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Verber NS, Shepheard SR, Sassani M, McDonough HE, Moore SA, Alix JJP, Wilkinson ID, Jenkins TM, Shaw PJ. Biomarkers in Motor Neuron Disease: A State of the Art Review. Front Neurol 2019; 10:291. [PMID: 31001186 PMCID: PMC6456669 DOI: 10.3389/fneur.2019.00291] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Motor neuron disease can be viewed as an umbrella term describing a heterogeneous group of conditions, all of which are relentlessly progressive and ultimately fatal. The average life expectancy is 2 years, but with a broad range of months to decades. Biomarker research deepens disease understanding through exploration of pathophysiological mechanisms which, in turn, highlights targets for novel therapies. It also allows differentiation of the disease population into sub-groups, which serves two general purposes: (a) provides clinicians with information to better guide their patients in terms of disease progression, and (b) guides clinical trial design so that an intervention may be shown to be effective if population variation is controlled for. Biomarkers also have the potential to provide monitoring during clinical trials to ensure target engagement. This review highlights biomarkers that have emerged from the fields of systemic measurements including biochemistry (blood, cerebrospinal fluid, and urine analysis); imaging and electrophysiology, and gives examples of how a combinatorial approach may yield the best results. We emphasize the importance of systematic sample collection and analysis, and the need to correlate biomarker findings with detailed phenotype and genotype data.
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Affiliation(s)
- Nick S Verber
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Stephanie R Shepheard
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Matilde Sassani
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Harry E McDonough
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Sophie A Moore
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - James J P Alix
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Iain D Wilkinson
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Tom M Jenkins
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
| | - Pamela J Shaw
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, United Kingdom
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Barritt AW, Gabel MC, Cercignani M, Leigh PN. Emerging Magnetic Resonance Imaging Techniques and Analysis Methods in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:1065. [PMID: 30564192 PMCID: PMC6288229 DOI: 10.3389/fneur.2018.01065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/22/2018] [Indexed: 12/17/2022] Open
Abstract
Objective markers of disease sensitive to the clinical activity, symptomatic progression, and underlying substrates of neurodegeneration are highly coveted in amyotrophic lateral sclerosis in order to more eloquently stratify the highly heterogeneous phenotype and facilitate the discovery of effective disease modifying treatments for patients. Magnetic resonance imaging (MRI) is a promising, non-invasive biomarker candidate whose acquisition techniques and analysis methods are undergoing constant evolution in the pursuit of parameters which more closely represent biologically-applicable tissue changes. Neurite Orientation Dispersion and Density Imaging (NODDI; a form of diffusion imaging), and quantitative Magnetization Transfer Imaging (qMTi) are two such emerging modalities which have each broadened the understanding of other neurological disorders and have the potential to provide new insights into structural alterations initiated by the disease process in ALS. Furthermore, novel neuroimaging data analysis approaches such as Event-Based Modeling (EBM) may be able to circumvent the requirement for longitudinal scanning as a means to comprehend the dynamic stages of neurodegeneration in vivo. Combining these and other innovative imaging protocols with more sophisticated techniques to analyse ever-increasing datasets holds the exciting prospect of transforming understanding of the biological processes and temporal evolution of the ALS syndrome, and can only benefit from multicentre collaboration across the entire ALS research community.
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Affiliation(s)
- Andrew W Barritt
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, United Kingdom.,Hurstwood Park Neurological Centre Haywards Heath, West Sussex, United Kingdom
| | - Matt C Gabel
- Department of Neuroscience, Trafford Centre for Biomedical Research Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Mara Cercignani
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - P Nigel Leigh
- Hurstwood Park Neurological Centre Haywards Heath, West Sussex, United Kingdom.,Department of Neuroscience, Trafford Centre for Biomedical Research Brighton and Sussex Medical School, Falmer, United Kingdom
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Chen J, Kostenko V, Pioro EP, Trapp BD. MR Imaging-based Estimation of Upper Motor Neuron Density in Patients with Amyotrophic Lateral Sclerosis: A Feasibility Study. Radiology 2018; 287:955-964. [PMID: 29361242 DOI: 10.1148/radiol.2018162967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if magnetic resonance (MR) imaging metrics can estimate primary motor cortex (PMC) motor neuron (MN) density in patients with amyotrophic lateral sclerosis (ALS). Materials and Methods Between 2012 and 2014, in situ brain MR imaging was performed in 11 patients with ALS (age range, 35-81 years; seven women and four men) soon after death (mean, 5.5 hours after death; range, 3.2-9.6 hours). The brain was removed, right PMC (RPMC) was excised, and MN density was quantified. RPMC metrics (thickness, volume, and magnetization transfer ratio) were calculated from MR images. Regression modeling was used to estimate MN density by using RPMC and global MR imaging metrics (brain and tissue volumes); clinical variables were subsequently evaluated as additional estimators. Models were tested at in vivo MR imaging by using the same imaging protocol (six patients with ALS; age range, 54-66 years; three women and three men). Results RPMC mean MN density varied over a greater than threefold range across patients and was estimated by a linear function of normalized gray matter volume (adjusted R2 = 0.51; P = .008; <10% error in most patients). When considering only sporadic ALS, a linear function of normalized RPMC and white matter volumes estimated MN density (adjusted R2 = 0.98; P = .01; <10% error in all patients). In vivo data analyses detected decreases in MN density over time. Conclusion PMC mean MN density varies widely in end-stage ALS possibly because of disease heterogeneity. MN density can potentially be estimated by MR imaging metrics. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Jacqueline Chen
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
| | - Volodymyr Kostenko
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
| | - Erik P Pioro
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
| | - Bruce D Trapp
- From the Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (J.C., V.K., B.D.T.); and Department of Neurology, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio (E.P.P.)
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Multimodal assessment of white matter tracts in amyotrophic lateral sclerosis. PLoS One 2017; 12:e0178371. [PMID: 28575122 PMCID: PMC5456080 DOI: 10.1371/journal.pone.0178371] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 05/11/2017] [Indexed: 11/19/2022] Open
Abstract
Several quantitative magnetic resonance imaging (MRI) techniques have been proposed to investigate microstructural tissue changes in amyotrophic lateral sclerosis (ALS) including diffusion tensor imaging (DTI), magnetization transfer imaging, and R2* mapping. Here, in this study, we compared these techniques with regard to their capability for detecting ALS related white matter (WM) changes in the brain and their association with clinical findings. We examined 27 ALS patients and 35 age-matched healthy controls. MRI was performed at 3T, after which we analyzed the diffusion properties, the magnetization transfer ratio (MTR), and the effective transversal relaxation rate R2* in 18 WM tracts that were obtained by a fully automated segmentation technique. ALS patients, especially with a bulbar onset, showed a bilateral increase in radial and mean diffusivity, as well as a reduction in fractional anisotropy of the corticospinal tract (CST), and diffusion changes in the parietal and temporal superior longitudinal fasciculus. A reduction of the MTR was found in both CSTs and an R2* reduction was seen only in the left CST. Tract-specific diffusion properties were not related to clinical status in a cross-sectional manner but demonstrated some association with disease progression over three subsequent months. DTI reveals more widespread WM tissue changes than MTR and R2*. These changes are not restricted to the CST, but affect also other WM tracts (especially in patients with bulbar onset), and are associated with the short term course of the disease.
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Jang C, Park HJ, Chang WS, Pae C, Chang JW. Immediate and Longitudinal Alterations of Functional Networks after Thalamotomy in Essential Tremor. Front Neurol 2016; 7:184. [PMID: 27822200 PMCID: PMC5076435 DOI: 10.3389/fneur.2016.00184] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/10/2016] [Indexed: 12/12/2022] Open
Abstract
Thalamotomy at the ventralis intermedius nucleus has been an effective treatment method for essential tremor, but how the brain network changes immediately responding to this deliberate lesion and then reorganizes afterwards are not clear. Taking advantage of a non-cranium-opening MRI-guided focused ultrasound ablation technique, we investigated functional network changes due to a focal lesion. To classify the diverse time courses of those network changes with respect to symptom-related long-lasting treatment effects and symptom-unrelated transient effects, we applied graph-theoretic analyses to longitudinal resting-state functional magnetic resonance imaging data before and 1 day, 7 days, and 3 months after thalamotomy with essential tremor. We found reduced average connections among the motor-related areas, reduced connectivity between substantia nigra and external globus pallidum and reduced total connection in the thalamus after thalamotomy, which are all associated with clinical rating scales. The average connectivity among whole brain regions and inter-hemispheric network asymmetry show symptom-unrelated transient increases, indicating temporary reconfiguration of the whole brain network. In summary, thalamotomy regulates interactions over the motor network via symptom-related connectivity changes but accompanies transient, symptom-unrelated diaschisis in the global brain network. This study suggests the significance of longitudinal network analysis, combined with minimal-invasive treatment techniques, in understanding time-dependent diaschisis in the brain network due to a focal lesion.
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Affiliation(s)
- Changwon Jang
- BK21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine , Seoul , South Korea
| | - Hae-Jeong Park
- BK21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Cognitive Science, Yonsei University, Seoul, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Yonsei University College of Medicine , Seoul , South Korea
| | - Chongwon Pae
- BK21 PLUS Project for Medical Science, Severance Hospital, Yonsei University College of Medicine , Seoul , South Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine , Seoul , South Korea
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Foster‐Dingley JC, Moonen JE, van den Berg‐Huijsmans AA, de Craen AJ, de Ruijter W, van der Grond J, van der Mast RC. Lower Blood Pressure and Gray Matter Integrity Loss in Older Persons. J Clin Hypertens (Greenwich) 2015; 17:630-7. [PMID: 25867921 PMCID: PMC8031938 DOI: 10.1111/jch.12550] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/03/2015] [Accepted: 03/08/2015] [Indexed: 01/23/2023]
Abstract
In contrast to middle age, it is unclear whether blood pressure (BP) in older persons is associated with cerebral small vessel disease (cSVD). The authors evaluated the association of BP with signs of cSVD as well as gray and white matter integrity in older persons. In 220 participants aged 75 years and older from the Discontinuation of Antihypertensive Treatment in the Elderly (DANTE) study, cSVD was assessed with conventional magnetic resonance imaging, and microstructural integrity with diffusion tensor and magnetization transfer (MT) imaging. BP measures were not associated with cSVD. However, lower systolic and diastolic BP and mean arterial pressure were associated with decreased gray matter MT ratio peak height and MT ratio in cortical gray matter. Mean arterial pressure was also associated with increased gray matter diffusivity. A lower level of BP was especially associated with worse gray matter integrity. Results suggest that not only upper but preferably lower thresholds of BP values should be observed in older persons.
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Affiliation(s)
| | - Justine E.F. Moonen
- Department of PsychiatryLeiden University Medical CenterLeidenthe Netherlands
| | | | - Anton J.M. de Craen
- Department of Gerontology and GeriatricsLeiden University Medical CenterLeidenthe Netherlands
| | - Wouter de Ruijter
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
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Akintola AA, van den Berg A, Altmann-Schneider I, Jansen SW, van Buchem MA, Slagboom PE, Westendorp RG, van Heemst D, van der Grond J. Parameters of glucose metabolism and the aging brain: a magnetization transfer imaging study of brain macro- and micro-structure in older adults without diabetes. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9802. [PMID: 26178969 PMCID: PMC4503707 DOI: 10.1007/s11357-015-9802-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 06/09/2015] [Indexed: 06/04/2023]
Abstract
Given the concurrent, escalating epidemic of diabetes mellitus and neurodegenerative diseases, two age-related disorders, we aimed to understand the relation between parameters of glucose metabolism and indices of pathology in the aging brain. From the Leiden Longevity Study, 132 participants (mean age 66 years) underwent a 2-h oral glucose tolerance test to assess glucose tolerance (fasted and area under the curve (AUC) glucose), insulin sensitivity (fasted and AUC insulin and homeostatic model assessment of insulin sensitivity (HOMA-IS)) and insulin secretion (insulinogenic index). 3-T brain MRI was used to detect macro-structural damage (atrophy, white matter hyper-intensities, infarcts and/or micro-bleeds) and magnetization transfer imaging (MTI) to detect loss of micro-structural homogeneity that remains otherwise invisible on conventional MRI. Macro-structurally, higher fasted glucose was significantly associated with white matter atrophy (P = 0.028). Micro-structurally, decreased magnetization transfer ratio (MTR) peak height in gray matter was associated with higher fasted insulin (P = 0.010), AUCinsulin (P = 0.001), insulinogenic index (P = 0.008) and lower HOMA-IS index (P < 0.001). Similar significant associations were found for white matter. Thus, while higher glucose was associated with macro-structural damage, impaired insulin action was associated more strongly with reduced micro-structural brain parenchymal homogeneity. These findings offer some insight into the association between different parameters of glucose metabolism (impairment of which is characteristic of diabetes mellitus) and brain aging.
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Affiliation(s)
- Abimbola A Akintola
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands,
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de Albuquerque M, Anjos LG, Maia Tavares de Andrade H, de Oliveira MS, Castellano G, Junqueira Ribeiro de Rezende T, Nucci A, Cavalcante França Junior M. MRI Texture Analysis Reveals Deep Gray Nuclei Damage in Amyotrophic Lateral Sclerosis. J Neuroimaging 2015; 26:201-6. [DOI: 10.1111/jon.12262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Milena de Albuquerque
- Departments of Neurology and Neuroimaging Laboratory, School of Medical Sciences; University of Campinas - UNICAMP; Brazil
| | - Lara G.V. Anjos
- Departments of Neurology and Neuroimaging Laboratory, School of Medical Sciences; University of Campinas - UNICAMP; Brazil
| | - Helen Maia Tavares de Andrade
- Departments of Neurology and Neuroimaging Laboratory, School of Medical Sciences; University of Campinas - UNICAMP; Brazil
| | - Márcia S. de Oliveira
- Neurophysics Group, Institute of Physics Gleb Wataghin; University of Campinas -UNICAMP; Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN)
| | - Gabriela Castellano
- Neurophysics Group, Institute of Physics Gleb Wataghin; University of Campinas -UNICAMP; Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN)
| | - Thiago Junqueira Ribeiro de Rezende
- Departments of Neurology and Neuroimaging Laboratory, School of Medical Sciences; University of Campinas - UNICAMP; Brazil
- Neurophysics Group, Institute of Physics Gleb Wataghin; University of Campinas -UNICAMP; Brazil
| | - Anamarli Nucci
- Departments of Neurology and Neuroimaging Laboratory, School of Medical Sciences; University of Campinas - UNICAMP; Brazil
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Goveas J, O'Dwyer L, Mascalchi M, Cosottini M, Diciotti S, De Santis S, Passamonti L, Tessa C, Toschi N, Giannelli M. Diffusion-MRI in neurodegenerative disorders. Magn Reson Imaging 2015; 33:853-76. [PMID: 25917917 DOI: 10.1016/j.mri.2015.04.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 04/18/2015] [Accepted: 04/19/2015] [Indexed: 12/11/2022]
Abstract
The ability to image the whole brain through ever more subtle and specific methods/contrasts has come to play a key role in understanding the basis of brain abnormalities in several diseases. In magnetic resonance imaging (MRI), "diffusion" (i.e. the random, thermally-induced displacements of water molecules over time) represents an extraordinarily sensitive contrast mechanism, and the exquisite structural detail it affords has proven useful in a vast number of clinical as well as research applications. Since diffusion-MRI is a truly quantitative imaging technique, the indices it provides can serve as potential imaging biomarkers which could allow early detection of pathological alterations as well as tracking and possibly predicting subtle changes in follow-up examinations and clinical trials. Accordingly, diffusion-MRI has proven useful in obtaining information to better understand the microstructural changes and neurophysiological mechanisms underlying various neurodegenerative disorders. In this review article, we summarize and explore the main applications, findings, perspectives as well as challenges and future research of diffusion-MRI in various neurodegenerative disorders including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, Huntington's disease and degenerative ataxias.
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Affiliation(s)
- Joseph Goveas
- Department of Psychiatry and Behavioral Medicine, and Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laurence O'Dwyer
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Mario Mascalchi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; Quantitative and Functional Neuroradiology Research Program at Meyer Children and Careggi Hospitals of Florence, Florence, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Pisa, Italy; Unit of Neuroradiology, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Silvia De Santis
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
| | - Luca Passamonti
- Institute of Bioimaging and Molecular Physiology, National Research Council, Catanzaro, Italy; Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Carlo Tessa
- Division of Radiology, "Versilia" Hospital, AUSL 12 Viareggio, Lido di Camaiore, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Medical Physics Section, University of Rome "Tor Vergata", Rome, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marco Giannelli
- Unit of Medical Physics, Pisa University Hospital "Azienda Ospedaliero-Universitaria Pisana", Pisa, Italy.
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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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Stoppel CM, Vielhaber S, Eckart C, Machts J, Kaufmann J, Heinze HJ, Kollewe K, Petri S, Dengler R, Hopf JM, Schoenfeld MA. Structural and functional hallmarks of amyotrophic lateral sclerosis progression in motor- and memory-related brain regions. NEUROIMAGE-CLINICAL 2014; 5:277-90. [PMID: 25161894 PMCID: PMC4141983 DOI: 10.1016/j.nicl.2014.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 07/03/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022]
Abstract
Previous studies have shown that in amyotrophic lateral sclerosis (ALS) multiple motor and extra-motor regions display structural and functional alterations. However, their temporal dynamics during disease-progression are unknown. To address this question we employed a longitudinal design assessing motor- and novelty-related brain activity in two fMRI sessions separated by a 3-month interval. In each session, patients and controls executed a Go/NoGo-task, in which additional presentation of novel stimuli served to elicit hippocampal activity. We observed a decline in the patients' movement-related activity during the 3-month interval. Importantly, in comparison to controls, the patients' motor activations were higher during the initial measurement. Thus, the relative decrease seems to reflect a breakdown of compensatory mechanisms due to progressive neural loss within the motor-system. In contrast, the patients' novelty-evoked hippocampal activity increased across 3 months, most likely reflecting the build-up of compensatory processes typically observed at the beginning of lesions. Consistent with a stage-dependent emergence of hippocampal and motor-system lesions, we observed a positive correlation between the ALSFRS-R or MRC-Megascores and the decline in motor activity, but a negative one with the hippocampal activation-increase. Finally, to determine whether the observed functional changes co-occur with structural alterations, we performed voxel-based volumetric analyses on magnetization transfer images in a separate patient cohort studied cross-sectionally at another scanning site. Therein, we observed a close overlap between the structural changes in this cohort, and the functional alterations in the other. Thus, our results provide important insights into the temporal dynamics of functional alterations during disease-progression, and provide support for an anatomical relationship between functional and structural cerebral changes in ALS.
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Affiliation(s)
- Christian Michael Stoppel
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
- Corresponding author.
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
- DZNE — German Centre for Neurodegenerative Diseases, Leipziger Str. 44, Magdeburg 39120, Germany
- Corresponding author.
| | - Cindy Eckart
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
- Institute for Systemic Neurosciences, University Clinic, Martinistr. 52, Hamburg 20246, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
- Leibniz-Institute for Neurobiology, Brennecke Str. 6, Magdeburg 39118, Germany
| | - Katja Kollewe
- Department of Neurology, Medical School Hannover, Carl-Neuberg-str. 1, Hannover 30625, Germany
| | - Susanne Petri
- Department of Neurology, Medical School Hannover, Carl-Neuberg-str. 1, Hannover 30625, Germany
| | - Reinhard Dengler
- Department of Neurology, Medical School Hannover, Carl-Neuberg-str. 1, Hannover 30625, Germany
| | - Jens-Max Hopf
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
- Leibniz-Institute for Neurobiology, Brennecke Str. 6, Magdeburg 39118, Germany
| | - Mircea Ariel Schoenfeld
- Department of Neurology, Otto-von-Guericke-University, Leipziger Str. 44, Magdeburg 39120, Germany
- Leibniz-Institute for Neurobiology, Brennecke Str. 6, Magdeburg 39118, Germany
- Kliniken Schmieder, Zum Tafelholz 8, Allensbach 78476, Germany
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12
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Romano A, Guo J, Prokscha T, Meyer T, Hirsch S, Braun J, Sack I, Scheel M. In vivo waveguide elastography: Effects of neurodegeneration in patients with amyotrophic lateral sclerosis. Magn Reson Med 2013; 72:1755-61. [DOI: 10.1002/mrm.25067] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jing Guo
- Department of Radiology; Charité-Universitätsmedizin; Berlin Germany
| | - Torben Prokscha
- Department of Neurology; Charité-Universitätsmedizin; Berlin Germany
| | - Thomas Meyer
- Department of Neurology; Charité-Universitätsmedizin; Berlin Germany
| | - Sebastian Hirsch
- Department of Radiology; Charité-Universitätsmedizin; Berlin Germany
| | - Jürgen Braun
- Institute of Medical Informatics; Charité-Universitätsmedizin; Berlin Germany
| | - Ingolf Sack
- Department of Radiology; Charité-Universitätsmedizin; Berlin Germany
| | - Michael Scheel
- Department of Radiology; Charité-Universitätsmedizin; Berlin Germany
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13
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Mascalchi M, Toschi N, Ginestroni A, Giannelli M, Nicolai E, Aiello M, Soricelli A, Diciotti S. Gender, age-related, and regional differences of the magnetization transfer ratio of the cortical and subcortical brain gray matter. J Magn Reson Imaging 2013; 40:360-6. [PMID: 24923993 DOI: 10.1002/jmri.24355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 07/29/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To explore gender, age-related, and regional differences of magnetization transfer ratio (MTR) of brain cortical and subcortical gray matter (GM). MATERIALS AND METHODS In all, 102 healthy subjects (51 women and 51 men; range 25-84 years) were examined with 3-mm thick MT images. We assessed MTR in automatically segmented GM structures including frontal, parietal-insular, temporal, and occipital cortex, caudate, pallidus and putamen, and cerebellar cortex. A general linear model analysis was conducted to ascertain the linear and quadratic relationship among the MTR and gender, age, and anatomical structure. RESULTS The effect of gender was borderline (P = 0.07) in all GM structures (with higher MTR values in men), whereas age showed a significant linear as well as quadratic effect in all cortical and subcortical GM structures (P ≤ 0.001). Quadratic age-related decrease in MTR began at about 40 years of age. Mean and standard deviation (SD) of MTR had the following decreasing order: thalamus (58.3 + 0.8), pallidus (56.8 ± 1.3), caudate (55.5 ± 1.6) and putamen (54.6 ± 1.1); temporal (56.8 ± 0.9), parietal-insular (56.8 ± 1.1), frontal (56.5 ± 1.1), occipital (55.4 ± 1.0) and cerebellar (53.2 ± 1.0) cortex. In post-hoc testing, all regional pairwise differences were statistically significant except pallidus vs. temporal or parietal-insular cortex, caudate vs. occipital cortex, frontal vs. parietal-insular or temporal cortex. CONCLUSION MTR of the cortical and subcortical brain GM structures decreases quadratically after midlife and shows significant regional differences.
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Affiliation(s)
- Mario Mascalchi
- Quantitative and Functional Neuroradiology Program at Meyer Children's Hospital and Careggi Hospital of Florence, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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14
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Cosottini M, Cecchi P, Piazza S, Pesaresi I, Fabbri S, Diciotti S, Mascalchi M, Siciliano G, Bonuccelli U. Mapping cortical degeneration in ALS with magnetization transfer ratio and voxel-based morphometry. PLoS One 2013; 8:e68279. [PMID: 23874570 PMCID: PMC3706610 DOI: 10.1371/journal.pone.0068279] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 05/27/2013] [Indexed: 12/02/2022] Open
Abstract
Pathological and imaging data indicate that amyotrophic lateral sclerosis (ALS) is a multisystem disease involving several cerebral cortical areas. Advanced quantitative magnetic resonance imaging (MRI) techniques enable to explore in vivo the volume and microstructure of the cerebral cortex in ALS. We studied with a combined voxel-based morphometry (VBM) and magnetization transfer (MT) imaging approach the capability of MRI to identify the cortical areas affected by neurodegeneration in ALS patients. Eighteen ALS patients and 18 age-matched healthy controls were examined on a 1.5T scanner using a high-resolution 3D T1 weighted spoiled gradient recalled sequence with and without MT saturation pulse. A voxel-based analysis (VBA) was adopted in order to automatically compute the regional atrophy and MT ratio (MTr) changes of the entire cerebral cortex. By using a multimodal image analysis MTr was adjusted for local gray matter (GM) atrophy to investigate if MTr changes can be independent of atrophy of the cerebral cortex. VBA revealed several clusters of combined GM atrophy and MTr decrease in motor-related areas and extra-motor frontotemporal cortex. The multimodal image analysis identified areas of isolated MTr decrease in premotor and extra-motor frontotemporal areas. VBM and MTr are capable to detect the distribution of neurodegenerative alterations in the cortical GM of ALS patients, supporting the hypothesis of a multi-systemic involvement in ALS. MT imaging changes exist beyond volume loss in frontotemporal cortices.
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Affiliation(s)
- Mirco Cosottini
- Department of Neuroscience, University of Pisa, Pisa, Italy.
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15
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Degeneration and impaired regeneration of gray matter oligodendrocytes in amyotrophic lateral sclerosis. Nat Neurosci 2013; 16:571-9. [PMID: 23542689 PMCID: PMC3637847 DOI: 10.1038/nn.3357] [Citation(s) in RCA: 428] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/13/2013] [Indexed: 12/11/2022]
Abstract
Oligodendrocytes associate with axons to establish myelin and provide metabolic support to neurons. In the spinal cord of ALS mice, oligodendrocytes downregulate transporters that transfer glycolytic substrates to neurons and oligodendrocyte progenitors (NG2+ cells) exhibit enhanced proliferation and differentiation, although the cause of these changes in oligodendroglia is unknown. Here we report that there is extensive degeneration of gray matter oligodendrocytes in the spinal cord of ALS mice before disease onset. Although new oligodendrocytes were formed, they failed to mature, resulting in progressive demyelination. Oligodendrocyte dysfunction also is prevalent in human ALS, as gray matter demyelination and reactive changes in NG2+ cells were observed in motor cortex and spinal cord of ALS patients. Selective removal of mutant SOD1 from oligodendroglia substantially delayed disease onset and prolonged survival in ALS mice, suggesting that ALS-linked genes enhance the vulnerability of motor neurons and accelerate disease by directly impairing the function of oligodendrocytes.
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Carrara G, Carapelli C, Venturi F, Ferraris MM, Lequio L, Chiò A, Calvo A, Sirgiovanni S, Cistaro A, Valentini MC. A distinct MR imaging phenotype in amyotrophic lateral sclerosis: correlation between T1 magnetization transfer contrast hyperintensity along the corticospinal tract and diffusion tensor imaging analysis. AJNR Am J Neuroradiol 2012; 33:733-9. [PMID: 22194369 DOI: 10.3174/ajnr.a2855] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In the search for a diagnostic marker in ALS, we focused our attention on the hyperintense signal intensity in T1 MTC MR images along the CST, detected in some patients and not found in other patients with ALS and in control subjects. The aim of this study was to investigate the relationship between the hyperintense signal intensity in T1 MTC images and white matter damage. To this purpose, we studied potential heterogeneities in DTI values within our patients by using TBSS without a priori anatomic information. MATERIALS AND METHODS In 43 patients with ALS and 43 healthy control subjects, the presence or absence of T1 MTC hyperintense signal intensity was evaluated. With a DTI analysis with a TBSS approach, differences in FA distribution between the 2 groups (patients with T1 MTC hyperintense signal intensity and patients without it) compared with each other and with control subjects were investigated. RESULTS We found regional differences in white matter FA between patients with T1 MTC hyperintense signal intensity (37.2%) and patients without it. Patients with T1 MTC abnormal signal intensity showed lower FA strictly limited to the motor network and the posterior aspect of the body of the CC without extramotor FA reductions, whereas patients without this sign showed FA reductions in several confluent regions within and outside the CST and in the whole CC. CONCLUSIONS T1 MTC hyperintense signal intensity in the CST and posterior CC, when present, is specific for ALS and represents, among patients with ALS, a possible distinct phenotype of presentation of the disease with prominent UMN involvement.
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Affiliation(s)
- G Carrara
- Neuroradiology Department of CTO Hospital, Torino, Italy.
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