Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France.
Département de Neurology, Centre Référent SLA, CHU de Lille, Centre LICEND COEN, Lille, France.
J Neurol. 2023 Aug;270(8):3885-3895. doi: 10.1007/s00415-023-11727-w. Epub 2023 Apr 27.
Motor capacity is crucial in amyotrophic lateral sclerosis (ALS) clinical trial design and patient care. However, few studies have explored the potential of multimodal MRI to predict motor capacity in ALS. This study aims to evaluate the predictive value of cervical spinal cord MRI parameters for motor capacity in ALS compared to clinical prognostic factors.
Spinal multimodal MRI was performed shortly after diagnosis in 41 ALS patients and 12 healthy participants as part of a prospective multicenter cohort study, the PULSE study (NCT00002013-A00969-36). Motor capacity was assessed using ALSFRS-R scores. Multiple stepwise linear regression models were constructed to predict motor capacity at 3 and 6 months from diagnosis, based on clinical variables, structural MRI measurements, including spinal cord cross-sectional area (CSA), anterior-posterior, and left-to-right cross-section diameters at vertebral levels from C1 to T4, and diffusion parameters in the lateral corticospinal tracts (LCSTs) and dorsal columns.
Structural MRI measurements were significantly correlated with the ALSFRS-R score and its sub-scores. And as early as 3 months from diagnosis, structural MRI measurements fit the best multiple linear regression model to predict the total ALSFRS-R (R = 0.70, p value = 0.0001) and arm sub-score (R = 0.69, p value = 0.0002), and combined with DTI metric in the LCST and clinical factors fit the best multiple linear regression model to predict leg sub-score (R = 0.73, p value = 0.0002).
Spinal multimodal MRI could be promising as a tool to enhance prognostic accuracy and serve as a motor function proxy in ALS.
运动能力在肌萎缩侧索硬化症（ALS）临床试验设计和患者护理中至关重要。然而，很少有研究探索多模态 MRI 预测 ALS 运动能力的潜力。本研究旨在评估颈椎脊髓 MRI 参数在 ALS 中预测运动能力的价值，与临床预后因素相比。
41 例 ALS 患者和 12 例健康对照者在诊断后不久即进行了脊髓多模态 MRI 检查，这是一项前瞻性多中心队列研究，即 PULSE 研究（NCT00002013-A00969-36）。采用 ALSFRS-R 评分评估运动能力。基于临床变量、结构 MRI 测量值，包括脊髓横截面积（CSA）、C1 至 T4 椎体水平的前后和左右截面直径，以及外侧皮质脊髓束（LCSTs）和背柱的扩散参数，构建多个逐步线性回归模型，以预测从诊断开始 3 个月和 6 个月的运动能力。
结构 MRI 测量值与 ALSFRS-R 评分及其子评分显著相关。早在诊断后 3 个月，结构 MRI 测量值就能最佳拟合总 ALSFRS-R（R=0.70，p 值=0.0001）和手臂子评分（R=0.69，p 值=0.0002）的多元线性回归模型，结合 LCST 中的 DTI 指标和临床因素能最佳拟合腿子评分（R=0.73，p 值=0.0002）的多元线性回归模型。
脊髓多模态 MRI 可能是一种有前途的工具，可以提高预后准确性，并作为 ALS 中的运动功能替代指标。
