Iuzzolino Valentina Virginia, Scaravilli Alessandra, Carignani Guglielmo, Senerchia Gianmaria, Pontillo Giuseppe, Dubbioso Raffaele, Cocozza Sirio
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Neuroradiology. 2025 May 2. doi: 10.1007/s00234-025-03629-7.
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease primarily affecting motor neurons, yet with substantial clinical variability. Furthermore, beyond motor symptoms, ALS patients also show non-motor features, reflecting its classification as a multi-system disorder. The identification of reliable biomarkers is a critical challenge for improving diagnosis, tracking disease progression, and predicting patient outcomes. This review explores macro- and microstructural alterations in ALS, focusing on gray matter (GM) and white matter (WM) as observed through Magnetic Resonance Imaging (MRI). This approach synthesizes not only the expected involvement of motor areas but also highlights emerging evidence that these changes extend to extra-motor areas, such as the frontal and temporal lobes, underscoring the complex pathophysiology of ALS. The review emphasizes the potential of MRI as a non-invasive tool to provide new biomarkers by assessing both GM and WM integrity, a key advancement in ALS research. Additionally, it addresses existing discrepancies in findings and stresses the need for standardized imaging protocols. It also highlights the role of multi-modal MRI approaches in deepening our understanding of ALS pathology, emphasizing the importance of combining structural and diffusion MRI techniques to offer more comprehensive insights into ALS progression, ultimately advancing the potential for personalized treatment strategies and improving patient outcomes.
肌萎缩侧索硬化症（ALS）是一种主要影响运动神经元的进行性神经退行性疾病，但临床症状差异很大。此外，除了运动症状外，ALS患者还表现出非运动特征，这反映了其作为一种多系统疾病的分类。识别可靠的生物标志物是改善诊断、跟踪疾病进展和预测患者预后的关键挑战。本综述探讨了ALS中的宏观和微观结构改变，重点关注通过磁共振成像（MRI）观察到的灰质（GM）和白质（WM）。这种方法不仅综合了运动区域的预期受累情况，还突出了新出现的证据，即这些变化扩展到了运动外区域，如额叶和颞叶，强调了ALS复杂的病理生理学。该综述强调了MRI作为一种非侵入性工具的潜力，通过评估GM和WM的完整性来提供新的生物标志物，这是ALS研究中的一项关键进展。此外，它还解决了现有研究结果中的差异，并强调了标准化成像方案的必要性。它还强调了多模态MRI方法在深化我们对ALS病理学理解方面的作用，强调了结合结构和扩散MRI技术以更全面地了解ALS进展的重要性，最终推进个性化治疗策略的可能性并改善患者预后。
