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Darabi S, Ariaei A, Rustamzadeh A, Afshari D, Charkhat Gorgich EA, Darabi L. Cerebrospinal fluid and blood exosomes as biomarkers for amyotrophic lateral sclerosis; a systematic review. Diagn Pathol 2024; 19:47. [PMID: 38429818 PMCID: PMC10908104 DOI: 10.1186/s13000-024-01473-6] [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: 10/07/2023] [Accepted: 02/25/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive and fatal motor neuron disease. Due to the limited knowledge about potential biomarkers that help in early diagnosis and monitoring disease progression, today's diagnoses are based on ruling out other diseases, neurography, and electromyography examination, which takes a time-consuming procedure. METHODS PubMed, ScienceDirect, and Web of Science were explored to extract articles published from January 2015 to June 2023. In the searching strategy following keywords were included; amyotrophic lateral sclerosis, biomarkers, cerebrospinal fluid, serum, and plama. RESULTS A total number of 6 studies describing fluid-based exosomal biomarkers were included in this study. Aggregated proteins including SOD1, TDP-43, pTDP-43, and FUS could be detected in the microvesicles (MVs). Moreover, TDP-43 and NFL extracted from plasma exosomes could be used as prognostic biomarkers. Also, downregulated miR-27a-3p detected through exoEasy Maxi and exoQuick Kit in the plasma could be measured as a diagnostic biomarker. Eventually, the upregulated level of CORO1A could be used to monitor disease progression. CONCLUSION Based on the results, each biomarker alone is insufficient to evaluate ALS. CNS-derived exosomes contain multiple ALS-related biomarkers (SOD1, TDP-43, pTDP-43, FUS, and miRNAs) that are detectable in cerebrospinal fluid and blood is a proper alternation. Exosome detecting kits listed as exoEasy, ExoQuick, Exo-spin, ME kit, ExoQuick Plus, and Exo-Flow, are helpful to reach this purpose.
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Affiliation(s)
- Shahram Darabi
- Cellular and Molecular Research Center, Research Institute for Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Armin Ariaei
- Student Research Committee, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Auob Rustamzadeh
- Cellular and Molecular Research Center, Research Institute for Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
- Department of Anatomical Sciences, School of Medicine, Iran University of Medical Sciences, Hemmat Highway, next to Milad Tower, Tehran, Iran.
| | - Dariush Afshari
- Department of Neurology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Leila Darabi
- Department of Neurology, Tehran Medical Science Branch, Amir Al Momenin Hospital, Islamic Azad University, Tehran, Iran
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Editorial Comment: Iron-sensitive MR imaging of the primary motor cortex to differentiate hereditary spastic paraplegia from other motor neuron diseases. Eur Radiol 2022; 32:8055-8057. [PMID: 36074266 DOI: 10.1007/s00330-022-09093-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/10/2022] [Accepted: 07/03/2022] [Indexed: 11/04/2022]
Abstract
KEY POINTS • Conventional and advanced MR techniques may aid in the diagnosis of motor neuron disease.• Iron-sensitive MR imaging of the primary motor cortex may reveal changes to help differentiate hereditary spastic paraplegia (HSP) from UMM predominant amyotrophic lateral sclerosis (UMN-ALS) and primary lateral sclerosis (PLS).• Additional research in this area is necessary.
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Iron-sensitive MR imaging of the primary motor cortex to differentiate hereditary spastic paraplegia from other motor neuron diseases. Eur Radiol 2022; 32:8058-8064. [PMID: 35593959 DOI: 10.1007/s00330-022-08865-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/15/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Hereditary spastic paraplegia (HSP) is a group of genetic neurodegenerative diseases characterised by upper motor neuron (UMN) impairment of the lower limbs. The differential diagnosis with primary lateral sclerosis (PLS) and amyotrophic lateral sclerosis (ALS) can be challenging. As microglial iron accumulation was reported in the primary motor cortex (PMC) of ALS cases, here we assessed the radiological appearance of the PMC in a cohort of HSP patients using iron-sensitive MR imaging and compared the PMC findings among HSP, PLS, and ALS patients. METHODS We included 3-T MRI scans of 23 HSP patients, 7 PLS patients with lower limb onset, 8 ALS patients with lower limb and prevalent UMN onset (UMN-ALS), and 84 ALS patients with any other clinical picture. The PMC was visually rated on 3D T2*-weighted images as having normal signal intensity, mild hypointensity, or marked hypointensity, and differences in the frequency distribution of signal intensity among the diseases were investigated. RESULTS The marked hypointensity in the PMC was visible in 3/22 HSP patients (14%), 7/7 PLS patients (100%), 6/8 UMN-ALS patients (75%), and 35/84 ALS patients (42%). The frequency distribution of normal signal intensity, mild hypointensity, and marked hypointensity in HSP patients was different than that in PLS, UMN-ALS, and ALS patients (p < 0.01 in all cases). CONCLUSIONS Iron-sensitive imaging of the PMC could provide useful information in the diagnostic work - up of adult patients with a lower limb onset UMN syndrome, as the cortical hypointensity often seen in PLS and ALS cases is apparently rare in HSP patients. KEY POINTS • The T2* signal intensity of the primary motor cortex was investigated in patients with HSP, PLS with lower limb onset, and ALS with lower limb and prevalent UMN onset (UMN-ALS) using a clinical 3-T MRI sequence. • Most HSP patients had normal signal intensity in the primary motor cortex (86%); on the contrary, all the PLS and the majority of UMN-ALS patients (75%) had marked cortical hypointensity. • The T2*-weighted imaging of the primary motor cortex could provide useful information in the differential diagnosis of sporadic adult-onset UMN syndromes.
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Pandya S, Maia PD, Freeze B, Menke RAL, Talbot K, Turner MR, Raj A. Modeling seeding and neuroanatomic spread of pathology in amyotrophic lateral sclerosis. Neuroimage 2022; 251:118968. [PMID: 35143975 PMCID: PMC10729776 DOI: 10.1016/j.neuroimage.2022.118968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 12/12/2022] Open
Abstract
The neurodegenerative disorder amyotrophic lateral sclerosis (ALS) is characterized by the progressive loss of upper and lower motor neurons, with pathological involvement of cerebral motor and extra-motor areas in a clinicopathological spectrum with frontotemporal dementia (FTD). A key unresolved issue is how the non-random distribution of pathology in ALS reflects differential network vulnerability, including molecular factors such as regional gene expression, or preferential spread of pathology via anatomical connections. A system of histopathological staging of ALS based on the regional burden of TDP-43 pathology observed in postmortem brains has been supported to some extent by analysis of distribution of in vivo structural MRI changes. In this paper, computational modeling using a Network Diffusion Model (NDM) was used to investigate whether a process of focal pathological 'seeding' followed by structural network-based spread recapitulated postmortem histopathological staging and, secondly, whether this had any correlation to the pattern of expression of a panel of genes implicated in ALS across the healthy brain. Regionally parcellated T1-weighted MRI data from ALS patients (baseline n=79) was studied in relation to a healthy control structural connectome and a database of associated regional cerebral gene expression. The NDM provided strong support for a structural network-based basis for regional pathological spread in ALS, but no simple relationship to the spatial distribution of ALS-related genes in the healthy brain. Interestingly, OPTN gene was identified as a significant but a weaker non-NDM contributor within the network-gene interaction model (LASSO). Intriguingly, the critical seed regions for spread within the model were not within the primary motor cortex but basal ganglia, thalamus and insula, where NDM recapitulated aspects of the postmortem histopathological staging system. Within the ALS-FTD clinicopathological spectrum, non-primary motor structures may be among the earliest sites of cerebral pathology.
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Affiliation(s)
- Sneha Pandya
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY, United States.
| | - Pedro D Maia
- Department of Mathematics, University of Texas at Arlington, TX, United States
| | - Benjamin Freeze
- Scripps Health/MD Anderson Cancer Center, Department of Radiology, CA, United States
| | - Ricarda A L Menke
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, West Wing Level 6, Oxford OX2 7PZ, United Kingdom
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Martin R Turner
- Wellcome Centre for Integrative Neuroimaging, University of Oxford, West Wing Level 6, Oxford OX2 7PZ, United Kingdom; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - Ashish Raj
- Department of Radiology, Weill Cornell Medicine, 1300 York Avenue, New York, NY, United States; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94121, United States.
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Pai V, Trivedi CR, Pai B, Swaminathan SK. T1 hyperintensity in the spinal cord: A diagnostic marker of amyotrophic lateral sclerosis? J Clin Imaging Sci 2022; 12:20. [PMID: 35510239 PMCID: PMC9062945 DOI: 10.25259/jcis_24_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/12/2022] [Indexed: 12/05/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a rare, devastating motor neuron disease characterized by the degeneration of upper and lower motor neurons causing muscular weakness, paralysis, and eventual death. MRI plays a supportive role in the diagnosis; its primary role is to exclude other clinical mimics. Some of the imaging features associated with ALS include hypointense signal along the motor cortices on susceptibility or T2*-weighted imaging and hyperintensity along the corticospinal tracts (CST) within the cerebral hemispheres, brainstem, and spinal cord on the T2 weighted imaging. In this report, we discuss the value of T1 hyperintensity along the CST, especially in the spinal cord.
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Affiliation(s)
- Vivek Pai
- Division of Neuroradiology, Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Chintan R Trivedi
- Department of Radiology, Apollo Hospitals-Navi Mumbai, Mumbai, Maharashtra, India
| | - Bhujang Pai
- Department of Radiology, SevenHills Hospital, Mumbai, Maharashtra, India
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Düzel E, Costagli M, Donatelli G, Speck O, Cosottini M. Studying Alzheimer disease, Parkinson disease, and amyotrophic lateral sclerosis with 7-T magnetic resonance. Eur Radiol Exp 2021; 5:36. [PMID: 34435242 PMCID: PMC8387546 DOI: 10.1186/s41747-021-00221-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/07/2021] [Indexed: 12/18/2022] Open
Abstract
Ultra-high-field (UHF) magnetic resonance (MR) scanners, that is, equipment operating at static magnetic field of 7 tesla (7 T) and above, enable the acquisition of data with greatly improved signal-to-noise ratio with respect to conventional MR systems (e.g., scanners operating at 1.5 T and 3 T). The change in tissue relaxation times at UHF offers the opportunity to improve tissue contrast and depict features that were previously inaccessible. These potential advantages come, however, at a cost: in the majority of UHF-MR clinical protocols, potential drawbacks may include signal inhomogeneity, geometrical distortions, artifacts introduced by patient respiration, cardiac cycle, and motion. This article reviews the 7 T MR literature reporting the recent studies on the most widespread neurodegenerative diseases: Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis.
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Affiliation(s)
- Emrah Düzel
- Otto-von-Guericke University Magdeburg, Magdeburg, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany. .,University College London, London, UK.
| | - Mauro Costagli
- IRCCS Stella Maris, Pisa, Italy.,University of Genoa, Genova, Italy
| | - Graziella Donatelli
- Fondazione Imago 7, Pisa, Italy.,Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Oliver Speck
- Otto-von-Guericke University Magdeburg, Magdeburg, Germany.,German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Mirco Cosottini
- Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.,University of Pisa, Pisa, Italy
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Ragunathan S, Bell LC, Semmineh N, Stokes AM, Shefner JM, Bowser R, Ladha S, Quarles CC. Evaluation of Amyotrophic Lateral Sclerosis-Induced Muscle Degeneration Using Magnetic Resonance-Based Relaxivity Contrast Imaging (RCI). ACTA ACUST UNITED AC 2021; 7:169-179. [PMID: 34062974 PMCID: PMC8162571 DOI: 10.3390/tomography7020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: This work characterizes the sensitivity of magnetic resonance-based Relaxivity Contrast Imaging (RCI) to Amyotrophic Lateral Sclerosis (ALS)-induced changes in myofiber microstructure. Transverse Relaxivity at Tracer Equilibrium (TRATE), an RCI-based parameter, was evaluated in the lower extremities of ALS patients and healthy subjects. (2) Methods: In this IRB-approved study, 23 subjects (12 ALS patients and 11 healthy controls) were scanned at 3T (Philips, The Netherlands). RCI data were obtained during injection of a gadolinium-based contrast agent. TRATE, fat fraction and T2 measures, were compared in five muscle groups of the calf muscle, between ALS and control populations. TRATE was also evaluated longitudinally (baseline and 6 months) and was compared to clinical measures, namely ALS Functional Rating Scale (ALSFRS-R) and Hand-Held Dynamometry (HHD), in a subset of the ALS population. (3) Results: TRATE was significantly lower (p < 0.001) in ALS-affected muscle than in healthy muscle in all muscle groups. Fat fraction differences between ALS and healthy muscle were statistically significant for the tibialis anterior (p = 0.01), tibialis posterior (p = 0.004), and peroneus longus (p = 0.02) muscle groups but were not statistically significant for the medial (p = 0.07) and lateral gastrocnemius (p = 0.06) muscles. T2 differences between ALS and healthy muscle were statistically significant for the tibialis anterior (p = 0.004), peroneus longus (p = 0.004) and lateral gastrocnemius (p = 0.03) muscle groups but were not statistically significant for the tibialis posterior (p = 0.06) and medial gastrocnemius (p = 0.07) muscles. Longitudinally, TRATE, averaged over all patients, decreased by 28 ± 16% in the tibialis anterior, 47 ± 18% in the peroneus longus, 25 ± 19% in the tibialis posterior, 29 ± 14% in the medial gastrocnemius and 35 ± 18% in the lateral gastrocnemius muscles between two timepoints. ALSFRS-R scores were stable in two of four ALS patients. HHD scores decreased in three of four ALS patients. (4) Conclusion: RCI-based TRATE was shown to consistently differentiate ALS-affected muscle from healthy muscle and also provide a quantitative measure of longitudinal muscle degeneration.
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Affiliation(s)
- Sudarshan Ragunathan
- Barrow Neuroimaging Innovation Center, Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (L.C.B.); (N.S.); (A.M.S.); (C.C.Q.)
- Correspondence: ; Tel.: +1-(602)-406-7884
| | - Laura C. Bell
- Barrow Neuroimaging Innovation Center, Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (L.C.B.); (N.S.); (A.M.S.); (C.C.Q.)
| | - Natenael Semmineh
- Barrow Neuroimaging Innovation Center, Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (L.C.B.); (N.S.); (A.M.S.); (C.C.Q.)
| | - Ashley M. Stokes
- Barrow Neuroimaging Innovation Center, Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (L.C.B.); (N.S.); (A.M.S.); (C.C.Q.)
| | - Jeremy M. Shefner
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (J.M.S.); (R.B.)
| | - Robert Bowser
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (J.M.S.); (R.B.)
- Department of Neurobiology, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Shafeeq Ladha
- Gregory W. Fulton ALS and Neuromuscular Disease Center, Barrow Neurological Institute, Phoenix, AZ 85013, USA;
| | - C. Chad Quarles
- Barrow Neuroimaging Innovation Center, Division of Neuroimaging Research, Barrow Neurological Institute, Phoenix, AZ 85013, USA; (L.C.B.); (N.S.); (A.M.S.); (C.C.Q.)
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Barry RL, Babu S, Anteraper SA, Triantafyllou C, Keil B, Rowe OE, Rangaprakash D, Paganoni S, Lawson R, Dheel C, Cernasov PM, Rosen BR, Ratai EM, Atassi N. Ultra-high field (7T) functional magnetic resonance imaging in amyotrophic lateral sclerosis: a pilot study. NEUROIMAGE-CLINICAL 2021; 30:102648. [PMID: 33872993 PMCID: PMC8060594 DOI: 10.1016/j.nicl.2021.102648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022]
Abstract
Participants with ALS exhibited impaired function between the cortex and cerebellum. The cerebellum is associated with complex motor and cognitive processing tasks. These findings add to the growing number of ALS reports implicating the cerebellum.
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the central nervous system that results in a progressive loss of motor function and ultimately death. It is critical, yet also challenging, to develop non-invasive biomarkers to identify, localize, measure and/or track biological mechanisms implicated in ALS. Such biomarkers may also provide clues to identify potential molecular targets for future therapeutic trials. Herein we report on a pilot study involving twelve participants with ALS and nine age-matched healthy controls who underwent high-resolution resting state functional magnetic resonance imaging at an ultra-high field of 7 Tesla. A group-level whole-brain analysis revealed a disruption in long-range functional connectivity between the superior sensorimotor cortex (in the precentral gyrus) and bilateral cerebellar lobule VI. Post hoc analyses using atlas-derived left and right cerebellar lobule VI revealed decreased functional connectivity in ALS participants that predominantly mapped to bilateral postcentral and precentral gyri. Cerebellar lobule VI is a transition zone between anterior motor networks and posterior non-motor networks in the cerebellum, and is associated with a wide range of key functions including complex motor and cognitive processing tasks. Our observation of the involvement of cerebellar lobule VI adds to the growing number of studies implicating the cerebellum in ALS. Future avenues of scientific investigation should consider how high-resolution imaging at 7T may be leveraged to visualize differences in functional connectivity disturbances in various genotypes and phenotypes of ALS along the ALS-frontotemporal dementia spectrum.
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Affiliation(s)
- Robert L Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA.
| | - Suma Babu
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA.
| | - Sheeba Arnold Anteraper
- Department of Psychology, Northeastern University, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christina Triantafyllou
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA; Siemens Healthineers, Erlangen, Germany
| | - Boris Keil
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA; Mittelhessen University of Applied Sciences, Department of Life Science Engineering, Institute of Medical Physics and Radiation Protection, Giessen, Germany
| | - Olivia E Rowe
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - D Rangaprakash
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Sabrina Paganoni
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA; Spaulding Rehabilitation Hospital, Charlestown, MA, USA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Robert Lawson
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Christina Dheel
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Paul M Cernasov
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA; Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, MA, USA
| | - Eva-Maria Ratai
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA; Department of Radiology, Harvard Medical School, Boston, MA, USA; Division of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
| | - Nazem Atassi
- Sean M. Healey & AMG Center for ALS at Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Sanofi Genzyme, Cambridge, MA, USA
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9
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Eisen A. The Dying Forward Hypothesis of ALS: Tracing Its History. Brain Sci 2021; 11:brainsci11030300. [PMID: 33673524 PMCID: PMC7997258 DOI: 10.3390/brainsci11030300] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/25/2021] [Indexed: 01/15/2023] Open
Abstract
The site of origin of amyotrophic lateral sclerosis (ALS), although unsettled, is increasingly recognized as being cortico-fugal, which is a dying-forward process primarily starting in the corticomotoneuronal system. A variety of iterations of this concept date back to over 150 years. Recently, the hallmark TAR DNA-binding protein 43 (TDP-43) pathology, seen in >95% of patients with ALS, has been shown to be largely restricted to corticofugal projecting neurons (“dying forward”). Possibly, soluble but toxic cytoplasmic TDP-43 could enter the axoplasm of Betz cells, subsequently causing dysregulation of nuclear protein in the lower brainstem and spinal cord anterior horn cells. As the disease progresses, cortical involvement in ALS becomes widespread, including or starting with frontotemporal dementia, implying a broader view of ALS as a brain disease. The onset at the motor and premotor cortices should be considered a nidus at the edge of multiple cortical networks which eventually become disrupted, causing failure of a widespread cortical connectome.
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Affiliation(s)
- Andrew Eisen
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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10
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Sakurai T, Hirano S, Abe M, Uji Y, Shimizu K, Suzuki M, Nakano Y, Ishikawa A, Kojima K, Shibuya K, Murata A, Kuwabara S. Dysfunction of the left angular gyrus may be associated with writing errors in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:267-275. [PMID: 33331163 DOI: 10.1080/21678421.2020.1861021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Language dysfunction is a feature of cognitive impairment in amyotrophic lateral sclerosis (ALS) that may compromise communication. Objective: To elucidate language dysfunction in patients with ALS and its relationship with other neuropsychological tests and to identify the brain regions associated with this dysfunction using perfusion image. Methods: Overall, 37 patients with ALS were included in this study. Their neuropsychological function was investigated using the Western Aphasia Battery (WAB), Frontal Assessment Battery and Behavioral Assessment of the Dysexecutive Syndrome. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography was used to examine regional cerebral blood flow and its relationship with WAB scores was investigated using multiple regression analyses, controlled for age, sex and years of education. Results: Frequency of language abnormality in ALS was 8.5% for spontaneous speech, 25.7% for auditory verbal comprehension, 8.8% for repetition, 14.7% for naming, 17.6% for reading and 51.4% for writing. The writing error was mainly omission and substitution of kana letters. Executive tests were correlated with naming (r > 0.5, p < 0.001) and reading (r > 0.4, p < 0.01) scores. With respect to the writing sub-test, positive perfusional relationship was only detected in the left angular gyrus. Conclusions: The left angular gyrus is the region associated with the writing errors observed in ALS.
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Affiliation(s)
- Toru Sakurai
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Midori Abe
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | - Yuriko Uji
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | | | - Masahide Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshikazu Nakano
- Department of Neurology, Chiba Saiseikai Narashino Hospital, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, Chiba East Hospital, Chiba, Japan
| | - Kazuho Kojima
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Murata
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan.,Department of Rehabilitation, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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11
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Kamiya K, Hori M, Aoki S. NODDI in clinical research. J Neurosci Methods 2020; 346:108908. [PMID: 32814118 DOI: 10.1016/j.jneumeth.2020.108908] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/08/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022]
Abstract
Diffusion MRI (dMRI) has proven to be a useful imaging approach for both clinical diagnosis and research investigating the microstructures of nervous tissues, and it has helped us to better understand the neurophysiological mechanisms of many diseases. Though diffusion tensor imaging (DTI) has long been the default tool to analyze dMRI data in clinical research, acquisition with stronger diffusion weightings beyond the DTI regimen is now possible with modern clinical scanners, potentially enabling even more detailed characterization of tissue microstructures. To take advantage of such data, neurite orientation dispersion and density imaging (NODDI) has been proposed as a way to relate the dMRI signal to tissue features via biophysically inspired modeling. The number of reports demonstrating the potential clinical utility of NODDI is rapidly increasing. At the same time, the pitfalls and limitations of NODDI, and general challenges in microstructure modeling, are becoming increasingly recognized by clinicians. dMRI microstructure modeling is a rapidly evolving field with great promise, where people from different scientific backgrounds, such as physics, medicine, biology, neuroscience, and statistics, are collaborating to build novel tools that contribute to improving human healthcare. Here, we review the applications of NODDI in clinical research and discuss future perspectives for investigations toward the implementation of dMRI microstructure imaging in clinical practice.
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Affiliation(s)
- Kouhei Kamiya
- Department of Radiology, The University of Tokyo, Tokyo, Japan; Department of Radiology, Juntendo University, Tokyo, Japan; Department of Radiology, Toho University, Tokyo, Japan.
| | - Masaaki Hori
- Department of Radiology, Juntendo University, Tokyo, Japan; Department of Radiology, Toho University, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, Tokyo, Japan
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12
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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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13
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Lee MJ, Aronberg R, Manganaro MS, Ibrahim M, Parmar HA. Diagnostic Approach to Intrinsic Abnormality of Spinal Cord Signal Intensity. Radiographics 2020; 39:1824-1839. [PMID: 31589577 DOI: 10.1148/rg.2019190021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intramedullary cord hyperintensity at T2-weighted MRI is a common imaging feature of disease in the spinal cord, but it is nonspecific. Radiologists play a valuable role in helping narrow the differential diagnosis by integrating patient history and laboratory test results with key imaging characteristics. The authors present an algorithmic approach to evaluating intrinsic abnormality of spinal cord signal intensity (SI), which incorporates clinical evaluation results, time of onset (acute vs nonacute), cord expansion, and pattern of T2 SI abnormality. This diagnostic approach provides a practical framework to aid both trainees and practicing radiologists in workup of myelopathy.©RSNA, 2019.
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Affiliation(s)
- Michael J Lee
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Ryan Aronberg
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Matthew S Manganaro
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Mohannad Ibrahim
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
| | - Hemant A Parmar
- From the Department of Radiology, Division of Neuroradiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B1-D502, Ann Arbor, MI 48109
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14
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Gao J, Jiang M, Magin RL, Gatto RG, Morfini G, Larson AC, Li W. Multicomponent diffusion analysis reveals microstructural alterations in spinal cord of a mouse model of amyotrophic lateral sclerosis ex vivo. PLoS One 2020; 15:e0231598. [PMID: 32310954 PMCID: PMC7170503 DOI: 10.1371/journal.pone.0231598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/26/2020] [Indexed: 12/11/2022] Open
Abstract
The microstructure changes associated with degeneration of spinal axons in amyotrophic lateral sclerosis (ALS) may be reflected in altered water diffusion properties, potentially detectable with diffusion-weighted (DW) MRI. Prior work revealed the classical mono-exponential model fails to precisely depict decay in DW signal at high b-values. In this study, we aim to investigate signal decay behaviors at ultra-high b-values for non-invasive assessment of spinal cord alterations in the transgenic SOD1G93A mouse model of ALS. A multiexponential diffusion analysis using regularized non-negative least squares (rNNLS) algorithm was applied to a series of thirty DW MR images with b-values ranging from 0 to 858,022 s/mm2 on ex vivo spinal cords of transgenic SOD1G93A and age-matched control mice. We compared the distributions of measured diffusion coefficient fractions between the groups. The measured diffusion weighted signals in log-scale showed non-linear decay behaviors with increased b-values. Faster signal decays were observed with diffusion gradients applied parallel to the long axis of the spinal cord compared to when oriented in the transverse direction. Multiexponential analysis at the lumbar level in the spinal cord identified ten subintervals. A significant decrease of diffusion coefficient fractions was found in the ranges of [1.63×10−8,3.70×10−6] mm2/s (P = 0.0002) and of [6.01×10−6,4.20×10−5] mm2/s (P = 0.0388) in SOD1G93A mice. Anisotropic diffusion signals persisted at ultra-high b-value DWIs of the mouse spinal cord and multiexponential diffusion analysis offers the potential to evaluate microstructural alterations of ALS-affected spinal cord non-invasively.
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Affiliation(s)
- Jin Gao
- Department of Electrical and Computer Engineering, University of Illinois at Chicago, Chicago, IL, United States of America
- Research Resource Center, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Mingchen Jiang
- Department of Physiology, Northwestern University, Chicago, IL, United States of America
| | - Richard L. Magin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Rodolfo G. Gatto
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Gerardo Morfini
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Andrew C. Larson
- Department of Radiology, Northwestern University, Chicago, IL, United States of America
| | - Weiguo Li
- Research Resource Center, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, United States of America
- Department of Radiology, Northwestern University, Chicago, IL, United States of America
- * E-mail:
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15
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Contarino VE, Conte G, Morelli C, Trogu F, Scola E, Calloni SF, Sanmiguel Serpa LC, Liu C, Silani V, Triulzi F. Toward a marker of upper motor neuron impairment in amyotrophic lateral sclerosis: A fully automatic investigation of the magnetic susceptibility in the precentral cortex. Eur J Radiol 2020; 124:108815. [DOI: 10.1016/j.ejrad.2020.108815] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/13/2019] [Accepted: 12/26/2019] [Indexed: 12/12/2022]
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16
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Sass LR, Khani M, Romm J, Schmid Daners M, McCain K, Freeman T, Carter GT, Weeks DL, Petersen B, Aldred J, Wingett D, Martin BA. Non-invasive MRI quantification of cerebrospinal fluid dynamics in amyotrophic lateral sclerosis patients. Fluids Barriers CNS 2020; 17:4. [PMID: 31959193 PMCID: PMC6971921 DOI: 10.1186/s12987-019-0164-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
Abstract
Background Developing novel therapeutic agents to treat amyotrophic lateral sclerosis (ALS) has been difficult due to multifactorial pathophysiologic processes at work. Intrathecal drug administration shows promise due to close proximity of cerebrospinal fluid (CSF) to affected tissues. Development of effective intrathecal pharmaceuticals will rely on accurate models of how drugs are dispersed in the CSF. Therefore, a method to quantify these dynamics and a characterization of differences across disease states is needed. Methods Complete intrathecal 3D CSF geometry and CSF flow velocities at six axial locations in the spinal canal were collected by T2-weighted and phase-contrast MRI, respectively. Scans were completed for eight people with ALS and ten healthy controls. Manual segmentation of the spinal subarachnoid space was performed and coupled with an interpolated model of CSF flow within the spinal canal. Geometric and hydrodynamic parameters were then generated at 1 mm slice intervals along the entire spine. Temporal analysis of the waveform spectral content and feature points was also completed. Results Comparison of ALS and control groups revealed a reduction in CSF flow magnitude and increased flow propagation velocities in the ALS cohort. Other differences in spectral harmonic content and geometric comparisons may support an overall decrease in intrathecal compliance in the ALS group. Notably, there was a high degree of variability between cases, with one ALS patient displaying nearly zero CSF flow along the entire spinal canal. Conclusion While our sample size limits statistical confidence about the differences observed in this study, it was possible to measure and quantify inter-individual and cohort variability in a non-invasive manner. Our study also shows the potential for MRI based measurements of CSF geometry and flow to provide information about the hydrodynamic environment of the spinal subarachnoid space. These dynamics may be studied further to understand the behavior of CSF solute transport in healthy and diseased states.
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Affiliation(s)
- Lucas R Sass
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Mohammadreza Khani
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Jacob Romm
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA.,University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Kyle McCain
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Tavara Freeman
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA
| | - Gregory T Carter
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Douglas L Weeks
- St. Luke's Rehabilitation Institute, 711 South Cowley St., Spokane, WA, 99202, USA
| | - Brian Petersen
- Inland Imaging PS and LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Jason Aldred
- Selkirk Neurology, 610 South Sherman St. #201, Spokane, WA, 99202, USA
| | - Dena Wingett
- Inland Imaging LLC, 801 South Stevens St., Spokane, WA, 99204, USA
| | - Bryn A Martin
- Neurophysiological Imaging and Modeling Laboratory, University of Idaho, 875 Perimeter Dr. MS1122, Moscow, ID, 83844, USA. .,Biological Engineering, University of Idaho, 875 Perimeter Dr. MS0904, Moscow, ID, 83844-0904, USA.
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17
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Hu T, Hou Y, Wei Q, Yang J, Luo C, Chen Y, Gong Q, Shang H. Patterns of brain regional functional coherence in cognitive impaired ALS. Int J Neurosci 2020; 130:751-758. [PMID: 31906800 DOI: 10.1080/00207454.2019.1705806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: The aim of the study is to reveal the brain regional functional coherence alterations in the early-stage amyotrophic lateral sclerosis (ALS) patients with cognitive impairments.Methods: Resting state functional MRI (fMRI) was performed to characterize the amplitude of regional homogeneity (ReHo). Twenty-one ALS patients with cognitive impairments (ALSci), 21 ALS patients without cognitive impairments (ALSnci) and 21 healthy controls (HCs) were enrolled.Result: Compared with HCs, the ALSci subgroup showed increased ReHo in bilateral inferior parietal lobules (IPLs), precuneus and inferior cerebellar areas, and the ALSnci subgroup had increased ReHo in the left IPL and left inferior cerebellar area. The ALSci subgroup also had increased ReHo in the right IPL and right inferior cerebellar area relative to the ALSnci subgroup. Meantime, compared with HCs, both ALS subgroups showed decreased ReHo in bilateral sensorimotor cortices. The ReHo values in the right cerebellar area were negatively correlated with the Chinese version of Addenbrooke Cognitive Examination-revised (ACE-R) total scores in all ALS patients. In addition, the grey matter (GM) volume revealed no significant difference among three groups, which indicated that the altered ReHo was not caused by the anatomic change.Conclusion: The altered regional functional coherence might indicate the underlying deficits of ALS with and without cognitive impairments. Our findings support that ALS is a multisystem disease and provide the evidence that alterations of ReHo in the right inferior cerebellar area might be a special marker of ALS with cognitive impairment. Our results are preliminary and further investigations are needed.
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Affiliation(s)
- Tao Hu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Yanbing Hou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Chunyan Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Yongping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu Sichuan, China
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18
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Qiu T, Zhang Y, Tang X, Liu X, Wang Y, Zhou C, Luo C, Zhang J. Precentral degeneration and cerebellar compensation in amyotrophic lateral sclerosis: A multimodal MRI analysis. Hum Brain Mapp 2019; 40:3464-3474. [PMID: 31020731 PMCID: PMC6865414 DOI: 10.1002/hbm.24609] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/27/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive and intractable neurodegenerative disease of human motor system characterized by progressive muscular weakness and atrophy. A considerable body of research has demonstrated significant structural and functional abnormalities of the primary motor cortex in patients with ALS. In contrast, much less attention has been paid to the abnormalities of cerebellum in this disease. Using multimodal magnetic resonance imagining data of 60 patients with ALS and 60 healthy controls, we examined changes in gray matter volume (GMV), white matter (WM) fractional anisotropy (FA), and functional connectivity (FC) in patients with ALS. Compared with healthy controls, patients with ALS showed decreased GMV in the left precentral gyrus and increased GMV in bilateral cerebellum, decreased FA in the left corticospinal tract and body of corpus callosum, and decreased FC in multiple brain regions, involving bilateral postcentral gyrus, precentral gyrus and cerebellum anterior lobe, among others. Meanwhile, we found significant intermodal correlations among GMV of left precentral gyrus, FA of altered WM tracts, and FC of left precentral gyrus, and that WM microstructural alterations seem to play important roles in mediating the relationship between GMV and FC of the precentral gyrus, as well as the relationship between GMVs of the precentral gyrus and cerebellum. These findings provided evidence for the precentral degeneration and cerebellar compensation in ALS, and the involvement of WM alterations in mediating the relationship between pathologies of the primary motor cortex and cerebellum, which may contribute to a better understanding of the pathophysiology of ALS.
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Affiliation(s)
- Ting Qiu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduPeople's Republic of China
| | - Yuanchao Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduPeople's Republic of China
| | - Xie Tang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduPeople's Republic of China
| | - Xiaoping Liu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduPeople's Republic of China
| | - Yue Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and TechnologyUniversity of Electronic Science and Technology of ChinaChengduPeople's Republic of China
| | - Chaoyang Zhou
- Department of RadiologySouthwest Hospital, Third Military Medical UniversityChongqingPeople's Republic of China
| | - Chunxia Luo
- Department of NeurologySouthwest Hospital, Third Military Medical UniversityChongqingPeople's Republic of China
| | - Jiuquan Zhang
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingPeople's Republic of China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer HospitalChongqingPeople's Republic of China
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19
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Gatto RG, Amin M, Finkielsztein A, Weissmann C, Barrett T, Lamoutte C, Uchitel O, Sumagin R, Mareci TH, Magin RL. Unveiling early cortical and subcortical neuronal degeneration in ALS mice by ultra-high field diffusion MRI. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:549-561. [DOI: 10.1080/21678421.2019.1620285] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rodolfo G. Gatto
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA,
| | - Manish Amin
- Department of Biochemistry and Molecular Biology, National High Magnetic Field Laboratory, University of Florida, Gainesville, FL, USA,
| | - Ariel Finkielsztein
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,
| | - Carina Weissmann
- Institute for Physiology, Molecular Biology and Neurosciences (IFIBYNE CONICET-UBA), Buenos Aires, Argentina,
| | - Thomas Barrett
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA, and
| | - Caroline Lamoutte
- Department of Microbiology, University of Florida, Gainesville, FL, USA
| | - Osvaldo Uchitel
- Institute for Physiology, Molecular Biology and Neurosciences (IFIBYNE CONICET-UBA), Buenos Aires, Argentina,
| | - Ronen Sumagin
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA,
| | - Thomas H. Mareci
- Department of Biochemistry and Molecular Biology, National High Magnetic Field Laboratory, University of Florida, Gainesville, FL, USA,
| | - Richard L. Magin
- Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA,
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20
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Christidi F, Karavasilis E, Riederer F, Zalonis I, Ferentinos P, Velonakis G, Xirou S, Rentzos M, Argiropoulos G, Zouvelou V, Zambelis T, Athanasakos A, Toulas P, Vadikolias K, Efstathopoulos E, Kollias S, Karandreas N, Kelekis N, Evdokimidis I. Gray matter and white matter changes in non-demented amyotrophic lateral sclerosis patients with or without cognitive impairment: A combined voxel-based morphometry and tract-based spatial statistics whole-brain analysis. Brain Imaging Behav 2019; 12:547-563. [PMID: 28425061 DOI: 10.1007/s11682-017-9722-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The phenotypic heterogeneity in amyotrophic lateral sclerosis (ALS) implies that patients show structural changes within but also beyond the motor cortex and corticospinal tract and furthermore outside the frontal lobes, even if frank dementia is not detected. The aim of the present study was to investigate both gray matter (GM) and white matter (WM) changes in non-demented amyotrophic lateral sclerosis (ALS) patients with or without cognitive impairment (ALS-motor and ALS-plus, respectively). Nineteen ALS-motor, 31 ALS-plus and 25 healthy controls (HC) underwent 3D-T1-weighted and 30-directional diffusion-weighted imaging on a 3 T MRI scanner. Voxel-based morphometry and tract-based spatial-statistics analysis were performed to examine GM volume (GMV) changes and WM differences in fractional anisotropy (FA), axial and radial diffusivity (AD, RD, respectively). Compared to HC, ALS-motor patients showed decreased GMV in frontal and cerebellar areas and increased GMV in right supplementary motor area, while ALS-plus patients showed diffuse GMV reduction in primary motor cortex bilaterally, frontotemporal areas, cerebellum and basal ganglia. ALS-motor patients had increased GMV in left precuneus compared to ALS-plus patients. We also found decreased FA and increased RD in the corticospinal tract bilaterally, the corpus callosum and extra-motor tracts in ALS-motor patients, and decreased FA and increased AD and RD in motor and several WM tracts in ALS-plus patients, compared to HC. Multimodal neuroimaging confirms motor and extra-motor GM and WM abnormalities in non-demented cognitively-impaired ALS patients (ALS-plus) and identifies early extra-motor brain pathology in ALS patients without cognitive impairment (ALS-motor).
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece.
| | - Efstratios Karavasilis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Franz Riederer
- Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria
| | - Ioannis Zalonis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, Attikon University Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Sophia Xirou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Michalis Rentzos
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Georgios Argiropoulos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Thomas Zambelis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Athanasios Athanasakos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Panagiotis Toulas
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | | | - Efstathios Efstathopoulos
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Spyros Kollias
- Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Nikolaos Karandreas
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, Medical School, National & Kapodistrian University, Athens, Greece
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Yedavalli VS, Patil A, Shah P. Amyotrophic Lateral Sclerosis and its Mimics/Variants: A Comprehensive Review. J Clin Imaging Sci 2018; 8:53. [PMID: 30652056 PMCID: PMC6302559 DOI: 10.4103/jcis.jcis_40_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022] Open
Abstract
Motor neuron diseases (MNDs) are a debilitating subset of diseases, which result in progressive neuronal destruction and eventual loss of voluntary muscular function. These entities are often challenging to distinguish and accurately diagnose given overlapping clinical pictures and overall rarity. This group of diseases has a high morbidity and mortality rate overall and delineating each type of disease can help guide appropriate clinical management and improve quality of life for patients. Of all MNDs, amyotrophic lateral sclerosis (ALS) is by far the most common comprising 80%-90% of cases. However, other mimics and variants of ALS can appear similar both clinically and radiographically. In this review, we delve into the epidemiological, physiological, neuroimaging, and prognostic characteristics and management of ALS and its most common MND mimics/variants. In doing so, we hope to improve accuracy in diagnosis and potential management for this rare group of diseases.
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Affiliation(s)
- Vivek S Yedavalli
- Department of Neuroradiology and Neurointervention, Stanford University, Palo Alto, California, USA
| | - Abhijit Patil
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Parinda Shah
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
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Theme 8 Clinical imaging and electrophysiology. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:240-263. [DOI: 10.1080/21678421.2018.1510575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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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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Weerasekera A, Sima DM, Dresselaers T, Van Huffel S, Van Damme P, Himmelreich U. Non-invasive assessment of disease progression and neuroprotective effects of dietary coconut oil supplementation in the ALS SOD1 G93A mouse model: A 1H-magnetic resonance spectroscopic study. NEUROIMAGE-CLINICAL 2018; 20:1092-1105. [PMID: 30368196 PMCID: PMC6202692 DOI: 10.1016/j.nicl.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/28/2018] [Accepted: 09/16/2018] [Indexed: 12/12/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is an incurable neurodegenerative disease primarily characterized by progressive degeneration of motor neurons in the motor cortex, brainstem and spinal cord. Due to relatively fast progression of ALS, early diagnosis is essential for possible therapeutic intervention and disease management. To identify potential diagnostic markers, we investigated age-dependent effects of disease onset and progression on regional neurochemistry in the SOD1G93A ALS mouse model using localized in vivo magnetic resonance spectroscopy (MRS). We focused mainly on the brainstem region since brainstem motor nuclei are the primarily affected regions in SOD1G93A mice and ALS patients. In addition, metabolite profiles of the motor cortex were also assessed. In the brainstem, a gradual decrease in creatine levels were detected starting from the pre-symptomatic age of 70 days postpartum. During the early symptomatic phase (day 90), a significant increase in the levels of the inhibitory neurotransmitter γ- aminobutyric acid (GABA) was measured. At later time points, alterations in the form of decreased NAA, glutamate, glutamine and increased myo-inositol were observed. Also, decreased glutamate, NAA and increased taurine levels were seen at late stages in the motor cortex. A proof-of-concept (PoC) study was conducted to assess the effects of coconut oil supplementation in SODG93A mice. The PoC revealed that the coconut oil supplementation together with the regular diet delayed disease symptoms, enhanced motor performance, and prolonged survival in the SOD1G93A mouse model. Furthermore, MRS data showed stable metabolic profile at day 120 in the coconut oil diet group compared to the group receiving a standard diet without coconut oil supplementation. In addition, a positive correlation between survival and the neuronal marker NAA was found. To the best of our knowledge, this is the first study that reports metabolic changes in the brainstem using in vivo MRS and effects of coconut oil supplementation as a prophylactic treatment in SOD1G93A mice.
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Affiliation(s)
- A Weerasekera
- Biomedical MRI Unit/MoSAIC, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - D M Sima
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium; icometrix, R&D department, Leuven, Belgium
| | - T Dresselaers
- Radiology, Department of Imaging and Pathology, UZ Leuven, Leuven, Belgium
| | - S Van Huffel
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - P Van Damme
- Department of Neurology, University Hospitals Leuven, Laboratory of Neurobiology, Leuven, Belgium; Department of Neurosciences, KU Leuven, Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - U Himmelreich
- Biomedical MRI Unit/MoSAIC, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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25
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Wirth AM, Khomenko A, Baldaranov D, Kobor I, Hsam O, Grimm T, Johannesen S, Bruun TH, Schulte-Mattler W, Greenlee MW, Bogdahn U. Combinatory Biomarker Use of Cortical Thickness, MUNIX, and ALSFRS-R at Baseline and in Longitudinal Courses of Individual Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:614. [PMID: 30104996 PMCID: PMC6077217 DOI: 10.3389/fneur.2018.00614] [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: 02/15/2018] [Accepted: 07/09/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative process affecting upper and lower motor neurons as well as non-motor systems. In this study, precentral and postcentral cortical thinning detected by structural magnetic resonance imaging (MRI) were combined with clinical (ALS-specific functional rating scale revised, ALSFRS-R) and neurophysiological (motor unit number index, MUNIX) biomarkers in both cross-sectional and longitudinal analyses. Methods: The unicenter sample included 20 limb-onset classical ALS patients compared to 30 age-related healthy controls. ALS patients were treated with standard Riluzole and additional long-term G-CSF (Filgrastim) on a named patient basis after written informed consent. Combinatory biomarker use included cortical thickness of atlas-based dorsal and ventral subdivisions of the precentral and postcentral cortex, ALSFRS-R, and MUNIX for the musculus abductor digiti minimi (ADM) bilaterally. Individual cross-sectional analysis investigated individual cortical thinning in ALS patients compared to age-related healthy controls in the context of state of disease at initial MRI scan. Beyond correlation analysis of biomarkers at cross-sectional group level (n = 20), longitudinal monitoring in a subset of slow progressive ALS patients (n = 4) explored within-subject temporal dynamics of repeatedly assessed biomarkers in time courses over at least 18 months. Results: Cross-sectional analysis demonstrated individually variable states of cortical thinning, which was most pronounced in the ventral section of the precentral cortex. Correlations of ALSFRS-R with cortical thickness and MUNIX were detected. Individual longitudinal biomarker monitoring in four slow progressive ALS patients revealed evident differences in individual disease courses and temporal dynamics of the biomarkers. Conclusion: A combinatory use of structural MRI, neurophysiological and clinical biomarkers allows for an appropriate and detailed assessment of clinical state and course of disease of ALS.
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Affiliation(s)
- Anna M Wirth
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany.,Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Andrei Khomenko
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Dobri Baldaranov
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Ohnmar Hsam
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Thomas Grimm
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Siw Johannesen
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | - Tim-Henrik Bruun
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
| | | | - Mark W Greenlee
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University Hospital of Regensburg, Regensburg, Germany
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Suresh SN, Verma V, Sateesh S, Clement JP, Manjithaya R. Neurodegenerative diseases: model organisms, pathology and autophagy. J Genet 2018; 97:679-701. [PMID: 30027903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A proteostasis view of neurodegeneration (ND) identifies protein aggregation as a leading causative reason for damage seen at the cellular and organ levels. While investigative therapies that aim at dissolving aggregates have failed, and the promises of silencing expression of ND associated pathogenic proteins or the deployment of engineered induced pluripotent stem cells (iPSCs) are still in the horizon, emerging literature suggests degrading aggregates through autophagy-related mechanisms hold the current potential for a possible cure. Macroautophagy (hereafter autophagy) is an intracellular degradative pathway where superfluous or unwanted cellular cargoes (such as peroxisomes, mitochondria, ribosomes, intracellular bacteria and misfolded protein aggregates) are wrapped in double membrane vesicles called autophagosomes that eventually fuses with lysosomes for their degradation. The selective branch of autophagy that deals with identification, capture and degradation of protein aggregates is called aggrephagy. Here, we cover the workings of aggrephagy detailing its selectivity towards aggregates. The diverse cellular adaptors that bridge the aggregates with the core autophagy machinery in terms of autophagosome formation are discussed. In ND, essential protein quality control mechanisms fail as the constituent components also find themselves trapped in the aggregates. Thus, although cellular aggrephagy has the potential to be upregulated, its dysfunction further aggravates the pathogenesis. This phenomenonwhen combined with the fact that neurons can neither dilute out the aggregates by cell division nor the dead neurons can be replaced due to low neurogenesis, makes a compelling case for aggrephagy pathway as a potential therapeutic option.
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Affiliation(s)
- S N Suresh
- Molecular Biology and Genetics Unit, Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR), Jakkur, Bengaluru 560 064, India.
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Dharmadasa T, Huynh W, Tsugawa J, Shimatani Y, Ma Y, Kiernan MC. Implications of structural and functional brain changes in amyotrophic lateral sclerosis. Expert Rev Neurother 2018; 18:407-419. [PMID: 29667443 DOI: 10.1080/14737175.2018.1464912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that causes progressive muscle weakness and disability, eventually leading to death. Heterogeneity of disease has become a major barrier to understanding key clinical questions such as prognosis and disease spread, and has disadvantaged clinical trials in search of therapeutic intervention. Patterns of disease have been explored through recent advances in neuroimaging, elucidating structural, molecular and functional changes. Unique brain signatures have emerged that have lent a greater understanding of critical disease mechanisms, offering opportunities to improve diagnosis, guide prognosis, and establish candidate biomarkers to direct future therapeutic strategies. Areas covered: This review explores patterns of cortical and subcortical change in ALS through advanced neuroimaging techniques and discusses the implications of these findings. Expert commentary: Cortical and subcortical signatures and patterns of atrophy are now consistently recognised, providing important pathophysiological insight into this heterogenous disease. The spread of cortical change, particularly involving frontotemporal networks, correlates with cognitive impairment and poorer prognosis. Cortical differences are also evident between ALS phenotypes and genotypes, which may partly explain the heterogeneity of prognosis. Ultimately, multimodal approaches with larger cohorts will be needed to provide sensitive biomarkers of disease spread at the level of the individual patient.
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Affiliation(s)
| | - William Huynh
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia
| | - Jun Tsugawa
- c Department of Neurology , Fukuoka University Hospital , Fukuoka city , Japan
| | - Yoshimitsu Shimatani
- d Department of Neurology , Tokushima Prefectural Hospital , Tokushima city , Japan
| | - Yan Ma
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia
| | - Matthew C Kiernan
- a Brain and Mind Centre , The University of Sydney , Sydney , Australia.,b Department of Neurology , Royal Prince Alfred Hospital , Sydney , Australia
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Stämpfli P, Sommer S, Czell D, Kozerke S, Neuwirth C, Weber M, Sartoretti-Schefer S, Seifritz E, Gutzeit A, Reischauer C. Investigation of Neurodegenerative Processes in Amyotrophic Lateral Sclerosis Using White Matter Fiber Density. Clin Neuroradiol 2018; 29:493-503. [DOI: 10.1007/s00062-018-0670-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/19/2018] [Indexed: 12/20/2022]
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30
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Baldaranov D, Khomenko A, Kobor I, Bogdahn U, Gorges M, Kassubek J, Müller HP. Longitudinal Diffusion Tensor Imaging-Based Assessment of Tract Alterations: An Application to Amyotrophic Lateral Sclerosis. Front Hum Neurosci 2017; 11:567. [PMID: 29259550 PMCID: PMC5723297 DOI: 10.3389/fnhum.2017.00567] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/07/2017] [Indexed: 12/03/2022] Open
Abstract
Objective: The potential of magnetic resonance imaging (MRI) as a technical biomarker for cerebral microstructural alterations in neurodegenerative diseases is under investigation. In this study, a framework for the longitudinal analysis of diffusion tensor imaging (DTI)-based mapping was applied to the assessment of predefined white matter tracts in amyotrophic lateral sclerosis (ALS), as an example for a rapid progressive neurodegenerative disease. Methods: DTI was performed every 3 months in six patients with ALS (mean (M) = 7.7; range 3 to 15 scans) and in six controls (M = 3; range 2–5 scans) with the identical scanning protocol, resulting in a total of 65 longitudinal DTI datasets. Fractional anisotropy (FA), mean diffusivity (MD), axonal diffusivity (AD), radial diffusivity (RD), and the ratio AD/RD were studied to analyze alterations within the corticospinal tract (CST) which is a prominently affected tract structure in ALS and the tract correlating with Braak’s neuropathological stage 1. A correlation analysis was performed between progression rates based on DTI metrics and the revised ALS functional rating scale (ALS-FRS-R). Results: Patients with ALS showed an FA and AD/RD decline along the CST, while DTI metrics of controls did not change in longitudinal DTI scans. The FA and AD/RD decrease progression correlated significantly with ALS-FRS-R decrease progression. Conclusion: On the basis of the longitudinal assessment, DTI-based metrics can be considered as a possible noninvasive follow-up marker for disease progression in neurodegeneration. This finding was demonstrated here for ALS as a fast progressing neurodegenerative disease.
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Affiliation(s)
- Dobri Baldaranov
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Andrei Khomenko
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ines Kobor
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Gatto RG, Li W, Magin RL. Diffusion tensor imaging identifies presymptomatic axonal degeneration in the spinal cord of ALS mice. Brain Res 2017; 1679:45-52. [PMID: 29175489 DOI: 10.1016/j.brainres.2017.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/14/2017] [Accepted: 11/18/2017] [Indexed: 12/11/2022]
Abstract
Extensive pathological evidence indicates that axonal degeneration represents an early and critical event in amyotrophic lateral sclerosis (ALS). Unfortunately, few MRI studies have focused in the early detection of white matter (WM) alterations in the spinal cord region. To unveil these WM changes, we performed high resolution diffusion tensor imaging (DTI) and correlated the results with histological analysis of adjacent slices taken from the spinal cords of presymptomatic mice. The DTI studies demonstrated a significant reduction in fractional anisotropy (FA) as well as axial diffusivities (AD) and an increase in radial diffusivity (RD), predominantly at lower segments of the spinal cord. Increases in FA and a reduction in AD and RD were observed in spinal cord (SC) gray matter (GM). Diffusion changes are associated with early and progressive alterations in axonal connectivity following a distal to proximal progression. Histological data tagging neuronal, axonal and glial cell markers demonstrated presymptomatic alterations in spinal cord WM and GM. This study demonstrates that DTI methods are optimal preclinical imaging tools to detect structural anomalies in WM and GM spinal cord during early stages of the disease.
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Affiliation(s)
- Rodolfo G Gatto
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA.
| | - Weiguo Li
- Department of Bioengineering, University of Illinois at Chicago, School of Engineering, Chicago, IL 60612, USA
| | - Richard L Magin
- Department of Bioengineering, University of Illinois at Chicago, School of Engineering, Chicago, IL 60612, USA
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Lee JY, Lee YJ, Park DW, Nam Y, Kim SH, Park J, Kim YS, Kim HY, Oh KW. Quantitative susceptibility mapping of the motor cortex: a comparison of susceptibility among patients with amyotrophic lateral sclerosis, cerebrovascular disease, and healthy controls. Neuroradiology 2017; 59:1213-1222. [DOI: 10.1007/s00234-017-1933-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/02/2017] [Indexed: 01/11/2023]
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Boruah DK, Sanyal S, Prakash A, Achar S, Dhingani DD, Sarma B. Bimelic symmetric Hirayama disease: Spectrum of magnetic resonance imaging findings and comparative evaluation with classical monomelic amyotrophy and other motor neuron disease. IRANIAN JOURNAL OF NEUROLOGY 2017; 16:136-145. [PMID: 29114369 PMCID: PMC5673986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/05/2017] [Indexed: 11/05/2022]
Abstract
Background: The aim of the study was to evaluate the magnetic resonance imaging (MRI) findings in bilateral symmetrical Hirayama disease and find out MRI features which are probably more indicative of symmetrical Hirayama disease, thereby help in differentiating this entity from other motor neuron disease (MND). Methods: This prospective as well as retrospective study was carried out from December 2010 to September 2016 in a tertiary care center of northeast India on 92 patients with Hirayama disease. Only 19 patients having bilateral symmetric upper limb involvement at the time of presentation were included in this study sample. Results: Nineteen patients, who constituted 20.6% of 92 patients of clinical and flexion MRI confirmed Hirayama disease were found to have bilateral symmetrical wasting and weakness of distal upper limb muscles at the time of presentation. Mean ± standard deviation (SD) age of onset of the disease process was 21.7 ± 3.8 years with mean ± SD duration of illness of 3.6 ± 1.3 years. MRI revealed lower cervical cord flattening in 13 (68.4%) patients which was symmetrical in 6 (31.6%) patients and asymmetrical in 7 (36.8%) patients. In the majority of these patients, T2-weighted images (T2WI) cervical cord hyperintensities were found extending from C5 to C6 vertebral level. Seven (36.8%) patients in our study showed bilateral symmetric T2WI hyperintensities in anterior horn cells (AHC). Conclusion: Bilateral symmetrical involvement of Hirayama disease is an uncommon presentation. Symmetrical cervical cord flattening, T2WI cord and/or bilateral AHC hyperintensities were the major MRI findings detected. Flexion MRI demonstrated similar findings in both bimelic amyotrophy and classical unilateral amyotrophy. However, flexion MRI produced some distinguishing features more typical for bilateral symmetrical Hirayama disease which help to differentiate it from other MNDs.
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Affiliation(s)
- Deb Kumar Boruah
- Department of Radio-Diagnosis, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | | | - Arjun Prakash
- Department of Radio-Diagnosis, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Sashidhar Achar
- Department of Radio-Diagnosis, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Dhabal D. Dhingani
- Department of Radio-Diagnosis, Assam Medical College and Hospital, Dibrugarh, Assam, India
| | - Binod Sarma
- Department of Neurology, Assam Medical College and Hospital, Dibrugarh, Assam, India
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Bede P, Iyer PM, Finegan E, Omer T, Hardiman O. Virtual brain biopsies in amyotrophic lateral sclerosis: Diagnostic classification based on in vivo pathological patterns. NEUROIMAGE-CLINICAL 2017; 15:653-658. [PMID: 28664036 PMCID: PMC5479963 DOI: 10.1016/j.nicl.2017.06.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/28/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Abstract
Background Diagnostic uncertainty in ALS has serious management implications and delays recruitment into clinical trials. Emerging evidence of presymptomatic disease-burden provides the rationale to develop diagnostic applications based on the evaluation of in-vivo pathological patterns early in the disease. Objectives To outline and test a diagnostic classification approach based on an array of complementary imaging metrics in key disease-associated anatomical structures. Methods Data from 75 ALS patients and 75 healthy controls were randomly allocated in a ‘training’ and ‘validation’ cohort. Spatial masks were created for anatomical foci which best discriminate patients from controls in the ‘training sample’. In a virtual ‘brain biopsy’, data was then retrieved from these key disease-associated brain regions. White matter diffusivity indices, grey matter T1-signal intensity values and basal ganglia volumes were evaluated as predictor variables in a canonical discriminant function. Results Following predictor variable selection, a classification specificity of 85.5% and sensitivity of 89.1% was achieved in the training sample and 90% specificity and 90% sensitivity in the validation sample. Discussion This study evaluates disease-associated imaging measures in a dummy diagnostic application. Although larger samples will be required for robust validation, the study confirms the potential of multimodal quantitative imaging in future clinical applications. Reliable diagnostic, monitoring and prognostic biomarkers are urgently in ALS. Accurate diagnostic classification may be achieved based on MRI metrics. Basal ganglia, grey and white matter indices were integrated in a diagnostic model. 85.5% specificity and 89.1% sensitivity were achieved in the training sample. 90% specificity and 90% sensitivity were achieved in the validation sample.
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Affiliation(s)
- Peter Bede
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
| | - Parameswaran M Iyer
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Eoin Finegan
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
| | - Taha Omer
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Bontempi P, Busato A, Bonafede R, Schiaffino L, Scambi I, Sbarbati A, Mariotti R, Marzola P. MRI reveals therapeutical efficacy of stem cells: An experimental study on the SOD1(G93A) animal model. Magn Reson Med 2017; 79:459-469. [PMID: 28370153 DOI: 10.1002/mrm.26685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/25/2017] [Accepted: 03/03/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE The first part of the experiment identifies and validates MRI biomarkers distinctive of the disease progression in the transgenic superoxide dismutase gene (SOD1(G93A)) animal model. The second part assesses the efficacy of a mesenchymal stem cell-based therapy through the MRI biomarkers previously defined. METHODS The first part identifies MRI differences between SOD1(G93A) and healthy mice. The second part of the experiment follows the disease evolution of stem cell-treated and non-stem-cell treated SOD1(G93A) mice. The analysis focused on voxel-based morphometry and T2 mapping on the brain tissues, and T2-weighted imaging and diffusion tensor imaging (DTI) on the hind limbs. RESULTS Comparing diseased mice to healthy control revealed gray matter alterations in the brainstem area, accompanied by increased T2 relaxation time. Differences in muscle volume, muscle signal intensity, fractional anisotropy, axial diffusivity, and radial diffusivity were measured in the hind limbs. In the comparison between stem cell-treated mice and nontreated ones, differences in muscle volume, muscle signal intensity, and DTI-derived maps were found. CONCLUSION MRI-derived biomarkers can be used to identify differences between stem cell-treated and nontreated SOD1(G93A) mice. Magn Reson Med 79:459-469, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Pietro Bontempi
- Department of Computer Science, University of Verona, Verona, Italy
| | - Alice Busato
- Department of Computer Science, University of Verona, Verona, Italy
| | - Roberta Bonafede
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lorenzo Schiaffino
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ilaria Scambi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Sbarbati
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raffaella Mariotti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pasquina Marzola
- Department of Computer Science, University of Verona, Verona, Italy
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36
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Sarica A, Cerasa A, Valentino P, Yeatman J, Trotta M, Barone S, Granata A, Nisticò R, Perrotta P, Pucci F, Quattrone A. The corticospinal tract profile in amyotrophic lateral sclerosis. Hum Brain Mapp 2016; 38:727-739. [PMID: 27659483 DOI: 10.1002/hbm.23412] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 01/18/2023] Open
Abstract
This work evaluates the potential in diagnostic application of a new advanced neuroimaging method, which delineates the profile of tissue properties along the corticospinal tract (CST) in amyotrophic lateral sclerosis (ALS), by means of diffusion tensor imaging (DTI). Twenty-four ALS patients and twenty-four demographically matched healthy subjects were enrolled in this study. The Automated Fiber Quantification (AFQ), a tool for the automatic reconstruction of white matter tract profiles, based on a deterministic tractography algorithm to automatically identify the CST and quantify its diffusion properties, was used. At a group level, the highest non-overlapping DTI-related differences were detected in the cerebral peduncle, posterior limb of the internal capsule, and primary motor cortex. Fractional anisotropy (FA) decrease and mean diffusivity (MD) and radial diffusivity (RD) increases were detected when comparing ALS patients to controls. The machine learning approach used to assess the clinical utility of this DTI tool revealed that, by combining all DTI metrics measured along tract between the cerebral peduncle and the corona radiata, a mean 5-fold cross validation accuracy of 80% was reached in discriminating ALS from controls. Our study provides a useful new neuroimaging tool to characterize ALS-related neurodegenerative processes by means of CST profile. We demonstrated that specific microstructural changes in the upper part of the brainstem might be considered as a valid biomarker. With further validations this method has the potential to be considered a promising step toward the diagnostic utility of DTI measures in ALS. Hum Brain Mapp 38:727-739, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alessia Sarica
- Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Antonio Cerasa
- Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Paola Valentino
- Institute of Neurology, University Magna Graecia of Catanzaro, Germaneto, Catanzaro, Italy
| | - Jason Yeatman
- Institute for Learning & Brain Sciences and Department of Speech & Hearing Sciences, University of Washington, Seattle, Washington
| | - Maria Trotta
- Institute of Neurology, University Magna Graecia of Catanzaro, Germaneto, Catanzaro, Italy
| | - Stefania Barone
- Institute of Neurology, University Magna Graecia of Catanzaro, Germaneto, Catanzaro, Italy
| | - Alfredo Granata
- Institute of Neurology, University Magna Graecia of Catanzaro, Germaneto, Catanzaro, Italy
| | - Rita Nisticò
- Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Paolo Perrotta
- Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Franco Pucci
- Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council, Catanzaro, Italy
| | - Aldo Quattrone
- Institute of Bioimaging and Molecular Physiology (IBFM), National Research Council, Catanzaro, Italy.,Institute of Neurology, University Magna Graecia of Catanzaro, Germaneto, Catanzaro, Italy
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37
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Chavadi CV, Suprasanna K, Dudekula A, Hegde M, Kory S. Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration. J Clin Diagn Res 2016; 10:TD01-2. [PMID: 27504377 DOI: 10.7860/jcdr/2016/16969.7903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/18/2016] [Indexed: 11/24/2022]
Abstract
Rapid correction of hyponatremia is a well-known cause of central pontine and extrapontine myelinolysis. But uncommonly seen and rarely reported in Hypernatraemia. We report a rare case presenting as postpartum psychosis, wherein imaging revealed myelinolysis of corticospinal tracts in wine glass distribution and empty delta sign due to cortical venous thrombosis. At follow-up 3 months later, revealed significant neurological improvement. Concurrance occurrence of this dual pathology is not been described, which in our case was due to high serum sodium levels at presentation and dehydration.
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Affiliation(s)
- Chanabasappa V Chavadi
- Assistant Professor, Department of Radiology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - K Suprasanna
- Assistant Professor, Department of Radiology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Anees Dudekula
- Resident, Department of Radiology, Kasturba Medical College, Manipal University , Mangalore, Karnataka, India
| | - Madhav Hegde
- Associate Professor, Department Radiology, Dr. B.R. Ambedkar Medical College , Bengaluru, Karnataka, India
| | - Swetha Kory
- Resident, Department of Pathology, Yenepoya Medical College , Mangalore, Karnataka, India
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38
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Müller HP, Turner MR, Grosskreutz J, Abrahams S, Bede P, Govind V, Prudlo J, Ludolph AC, Filippi M, Kassubek J. A large-scale multicentre cerebral diffusion tensor imaging study in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2016; 87:570-9. [PMID: 26746186 DOI: 10.1136/jnnp-2015-311952] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/09/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Damage to the cerebral tissue structural connectivity associated with amyotrophic lateral sclerosis (ALS), which extends beyond the motor pathways, can be visualised by diffusion tensor imaging (DTI). The effective translation of DTI metrics as biomarker requires its application across multiple MRI scanners and patient cohorts. A multicentre study was undertaken to assess structural connectivity in ALS within a large sample size. METHODS 442 DTI data sets from patients with ALS (N=253) and controls (N=189) were collected for this retrospective study, from eight international ALS-specialist clinic sites. Equipment and DTI protocols varied across the centres. Fractional anisotropy (FA) maps of the control participants were used to establish correction matrices to pool data, and correction algorithms were applied to the FA maps of the control and ALS patient groups. RESULTS Analysis of data pooled from all centres, using whole-brain-based statistical analysis of FA maps, confirmed the most significant alterations in the corticospinal tracts, and captured additional significant white matter tract changes in the frontal lobe, brainstem and hippocampal regions of the ALS group that coincided with postmortem neuropathological stages. Stratification of the ALS group for disease severity (ALS functional rating scale) confirmed these findings. INTERPRETATION This large-scale study overcomes the challenges associated with processing and analysis of multiplatform, multicentre DTI data, and effectively demonstrates the anatomical fingerprint patterns of changes in a DTI metric that reflect distinct ALS disease stages. This success paves the way for the use of DTI-based metrics as read-out in natural history, prognostic stratification and multisite disease-modifying studies in ALS.
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Affiliation(s)
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Julian Grosskreutz
- Hans-Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sharon Abrahams
- Human Cognitive Neuroscience, Psychology-PPLS & Euan MacDonald Centre for MND Research & Centre for Cognitive Ageing and Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Peter Bede
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Varan Govind
- Department of Radiology, University of Miami School of Medicine, Miami, Florida, USA
| | - Johannes Prudlo
- Department of Neurology, University of Rostock and DZNE, Rostock, Germany
| | | | - Massimo Filippi
- Division of Neuroscience, Neuroimaging Research Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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39
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Assessment of the upper motor neuron in amyotrophic lateral sclerosis. Clin Neurophysiol 2016; 127:2643-60. [PMID: 27291884 DOI: 10.1016/j.clinph.2016.04.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 02/07/2023]
Abstract
Clinical signs of upper motor neuron (UMN) involvement are an important component in supporting the diagnosis of amyotrophic lateral sclerosis (ALS), but are often not easily appreciated in a limb that is concurrently affected by muscle wasting and lower motor neuron degeneration, particularly in the early symptomatic stages of ALS. Whilst recent criteria have been proposed to facilitate improved detection of lower motor neuron impairment through electrophysiological features that have improved diagnostic sensitivity, assessment of upper motor neuron involvement remains essentially clinical. As a result, there is often a significant diagnostic delay that in turn may impact institution of disease-modifying therapy and access to other optimal patient management. Biomarkers of pathological UMN involvement are also required to ensure patients with suspected ALS have timely access to appropriate therapeutic trials. The present review provides an analysis of current and recently developed assessment techniques, including novel imaging and electrophysiological approaches used to study corticomotoneuronal pathology in ALS.
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40
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Budrewicz S, Szewczyk P, Bladowska J, Podemski R, Koziorowska-Gawron E, Ejma M, Słotwiński K, Koszewicz M. The possible meaning of fractional anisotropy measurement of the cervical spinal cord in correct diagnosis of amyotrophic lateral sclerosis. Neurol Sci 2015; 37:417-21. [PMID: 26590991 PMCID: PMC4789300 DOI: 10.1007/s10072-015-2418-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/03/2015] [Indexed: 12/11/2022]
Abstract
Diagnosis of amyotrophic lateral sclerosis (ALS) is based on clinical criteria and electrophysiological tests (electromyography, and transcranial magnetic stimulation). In the search for ALS biomarkers, the role of imaging procedures is currently emphasized, especially modern MR techniques. MR procedures were performed on 15 ALS patients and a sex- and age-matched control group. The MR examinations were performed with a 1.5-T MR unit, and the protocol consisted of sagittal T1-weighed images, sagittal and axial T2-weighed images, and sagittal T2-weighed FAT SAT images followed by an axial diffusion tensor imaging (DTI) sequence of the cervical spinal cord. FA values in individual segments of the cervical spinal cord were decreased in the ALS group in comparison with the control group. After comparing FA values for anterior, posterior, and lateral corticospinal columns, the greatest difference was observed between the C2 and C5 segments. Spinal cord assessment with the use of FA measurements allows for confirmation of the motor pathways lesion in ALS patients. The method, together with clinical criteria, could be helpful in ALS diagnosis, assessment of clinical course, or even the effects of new drugs. The results also confirmed the theory of the generalized character of ALS.
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Affiliation(s)
- Slawomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Pawel Szewczyk
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Ryszard Podemski
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Ewa Koziorowska-Gawron
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Krzysztof Słotwiński
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
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41
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Hübers A, Müller HP, Dreyhaupt J, Böhm K, Lauda F, Tumani H, Kassubek J, Ludolph AC, Pinkhardt EH. Retinal involvement in amyotrophic lateral sclerosis: a study with optical coherence tomography and diffusion tensor imaging. J Neural Transm (Vienna) 2015; 123:281-7. [PMID: 26582428 DOI: 10.1007/s00702-015-1483-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/06/2015] [Indexed: 11/25/2022]
Abstract
Although motor neuron degeneration is the predominant feature in ALS, recent data point to a more widespread pathology also comprising non-motor symptoms. Retinal thinning has been reported in a variety of neurodegenerative conditions. Yet, studies of retinal involvement in ALS are sparse and results are heterogeneous. We studied retinal alterations in ALS using a systematic approach combining Optical Coherence Tomography (OCT), Diffusion Tensor Imaging (DTI) and clinical phenotyping. We hypothesized that selective changes of specific retinal layers may be a reflection of overall neurodegeneration as measured by DTI. Spectral domain OCT images were analyzed to calculate the average thickness of retinal layers in 71 ALS patients and 20 controls. In 30 patients, the region of interest (ROI) based fractional anisotrophy (FA) was measured in the corticospinal tract (CST), as this region is preferentially affected by motor neuron degeneration. Clinical data were collected for correlation analysis. Patients showed a significant thinning of the inner nuclear layer (INL; p = 0.04) and the retinal nerve fibre layer (RNFL; p = 0.004) compared to controls. We saw significant correlations between retinal thickness and FA values of the CST in patients (p = 0.005). No significant correlation between clinical parameters and retinal involvement was observed. Our study provides evidence for a retinal involvement in ALS. Interestingly, ALS patients show a reduction in FA of the CST, which is correlated to retinal thinning. We conclude that retinal involvement is in fact associated to overall neurodegeneration and may be regarded as a potential technical biomarker in ALS.
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Affiliation(s)
- Annemarie Hübers
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hans Peter Müller
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Schwabstraße 13, 89075, Ulm, Germany
| | - Kathrin Böhm
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Florian Lauda
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Elmar H Pinkhardt
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany.
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42
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Abstract
Cortical hubs are highly connected nodes in functional brain networks that play vital roles in the efficient transfer of information across brain regions. Although altered functional connectivity has been found in amyotrophic lateral sclerosis (ALS), the changing pattern in functional network hubs in ALS remains unknown. In this study, we applied a voxel-wise method to investigate the changing pattern of cortical hubs in ALS. Through resting-state fMRI, we constructed whole-brain voxel-wise functional networks by measuring the temporal correlations of each pair of brain voxels and identified hubs using the graph theory method. Specifically, a functional connectivity strength (FCS) map was derived from the data on 20 patients with ALS and 20 healthy controls. The brain regions with high FCS values were regarded as functional network hubs. Functional hubs were found mainly in the bilateral precuneus, parietal cortex, medial prefrontal cortex, and in several visual regions and temporal areas in both groups. Within the hub regions, the ALS patients exhibited higher FCS in the prefrontal cortex compared with the healthy controls. The FCS value in the significantly abnormal hub regions was correlated with clinical variables. Results indicated the presence of altered cortical hubs in the ALS patients and could therefore shed light on the pathophysiology mechanisms underlying ALS.
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43
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Christidi F, Zalonis I, Kyriazi S, Rentzos M, Karavasilis E, Wilde EA, Evdokimidis I. Uncinate fasciculus microstructure and verbal episodic memory in amyotrophic lateral sclerosis: a diffusion tensor imaging and neuropsychological study. Brain Imaging Behav 2015; 8:497-505. [PMID: 24190400 DOI: 10.1007/s11682-013-9271-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study evaluates the integrity of uncinate fasciculus (UF) and the association between UF microstructure and verbal episodic memory (as one of the cognitive functions linked to UF) in non-demented patients with amyotrophic lateral sclerosis (ALS) using diffusion tensor imaging (DTI). We studied 21 patients with ALS and 11 healthy, demographically-comparable volunteers. Fractional anisotropy, apparent diffusion coefficient, axial and radial diffusivity were the DTI metrics examined. Episodic memory was evaluated with Babcock Story Recall Test and Rey Auditory Verbal Learning Test (RAVLT) for patients; measures of immediate and delayed recall and retention for both tests and sum of words recalled through five learning trials for RAVLT were considered. Patients with ALS showed significant bilateral reduction of axial diffusivity in the UF as compared to controls. Furthermore, there were several significant relations between various DTI metrics (mostly in left hemisphere) and memory measures (specifically for the RAVLT). UF microstructural changes may contribute to ALS-related memory impairment, with word-list learning performance relying more upon the integrity of frontal and temporal connections than memory components associated with story recall.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University, Athens, Greece,
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44
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Steinbach R, Loewe K, Kaufmann J, Machts J, Kollewe K, Petri S, Dengler R, Heinze HJ, Vielhaber S, Schoenfeld MA, Stoppel CM. Structural hallmarks of amyotrophic lateral sclerosis progression revealed by probabilistic fiber tractography. J Neurol 2015; 262:2257-70. [PMID: 26159103 DOI: 10.1007/s00415-015-7841-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 12/27/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive limb and/or bulbar muscular weakness and atrophy. Although ALS-related alterations of motor and extra-motor neuronal networks have repeatedly been reported, their temporal dynamics during disease progression are not well understood. Recently, we reported a decline of motor system activity and a concurrent increase of hippocampal novelty-evoked modulations across 3 months of ALS progression. To address whether these functional changes are associated with structural ones, the current study employed probabilistic fiber tractography on diffusion tensor imaging (DTI) data using a longitudinal design. Therein, motor network integrity was assessed by DTI-based tracking of the intracranial corticospinal tract, while connectivity estimates of occipito-temporal tracts (between visual and entorhinal, perirhinal or parahippocampal cortices) served to assess structural changes that could be related to the increased novelty-evoked hippocampal activity across time described previously. Complementing these previous functional observations, the current data revealed an ALS-related decrease in corticospinal tract structural connectivity compared to controls, while in contrast, visuo-perirhinal connectivity was relatively increased in the patient group. Importantly, beyond these between-group differences, a rise in the patients' occipito-temporal tract strengths occurred across a 3-month interval, while at the same time no changes in corticospinal tract connectivity were observed. In line with previously identified functional alterations, the dynamics of these structural changes suggest that the affection of motor- and memory-related networks in ALS emerges at distinct disease stages: while motor network degeneration starts primarily during early (supposedly pre-symptomatic) phases, the hippocampal/medial temporal lobe dysfunctions arise at later stages of the disease.
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Affiliation(s)
- Robert Steinbach
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Kristian Loewe
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.,Department of Knowledge and Language Processing, Otto-von-Guericke-University, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Joern Kaufmann
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Katja Kollewe
- Department of Neurology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Reinhard Dengler
- Department of Neurology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.,Leibniz-Institute for Neurobiology, Brennecke Str. 6, 39118, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Mircea Ariel Schoenfeld
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany.,Leibniz-Institute for Neurobiology, Brennecke Str. 6, 39118, Magdeburg, Germany.,Kliniken Schmieder, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Christian Michael Stoppel
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, 39120, Magdeburg, Germany. .,Leibniz-Institute for Neurobiology, Brennecke Str. 6, 39118, Magdeburg, Germany. .,Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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45
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Budrewicz S, Szewczyk P, Slotwinski K, Koszewicz M. Symptoms of degeneration of the pyramidal tracts in conventional magnetic resonance imaging and diffusion tensor imaging in a young woman with primary lateral sclerosis. J Postgrad Med 2015; 61:206-8. [PMID: 26119443 PMCID: PMC4943406 DOI: 10.4103/0022-3859.150901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Primary lateral sclerosis (PLS) is one of the forms of motor neuron disease (MND), affecting only upper motor neurons. The diagnosis of PLS should be made on different diagnostic criteria, for example, Pringle or Gordon, but it is usually a diagnosis of exclusion. There are no characteristic findings in standard laboratory and electrophysiological assessment. We present details of a 31-year-old woman who had suffered from progressive paraparesis with right-side predominance. Conventional MRI of brain and spinal cord and diffusion tensor imaging (DTI) studies showed Hyperintense lesions in the upper part of the cervical spinal cord at the level C1 in lateral funicules, in the medulla oblongata at the pyramidal decussation and in the midbrain. Brain DTI revealed changes along the corticospinal tracts on fractional anisotropy (FA) maps. MRI of the thoracic spinal cord showed in T2-weighted images hyperintensive regions in the course of the lateral corticospinal tracts. This aided in PLS recognition.
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Affiliation(s)
| | | | | | - M Koszewicz
- Department of Neurology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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46
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Nicholson KA, Cudkowicz ME, Berry JD. Clinical Trial Designs in Amyotrophic Lateral Sclerosis: Does One Design Fit All? Neurotherapeutics 2015; 12:376-83. [PMID: 25700798 PMCID: PMC4404442 DOI: 10.1007/s13311-015-0341-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The last 2 decades have seen a surge in the number of amyotrophic lateral sclerosis (ALS) clinical trials with the hope of finding successful treatments. Clinical trialists aim to repurpose existing drugs and test novel compounds to target potential ALS disease pathophysiology. Recent technological advancements have led to the discovery of new causative genetic agents and modes of delivering potential therapy, calling for increasingly sophisticated trial design. The standard ALS clinical trial design may be modified depending on study needs: type of therapy; route of therapy delivery; phase of therapy development; applicable subpopulation; market availability of therapy; and utility of telemedicine. Novel biomarkers of diagnostic, predictive, prognostic, and pharmacodynamic value are undergoing development and validation for use in clinical trials. Design modifications build on the traditional clinical trial design and may be employed in either the learning or confirming trial phase. Novel designs aim to minimize patient risk, study duration, and sample size, while improving efficiency and promoting statistical power to herald an exciting era for clinical research in ALS.
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Affiliation(s)
- Katharine A Nicholson
- Massachusetts General Hospital, Department of Neurology, Neurological Clinical Research Institute, 165 Cambridge Street, Suite 600, Boston, MA, 02114, USA,
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47
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Rosskopf J, Müller HP, Dreyhaupt J, Gorges M, Ludolph AC, Kassubek J. Ex post facto assessment of diffusion tensor imaging metrics from different MRI protocols: preparing for multicentre studies in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:92-101. [PMID: 25574564 DOI: 10.3109/21678421.2014.977297] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Diffusion tensor imaging (DTI) for assessing ALS-associated white matter alterations has still not reached the level of a neuroimaging biomarker. Since large-scale multicentre DTI studies in ALS may be hampered by differences in scanning protocols, an approach for pooling of DTI data acquired with different protocols was investigated. Three hundred and nine datasets from 170 ALS patients and 139 controls were collected ex post facto from a monocentric database reflecting different scanning protocols. A 3D correction algorithm was introduced for a combined analysis of DTI metrics despite different acquisition protocols, with the focus on the CST as the tract correlate of ALS neuropathological stage 1. A homogenous set of data was obtained by application of 3D correction matrices. Results showed that a fractional anisotropy (FA) threshold of 0.41 could be defined to discriminate ALS patients from controls (sensitivity/specificity, 74%/72%). For the remaining test sample, sensitivity/specificity values of 68%/74% were obtained. In conclusion, the objective was to merge data recorded with different DTI protocols with 3D correction matrices for analyses at group level. These post processing tools might facilitate analysis of large study samples in a multicentre setting for DTI analysis at group level to aid in establishing DTI as a non-invasive biomarker for ALS.
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48
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Affiliation(s)
- J Gorodenker
- From George Washington University Medical Center, Washington, DC.
| | - L M Levy
- From George Washington University Medical Center, Washington, DC
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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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THEME 2 IMAGING, ELECTROPHYSIOLOGY AND MARKERS OF DISEASE PROGRESSION. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15 Suppl 1:68-80. [DOI: 10.3109/21678421.2014.960175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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