Highlights
- •Hyperintensity of Corticospinal Tract (CST) on FLAIR MRI can be used to evaluate upper motor neuron (UMN) degeneration in ALS.
- •Hyperintensity of CST is a simple and sensitive objective upper motor neuron degeneration markers in ALS.
- •Combining CST hyperintensity and clinical examination can improve the sensitivity of diagnostic performance for UMN degeneration in ALS.
Abstract
Objective
The involvement of upper motor neuron (UMN) degeneration is crucial to the diagnosis
of amyotrophic lateral sclerosis (ALS). However, it is difficult to detect in the
early stages, and particularly with predominantly lower motor neuron (LMN) dysfunction.
Thus, objective and sensitive UMN degeneration markers are needed for an accurate
and early diagnosis. Several studies have investigated the abnormal signal changes
in brain MRI for patients with ALS, so we hope to develop a neuroimaging diagnosis
method in brain MRI that can evaluate UMN degeneration.
Materials and methods
We investigated corticospinal tract (CST) hyperintensity on MRI-fluid attenuated inversion
recovery (FLAIR) images for 82 clinically verified ALS patients and 38 age-and gender-matched
control subjects. Visual evaluation of the FLAIR images was analyzed independently
by 3 observers. The clinical examination was implemented by an experienced neurological
physician.
Results
The three observers' views were identical regarding CST hyperintensity on FLAIR images
in subcortical precentral gyrus, centrum emiovale, internal capsule, and cerebral
peduncles levels (p > 0.05). The frequency of CST hyperintensity is significantly higher for the ALS group
than the control group in subcortical precentral gyrus, centrum semiovale, posterior
limbs of internal capsule and cerebral peduncles levels. (p < 0.01). The mean areas under the receiver operating characteristic curves (AUC) values
were not different among clinical examinations, CST hyperintensity and mixed-examination
(CST hyperintensity and clinical examination groups) in subcortical precentral gyrus,
centrum semiovale, internal capsule, and cerebral peduncles levels (p > 0.05), although AUC values of CST hyperintensity was slightly higher than clinical
examination in centrum semiovale level. There was no statistically significant correlation
between CST hyperintensity and age of onset, gender, disease duration, region of onset,
and clinical UMN manifestation. (p > 0.05).
Conclusion
CST hyperintensity was found more frequently in patients with ALS compared to the
matched control group. It can be used to evaluate UMN degeneration effectively in
subcortical precentral gyrus, centrum semiovale and cerebral peduncles levels. Combining
CST hyperintensity and clinical examination can improve the sensitivity of diagnostic
performance for UMN degeneration in ALS.
Keywords
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Article info
Publication history
Published online: June 03, 2016
Accepted:
June 2,
2016
Received in revised form:
April 19,
2016
Received:
October 14,
2015
Footnotes
☆Acknowledgements and Source of Funding: This paper is supported by the Shaanxi Science and Technology Program (Grant no. 2014K11-02-01-04) and the Shaanxi International Technology Cooperation and Communication Program (Grant no. 2015KW-051)
Identification
Copyright
© 2016 Elsevier B.V. All rights reserved.
