophic lateral sclerosis: a diffusion tensor MR imaging tractography study. AJNR Am J Neuroradiol 2010; 31:1457-61. [PMID: 20395382 DOI: 10.3174/ajnr.a2105] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Most DTI studies in ALS have been limited to the assessment of the CST damage. In this study, we used DTI tractography to investigate whether microstructural abnormalities occur in the major motor and extramotor WM tracts in mildly disabled patients with ALS. MATERIALS AND METHODS Brain conventional MR imaging and DTI were performed in 24 patients with probable or definite ALS and mild disability (ALSFRS score, ≥20) and 20 healthy controls. The mean disease progression rate was 0.62 (range = 0.08-2.50). DTI tractography was used to segment the CST, the corpus callosum, and the major WM association tracts (ie, cingulum, uncinate fasciculus, inferior fronto-occipital, inferior longitudinal, and superior longitudinal fasciculi). RESULTS Compared with healthy controls, patients with ALS showed significantly decreased FA and significantly increased MD and radial D of the CST bilaterally (P values from .005 to .01). Patients with ALS also had a significantly increased axial D of the right uncinate fasciculus relative to controls (P = .04). CST FA significantly correlated with the rate of disease progression (right CST: r = -0.50, P = .02; left CST: r = -0.41, P = .05). CONCLUSIONS Patients with ALS and mild disability have preferential damage to the CST. The association of CST damage with the rate of disease progression suggests that DTI has the potential to provide in vivo markers of ALS evolution. The subtle involvement of the uncinate fasciculus may precede the appearance of behavioral symptoms in patients with ALS.
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Affiliation(s)
- F Agosta
- Institute of Experimental Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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Agosta F, Chiò A, Cosottini M, De Stefano N, Falini A, Mascalchi M, Rocca MA, Silani V, Tedeschi G, Filippi M. The present and the future of neuroimaging in amyotrophic lateral sclerosis. AJNR Am J Neuroradiol 2010; 31:1769-77. [PMID: 20360339 DOI: 10.3174/ajnr.a2043] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
In patients with ALS, conventional MR imaging is frequently noninformative, and its use has been restricted to excluding other conditions that can mimic ALS. Conversely, the extensive application of modern MR imaging-based techniques to the study of ALS has undoubtedly improved our understanding of disease pathophysiology and is likely to have a role in the identification of potential biomarkers of disease progression. This review summarizes how new MR imaging technology is changing dramatically our understanding of the factors associated with ALS evolution and highlights the reasons why it should be used more extensively in studies of disease progression, including clinical trials.
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Affiliation(s)
- F Agosta
- Institute of Experimental Neurology, University Hospital San Raffaele, Milan, Italy
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Filippi M, Agosta F, Abrahams S, Fazekas F, Grosskreutz J, Kalra S, Kassubek J, Silani V, Turner MR, Masdeu JC. EFNS guidelines on the use of neuroimaging in the management of motor neuron diseases. Eur J Neurol 2010; 17:526-e20. [PMID: 20136647 DOI: 10.1111/j.1468-1331.2010.02951.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE These European Federation of Neurological Societies guidelines on neuroimaging of motor neuron diseases (MNDs) are designed to provide practical help for the neurologists to make appropriate use of neuroimaging techniques in patients with MNDs, which ranges from diagnostic and monitoring aspects to the in vivo study of the pathobiology of such conditions. METHODS Literature searches were performed before expert members of the Task Force wrote proposal. Then, consensus was reached by circulating drafts of the manuscript to the Task Force members and by discussion of the classification of evidence and recommendations. RESULTS AND CONCLUSIONS The use of conventional MRI in patients suspected of having a MND is yet restricted to exclude other causes of signs and symptoms of MN pathology [class IV, level good clinical practice point (GCPP)]. Although the detection of corticospinal tract hyperintensities on conventional MRI and a T2-hypointense rim in the pre-central gyrus can support a pre-existing suspicion of MND, the specific search of these abnormalities for the purpose of making a firm diagnosis of MND is not recommended (class IV, level GCPP). At present, advanced neuroimaging techniques, including diffusion tensor imaging and proton magnetic resonance spectroscopic imaging, do not have a role in the diagnosis or routine monitoring of MNDs yet (class IV, level GCPP). However, it is strongly advisable to incorporate measures derived from these techniques into new clinical trials as exploratory outcomes to gain additional insights into disease pathophysiology and into the value of these techniques in the (longitudinal) assessment of MNDs (class IV, level GCPP).
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Affiliation(s)
- M Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Scientific Institute and University Hospital San Raffaele, Institute of Experimental Neurology, Milan, Italy.
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Charil A, Corbo M, Filippi M, Kesavadas C, Agosta F, Munerati E, Gambini A, Comi G, Scotti G, Falini A. Structural and metabolic changes in the brain of patients with upper motor neuron disorders: A multiparametric MRI study. ACTA ACUST UNITED AC 2009; 10:269-79. [DOI: 10.3109/17482960902777339] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Graaff MM, de Jong JMBV, Baas F, de Visser M. Upper motor neuron and extra-motor neuron involvement in amyotrophic lateral sclerosis: a clinical and brain imaging review. Neuromuscul Disord 2008; 19:53-8. [PMID: 19070491 DOI: 10.1016/j.nmd.2008.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 09/25/2008] [Accepted: 10/05/2008] [Indexed: 11/17/2022]
Abstract
There is an ongoing discussion whether ALS is primarily a disease of upper motor neurons or lower motor neurons. We undertook a review to assess how new insights have contributed to solve this controversy. For this purpose we selected relevant publications from 1995 onwards focussing on (1) primary targets and disease progression in ALS and variants of ALS, (2) brain imaging markers for upper motor neuron lesion, and (3) evidence for ALS being a multisystem disorder. Clinically, upper motor and lower motor neuron symptoms can occur in any order over time. Brain imaging markers show upper motor neuron involvement in early disease. Overlap syndromes of ALS and dementia, and involvement of autonomic and sensory nerves occur frequently. PET/SPECT scans, functional MRI and voxel based morphometry studies clearly show abnormalities in extra-motor areas of the brain. Pathologically, the 43 kDa TAR DNA-binding protein (TDP-43) provides a clue to these overlapping disorders. In conclusion, evidence accumulates that ALS is a multisystem disorder rather than a pure lower and/or upper motor neuron disorder.
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Affiliation(s)
- M M van der Graaff
- Department of Neurology, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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