1
|
Müller HP, Behler A, Münch M, Dorst J, Ludolph AC, Kassubek J. Sequential alterations in diffusion metrics as correlates of disease severity in amyotrophic lateral sclerosis. J Neurol 2023; 270:2308-2313. [PMID: 36763176 PMCID: PMC10025190 DOI: 10.1007/s00415-023-11582-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND AND OBJECTIVE The neuropathology of amyotrophic lateral sclerosis (ALS) follows a regional distribution pattern in the brain with four stages. Using diffusion tensor imaging (DTI), this pattern can be translated into a tract-based staging scheme to assess cerebral progression in vivo. This study investigates the association between the sequential alteration pattern and disease severity in patients with ALS. METHODS DTI data of 325 patients with ALS and 130 healthy controls were analyzed in a tract of interest (TOI)-based approach. Patients were categorized according to their ALS-FRS-R scores into groups with declining functionality. The fractional anisotropy (FA) values in the tracts associated with neuropathological stages were group-wise compared with healthy controls. RESULTS The FA in the tracts associated with ALS stages showed a decrease which could be related to the disease severity stratification, i.e., at the group level, the lower the ALS-FRS-R of the categorized patient group, the higher was the effect size of the stage-related tract. In the patient group with the highest ALS-FRS-R, Cohen's d showed a medium effect size in the corticospinal tract and small effect sizes in the other stage-related tracts. Overall, the lower the ALS-FRS-R of the categorized patient group the higher was the effect size of the comparison with healthy controls. CONCLUSION The progression of white matter alterations across tracts according to the model of sequential tract involvement is associated with clinical disease severity in patients with ALS, suggesting the use of staging-based DTI as a technical marker for disease progression.
Collapse
Affiliation(s)
- Hans-Peter Müller
- Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Anna Behler
- Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Maximilian Münch
- Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Johannes Dorst
- Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany.
| |
Collapse
|
3
|
Li H, Zhang Q, Duan Q, Jin J, Hu F, Dang J, Zhang M. Brainstem Involvement in Amyotrophic Lateral Sclerosis: A Combined Structural and Diffusion Tensor MRI Analysis. Front Neurosci 2021; 15:675444. [PMID: 34149349 PMCID: PMC8206526 DOI: 10.3389/fnins.2021.675444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction The brainstem is an important component in the pathology of amyotrophic lateral sclerosis (ALS). Although neuroimaging studies have shown multiple structural changes in ALS patients, few studies have investigated structural alterations in the brainstem. Herein, we compared the brainstem structure between patients with ALS and healthy controls. Methods A total of 33 patients with ALS and 33 healthy controls were recruited in this study. T1-weighted and diffusion tensor imaging (DTI) were acquired on a 3 Tesla magnetic resonance imaging (3T MRI) scanner. Volumetric and vertex-wised approaches were implemented to assess the differences in the brainstem’s morphological features between the two groups. An atlas-based region of interest (ROI) analysis was performed to compare the white matter integrity of the brainstem between the two groups. Additionally, a correlation analysis was used to evaluate the relationship between ALS clinical characteristics and structural features. Results Volumetric analyses showed no significant difference in the subregion volume of the brainstem between ALS patients and healthy controls. In the shape analyses, ALS patients had a local abnormal surface contraction in the ventral medulla oblongata and ventral pons. Compared with healthy controls, ALS patients showed significantly lower fractional anisotropy (FA) in the left corticospinal tract (CST) and bilateral frontopontine tracts (FPT) at the brainstem level, and higher radial diffusivity (RD) in bilateral CST and left FPT at the brainstem level by ROI analysis in DTI. Correlation analysis showed that disease severity was positively associated with FA in left CST and left FPT. Conclusion These findings suggest that the brainstem in ALS suffers atrophy, and degenerative processes in the brainstem may reflect disease severity in ALS. These findings may be helpful for further understanding of potential neural mechanisms in ALS.
Collapse
Affiliation(s)
- Haining Li
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiuli Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qianqian Duan
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiaoting Jin
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fangfang Hu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingxia Dang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
7
|
Kalra S, Müller HP, Ishaque A, Zinman L, Korngut L, Genge A, Beaulieu C, Frayne R, Graham SJ, Kassubek J. A prospective harmonized multicenter DTI study of cerebral white matter degeneration in ALS. Neurology 2020; 95:e943-e952. [PMID: 32646955 DOI: 10.1212/wnl.0000000000010235] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/17/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate progressive white matter (WM) degeneration in amyotrophic lateral sclerosis (ALS). METHODS Sixty-six patients with ALS and 43 healthy controls were enrolled in a prospective, longitudinal, multicenter study in the Canadian ALS Neuroimaging Consortium (CALSNIC). Participants underwent a harmonized neuroimaging protocol across 4 centers that included diffusion tensor imaging (DTI) for assessment of WM integrity. Three visits were accompanied by clinical assessments of disability (ALS Functional Rating Scale-Revised [ALSFRS-R]) and upper motor neuron (UMN) function. Voxel-wise whole-brain and quantitative tract-wise DTI assessments were done at baseline and longitudinally. Correction for site variance incorporated data from healthy controls and from healthy volunteers who underwent the DTI protocol at each center. RESULTS Patients with ALS had a mean progressive decline in fractional anisotropy (FA) of the corticospinal tract (CST) and frontal lobes. Tract-wise analysis revealed reduced FA in the CST, corticopontine/corticorubral tract, and corticostriatal tract. CST FA correlated with UMN function, and frontal lobe FA correlated with the ALSFRS-R score. A progressive decline in CST FA correlated with a decline in the ALSFRS-R score and worsening UMN signs. Patients with fast vs slow progression had a greater reduction in FA of the CST and upper frontal lobe. CONCLUSIONS Progressive WM degeneration in ALS is most prominent in the CST and frontal lobes and, to a lesser degree, in the corticopontine/corticorubral tracts and corticostriatal pathways. With the use of a harmonized imaging protocol and incorporation of analytic methods to address site-related variances, this study is an important milestone toward developing DTI biomarkers for cerebral degeneration in ALS. CLINICALTRIALSGOV IDENTIFIER NCT02405182.
Collapse
Affiliation(s)
- Sanjay Kalra
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada.
| | - Hans-Peter Müller
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Abdullah Ishaque
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Lorne Zinman
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Lawrence Korngut
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Angela Genge
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Christian Beaulieu
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Richard Frayne
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Simon J Graham
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jan Kassubek
- From the Division of Neurology (S.K.), Department of Medicine, Neuroscience and Mental Health Institute (S.K., A.I.), and Department of Biomedical Engineering (C.B.), University of Alberta, Edmonton, Canada; Department of Neurology (H.-P.M., J.K.), University of Ulm, Germany; Sunnybrook Health Sciences Centre (L.Z., S.J.G.), University of Toronto, Ontario; Departments of Clinical Neurosciences (L.K., R.F.) and Radiology (R.F.), Hotchkiss Brain Institute, University of Calgary, Alberta; Montreal Neurological Institute and Hospital (A.G.), McGill University, Quebec; and Seaman Family MR Research Centre (R.F.), Foothills Medical Centre, Calgary, Alberta, Canada
| |
Collapse
|