Charil Arnaud, Corbo Massimo, Filippi Massimo, Kesavadas Chandrasekharan, Agosta Federica, Munerati Elisabetta, Gambini Anna, Comi Giancarlo, Scotti Giuseppe, Falini Andrea
Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, via Olgettina 60, Milan, Italy.
Amyotroph Lateral Scler. 2009 Oct-Dec;10(5-6):269-79. doi: 10.3109/17482960902777339.
Our objective was to assess and compare the diagnostic sensitivity of conventional MRI (cMRI), magnetization transfer imaging (MTI), diffusion-weighted imaging (DWI), and proton magnetic resonance spectroscopic imaging ((1)H-MRSI) in patients with amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS). Thirty-eight ALS patients, nine PLS patients, and 22 healthy controls were enrolled. cMRI, MTI, DWI and (1)H-MRSI were obtained. ALS patients were classified as advanced phase (Ap)-ALS (definite+probable) and early phase (Ep)-ALS (possible+probable-laboratory supported). cMRI was highly sensitive in detecting corticospinal tract (CST) hyperintensities in Ap-ALS (63.4%) and PLS (71.9%), but it was poorly sensitive in Ep-ALS (17.1%). Hyperintensity on proton density-weighted images correlated with ALS severity (p=0.02). CST apparent diffusion coefficient was significantly increased in ALS (p<0.01) and PLS (p=0.02) versus controls. The N-acetylaspartate/creatine ratio was significantly reduced in the motor cortex of patients versus controls (p< or = 0.01 in PLS, p=0.02 in Ap-ALS). The study shows the utility of cMRI for diagnosing ALS. Nevertheless, MRI sensitivity is limited at the early stages of the disease. In these cases, DWI and (1)H-MRSI seem to have the potential to ameliorate the patients' work-up and estimate the nature and extent of the underlying pathological damage.
我们的目的是评估和比较传统MRI（cMRI）、磁化传递成像（MTI）、扩散加权成像（DWI）以及质子磁共振波谱成像（（1）H-MRSI）在肌萎缩侧索硬化症（ALS）和原发性侧索硬化症（PLS）患者中的诊断敏感性。纳入了38例ALS患者、9例PLS患者和22名健康对照者。获取了cMRI、MTI、DWI和（1）H-MRSI图像。ALS患者被分为晚期（Ap）-ALS（确诊+很可能）和早期（Ep）-ALS（可能+很可能-实验室支持）。cMRI在检测Ap-ALS（63.4%）和PLS（71.9%）患者的皮质脊髓束（CST）高信号方面具有较高敏感性，但在Ep-ALS患者中敏感性较差（17.1%）。质子密度加权图像上的高信号与ALS严重程度相关（p=0.02）。与对照组相比，ALS（p<0.01）和PLS（p=0.02）患者的CST表观扩散系数显著增加。与对照组相比，患者运动皮质中的N-乙酰天门冬氨酸/肌酸比值显著降低（PLS中p≤0.01，Ap-ALS中p=0.02）。该研究显示了cMRI在诊断ALS方面的实用性。然而，MRI在疾病早期阶段的敏感性有限。在这些情况下，DWI和（1）H-MRSI似乎有潜力改善患者的检查，并评估潜在病理损伤的性质和程度。
