de Albuquerque Milena, Branco Lucas Melo T, Rezende Thiago Junqueira R, de Andrade Helen Maia Tavares, Nucci Anamarli, França Marcondes Cavalcante
Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas - UNICAMP Rua Tessália Vieira de Camargo, 126, Cidade Universitaria "Zeferino Vaz" Campinas, SP 13083-887, Brazil.
Neuroimage Clin. 2017 Jan 24;14:269-276. doi: 10.1016/j.nicl.2017.01.024. eCollection 2017.
To evaluate MRI-based parameters as biomarkers of Amyotrophic Lateral Sclerosis (ALS) progression.
Twenty-seven patients and 27 controls performed two clinical and MRI acquisitions 8 months apart. ALSFRS-R scale was used to quantify disease severity at both time points. Multimodal analyses of MRI included cortical thickness measurements (FreeSurfer software), analysis of white matter integrity using diffusion-tensor imaging (tract-based spatial statistics-TBSS) and measurement of cervical spinal cord cross-sectional area (SpineSeg software). All analyses were corrected for multiple comparisons. The standardized response mean (SRM = mean score change / standard deviation of score change) was calculated for all methods herein employed and used for comparison purposes.
There were 18 men and mean age at first examination was 51.9 years. Mean ALSFRS-R scores at baseline and follow-up were 34.0 and 29.0, respectively. There was no region with progressive cortical thinning, but there was significant brainstem volumetric reduction (p = 0.001). TBSS analyses revealed progressive increase of AD (axial diffusivity) and MD (mean diffusivity) at the corpus callosum (p < 0.05), whereas SpineSeg showed progressive cord area reduction (p = 0.002). Cervical spinal cord cross-sectional area reduction was the only MRI parameter that correlated with ALSFRS-R change (r = 0.309, p = 0.038). SRM for ALSFRS-R was 0.95, for cord area 0.95, for corpus callosum AD 0.62 and MD 0.65, and for brainstem volume 0.002.
Structural MRI is able to detect short term longitudinal changes in ALS. Cervical spinal cord morphometry is a promising neuroimaging marker to assess ALS course.
评估基于磁共振成像（MRI）的参数作为肌萎缩侧索硬化症（ALS）进展的生物标志物。
27例患者和27名对照者在相隔8个月的时间里进行了两次临床和MRI检查。使用肌萎缩侧索硬化功能评分修订版（ALSFRS-R）量表在两个时间点量化疾病严重程度。MRI的多模态分析包括皮质厚度测量（FreeSurfer软件）、使用扩散张量成像分析白质完整性（基于纤维束的空间统计-TBSS）以及测量颈髓横截面积（SpineSeg软件）。所有分析均针对多重比较进行了校正。计算本文所采用的所有方法的标准化反应均值（SRM = 平均评分变化 / 评分变化的标准差）并用于比较。
有18名男性，首次检查时的平均年龄为51.9岁。基线和随访时的平均ALSFRS-R评分分别为34.0和29.0。没有区域出现进行性皮质变薄，但脑干体积有显著减少（p = 0.001）。TBSS分析显示胼胝体的轴向扩散率（AD）和平均扩散率（MD）有进行性增加（p < 0.05），而SpineSeg显示脊髓面积有进行性减少（p = 0.002）。颈髓横截面积减少是唯一与ALSFRS-R变化相关的MRI参数（r = 0.309，p = 0.038）。ALSFRS-R的SRM为0.95，脊髓面积为0.95，胼胝体AD为0.62，MD为0.65，脑干体积为0.002。
结构MRI能够检测ALS的短期纵向变化。颈髓形态测量是评估ALS病程的一个有前景的神经影像标志物。
