Weidman Elizabeth K, Schweitzer Andrew D, Niogi Sumit N, Brady Emily J, Starikov Anna, Askin Gulce, Shahbazi Mona, Wang Yi, Lange Dale, Tsiouris Apostolos John
Department of Radiology, NewYork-Presbyterian Hospital - Weill Cornell Medicine, New York, NY, United States of America.
Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, United States of America.
Clin Imaging. 2019 Jan-Feb;53:6-11. doi: 10.1016/j.clinimag.2018.09.015. Epub 2018 Sep 26.
Diffusion tensor imaging (DTI) and quantitative susceptibility mapping (QSM) have been proposed as methods to aid in the diagnosis of amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS), both diseases affecting upper motor neurons. We test the performance of DTI and QSM alone and in combination to distinguish patients with diseases affecting upper motor neurons (ALS/PLS) from patients with other motor symptom-predominant neurologic disorders.
3.0 Tesla MRI with DTI and QSM in patients referred to a subspecialty neurology clinic for evaluation of motor symptom-predominant neurologic disorders were retrospectively reviewed. Corticospinal tract fractional anisotropy and maximum motor cortex susceptibility were measured. Subjects were categorized by diagnosis and imaging metrics were compared between groups using Student's t-tests. Receiver operating characteristic curves were generated for imaging metrics alone and in combination.
MRI scans for 43 patients with ALS or PLS and 15 patients with motor symptom predominant, non-upper motor neuron disease (mimics) were reviewed. Fractional anisotropy was lower (0.57 vs. 0.60, p < 0.01) and maximum motor cortex magnetic susceptibility higher (64.4 vs. 52.7, p = 0.01) in patients with ALS/PLS compared to mimics. There was no significant difference in area under the curve for these metrics alone (0.73, 0.63; p > 0.05) or in combination (0.75; p > 0.05).
We found significant differences in DTI and QSM metrics in patients with diseases affecting upper motor neurons (ALS/PLS) compared to mimics, but no significant difference in the performance of these metrics in diagnosing ALS/PLS compared to mimics.
扩散张量成像（DTI）和定量磁化率成像（QSM）已被提议作为辅助诊断肌萎缩侧索硬化症（ALS）和原发性侧索硬化症（PLS）的方法，这两种疾病均影响上运动神经元。我们测试DTI和QSM单独及联合使用时，将患有影响上运动神经元疾病（ALS/PLS）的患者与以运动症状为主的其他神经系统疾病患者区分开来的性能。
回顾性分析了在亚专科神经科诊所因评估以运动症状为主的神经系统疾病而接受3.0特斯拉MRI检查及DTI和QSM检查的患者。测量皮质脊髓束各向异性分数和最大运动皮质磁化率。根据诊断对受试者进行分类，并使用学生t检验比较组间的成像指标。分别针对单独及联合的成像指标生成受试者操作特征曲线。
回顾了43例ALS或PLS患者以及15例以运动症状为主、非上运动神经元疾病（模拟疾病）患者的MRI扫描结果。与模拟疾病患者相比，ALS/PLS患者的各向异性分数较低（0.57对0.60，p<0.01），最大运动皮质磁化率较高（64.4对52.7，p=0.01）。这些指标单独使用时曲线下面积无显著差异（0.73，0.63；p>0.05），联合使用时也无显著差异（0.75；p>0.05）。
我们发现，与模拟疾病患者相比，患有影响上运动神经元疾病（ALS/PLS）的患者在DTI和QSM指标上存在显著差异，但这些指标在诊断ALS/PLS与模拟疾病方面的性能无显著差异。
