Department of Advanced Medical and Surgical Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.
Department of Psychology, Università degli Studi della Campania "Luigi Vanvitelli", Caserta, Italy, and.
Amyotroph Lateral Scler Frontotemporal Degener. 2021 Feb;22(1-2):117-126. doi: 10.1080/21678421.2020.1813306. Epub 2020 Sep 4.
Advanced neuroimaging techniques may offer the potential to monitor disease spreading in amyotrophic lateral sclerosis (ALS). We aim to investigate brain functional and structural magnetic resonance imaging (MRI) changes in a cohort of ALS patients, examined at diagnosis and clinically monitored over 18 months, in order to early discriminate fast progressors (FPs) from slow progressors (SPs). Resting state functional MRI (RS-fMRI), diffusion tensor imaging (DTI) and voxel-based morphometry (VBM) analyses were performed at baseline in 54 patients with ALS and 22 HCs. ALS patients were classified into FPs ( = 25) and SPs ( = 29) based on changes in Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised score from baseline to the 18-month assessment (ΔALSFRS-R), applying a k-means clustering algorithm. At diagnosis, when compared to HCs, ALS patients showed reduced functional connectivity in both motor and extra-motor networks. When compared to SPs, at baseline, FPs showed decreased function connectivity in paracentral lobule (sensorimotor network), precuneus (in the default mode network), middle frontal gyri (frontoparietal networks) and increased functional connectivity in insular cortices (salience network). Structural analyses did not reveal significant differences in gray and white matter damage by comparing FPs to SPs. Receiver operating characteristic (ROC) curve analysis showed that functional connectivity increase in the left insula at baseline best discriminated FPs and SPs (area under the curve 78%). Impairment of extra-motor networks may appear early in ALS patients with faster disease progression, suggesting that a more widespread functional connectivity damage may be an indicator of poorer prognosis.
高级神经影像学技术可能为监测肌萎缩侧索硬化症 (ALS) 中的疾病扩散提供潜力。我们旨在研究一组 ALS 患者的脑功能和结构磁共振成像 (MRI) 变化，这些患者在诊断时接受检查，并在 18 个月的临床监测中进行监测，以便早期区分快速进展者 (FPs) 和缓慢进展者 (SPs)。在 54 名 ALS 患者和 22 名健康对照者的基线期进行了静息态功能 MRI (RS-fMRI)、弥散张量成像 (DTI) 和基于体素的形态测量学 (VBM) 分析。根据从基线到 18 个月评估的肌萎缩侧索硬化功能评定量表修订版评分的变化 (ΔALSFRS-R)，将 ALS 患者分为 FPs ( = 25) 和 SPs ( = 29)，应用 k-均值聚类算法。在诊断时，与健康对照者相比，ALS 患者在运动和运动外网络中表现出功能连接减少。与 SPs 相比，在基线时，FPs 在前中央小叶 (运动网络)、楔前叶 (默认模式网络)、中额回 (额顶叶网络) 中表现出功能连接减少，在岛叶皮质 (突显网络) 中表现出功能连接增加。通过比较 FPs 和 SPs，结构分析未显示灰质和白质损伤的显著差异。受试者工作特征 (ROC) 曲线分析显示，基线时左侧岛叶功能连接增加可最佳区分 FPs 和 SPs (曲线下面积 78%)。在疾病进展较快的 ALS 患者中，运动外网络的损伤可能较早出现，这表明更广泛的功能连接损伤可能是预后较差的指标。
