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Diffusion tensor MRI of early upper motor neuron involvement in amyotrophic lateral sclerosis.
Brain. 2004 Feb; 127(Pt 2):340-50.B

Abstract

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative system disorder affecting both upper and lower motor neurons. Despite supportive electrophysiological investigations, the involvement of the upper motor neuron is often difficult to assess at an early stage of disease. Diffusion tensor MRI provides an estimate of the orientation of fibre bundles in white matter on the basis of the diffusion characteristics of water. Diffusivity is generally higher in directions along fibre tracts than perpendicular to them. This degree of directionality of diffusion can be measured as fractional anisotropy. Changes in tissue structure due to degeneration of the corticospinal fibres can lead to a modification of the degree of directionality which can be detected by diffusion tensor MRI. We investigated 15 patients with ALS, six of whom had no clinical signs of upper motor neuron involvement at the time of MRI investigation, but developed pyramidal tract symptoms later in the course of their disease. These patients met the El Escorial criteria as their disease progressed. We found a decrease in fractional anisotropy in the corticospinal tract, corpus callosum and thalamus in all 15 ALS patients, including the patients without clinical signs of upper motor neuron lesion, compared with healthy controls. Regression analysis showed a negative correlation between fractional anisotropy and central motor conduction time obtained by transcranial magnetic stimulation, allowing spatial differentiation between the degenerated corticospinal tract fibres that supply the upper and lower extremities. Thus, diffusion tensor MRI can be used to assess upper motor neuron involvement in ALS patients before clinical symptoms of corticospinal tract lesion become apparent, and it may therefore contribute to earlier diagnosis of motor neuron disease.

Authors+Show Affiliations

Department of Neurology, Neuroimage Nord, University Hosptial Hamburg, Eppendorf, Germany. sach@uke.uni-hamburg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14607785

Citation

Sach, Miriam, et al. "Diffusion Tensor MRI of Early Upper Motor Neuron Involvement in Amyotrophic Lateral Sclerosis." Brain : a Journal of Neurology, vol. 127, no. Pt 2, 2004, pp. 340-50.
Sach M, Winkler G, Glauche V, et al. Diffusion tensor MRI of early upper motor neuron involvement in amyotrophic lateral sclerosis. Brain. 2004;127(Pt 2):340-50.
Sach, M., Winkler, G., Glauche, V., Liepert, J., Heimbach, B., Koch, M. A., Büchel, C., & Weiller, C. (2004). Diffusion tensor MRI of early upper motor neuron involvement in amyotrophic lateral sclerosis. Brain : a Journal of Neurology, 127(Pt 2), 340-50.
Sach M, et al. Diffusion Tensor MRI of Early Upper Motor Neuron Involvement in Amyotrophic Lateral Sclerosis. Brain. 2004;127(Pt 2):340-50. PubMed PMID: 14607785.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diffusion tensor MRI of early upper motor neuron involvement in amyotrophic lateral sclerosis. AU - Sach,Miriam, AU - Winkler,Gerhard, AU - Glauche,Volkmar, AU - Liepert,Joachim, AU - Heimbach,Bernhard, AU - Koch,Martin A, AU - Büchel,Christian, AU - Weiller,Cornelius, Y1 - 2003/11/07/ PY - 2003/11/11/pubmed PY - 2004/2/26/medline PY - 2003/11/11/entrez SP - 340 EP - 50 JF - Brain : a journal of neurology JO - Brain VL - 127 IS - Pt 2 N2 - Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative system disorder affecting both upper and lower motor neurons. Despite supportive electrophysiological investigations, the involvement of the upper motor neuron is often difficult to assess at an early stage of disease. Diffusion tensor MRI provides an estimate of the orientation of fibre bundles in white matter on the basis of the diffusion characteristics of water. Diffusivity is generally higher in directions along fibre tracts than perpendicular to them. This degree of directionality of diffusion can be measured as fractional anisotropy. Changes in tissue structure due to degeneration of the corticospinal fibres can lead to a modification of the degree of directionality which can be detected by diffusion tensor MRI. We investigated 15 patients with ALS, six of whom had no clinical signs of upper motor neuron involvement at the time of MRI investigation, but developed pyramidal tract symptoms later in the course of their disease. These patients met the El Escorial criteria as their disease progressed. We found a decrease in fractional anisotropy in the corticospinal tract, corpus callosum and thalamus in all 15 ALS patients, including the patients without clinical signs of upper motor neuron lesion, compared with healthy controls. Regression analysis showed a negative correlation between fractional anisotropy and central motor conduction time obtained by transcranial magnetic stimulation, allowing spatial differentiation between the degenerated corticospinal tract fibres that supply the upper and lower extremities. Thus, diffusion tensor MRI can be used to assess upper motor neuron involvement in ALS patients before clinical symptoms of corticospinal tract lesion become apparent, and it may therefore contribute to earlier diagnosis of motor neuron disease. SN - 0006-8950 UR - https://www.unboundmedicine.com/medline/citation/14607785/Diffusion_tensor_MRI_of_early_upper_motor_neuron_involvement_in_amyotrophic_lateral_sclerosis_ L2 - https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awh041 DB - PRIME DP - Unbound Medicine ER -