EFNS guidelines on the use of neuroimaging in the management of motor neuron diseases

Filippi, Massimo; Agosta, Federica; Abrahams, Sharon; Fazekas, Franz; Großkreutz, Julian; Kalra, Sanjay; Kassubek, Jan; Silani, Vincenzo; Turner, Martin R; Masdeu, Joseph C.

doi:10.1111/j.1468-1331.2010.02951.x

Cited by 77 publications

(73 citation statements)

References 122 publications

(246 reference statements)

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“…The recommendations are summarized in the EFNS guidelines [Filippi et al 2010]. Here, advanced neuroimaging techniques such as volumetric analyses, DTI, MRS, or (rs-)fMRI do not have a role yet in the diagnosis or routine monitoring of MNDs (class IV, level GCPP).…”

Section: Future Perspectives: Preparing For Clinical Trialsmentioning

confidence: 99%

“…The European Federation of Neurological Societies (EFNS) guidelines on neuroimaging of MNDs (which were designed to provide practical help for neurologists to make appropriate use of neuroimaging techniques in patients with MNDs) are focused on MRI-based neuroimaging techniques [Filippi et al 2010]. For standard conventional MRI techniques, the following two basic recommendations are given.…”

Section: Magnetic Resonance Imaging Guidelinesmentioning

confidence: 99%

“…Despite the high potential of these task-based paradigms to address specific questions about motor or cognitive and other nonmotor functions, they are still biased by the limitations of physical disability. To date, fMRI is recommended for the neuroimaging approach in the assessment of cognitive network abnormalities in patients with MND [Filippi et al 2010]. Currently, task-free fMRI as the unbiased investigation of the 'resting state' of discrete cortical networks, designed to analyze inter-regional correlations of spontaneous brain activity as measured by blood oxygen level dependent signal fluctuations in the dimension of time, has opened up the possibility of probing functional changes on a broader scale, which may then better reflect a more interconnected 'network or system failure' model of ALS pathogenesis [Turner et al 2011].…”

Section: Computer-based Magnetic Resonance Imaging: Functional Magnetmentioning

confidence: 99%

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Neuroimaging of motor neuron diseases

Kassubek¹,

Ludolph²,

Müller³

2012

Ther Adv Neurol Disord

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It is agreed that conventional magnetic resonance imaging (MRI) of the brain and spine is one of the core elements in the differential diagnostic work up of patients with clinical signs of motor neuron diseases (MNDs), for example amyotrophic lateral sclerosis (ALS), to exclude MND mimics. However, the sensitivity and specificity of MRI signs in these disorders are moderate to low and do not have an evidence level higher than class IV (good clinical practice point). Currently computerized MRI analyses in ALS and other MNDs are not techniques used for individual diagnosis. However, they have improved the anatomical understanding of pathomorphological alterations in gray and white matter in various MNDs and the changes in functional networks by quantitative comparisons between patients with MND and controls at group level. For multiparametric MRI protocols, including T1-weighted three-dimensional datasets, diffusion-weighted imaging and functional MRI, the potential as a 'dry' surrogate marker is a subject of investigation in natural history studies with well defined patients. The additional value of MRI with respect to early diagnosis at an individual level and for future disease-modifying multicentre trials remains to be defined. There is still the need for more longitudinal studies in the very early stages of disease or when there is clinical uncertainty and for better standardization in the acquisition and postprocessing of computerbased MRI data. These requirements are to be addressed by establishing quality-controlled multicentre neuroimaging databases.

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Section: Future Perspectives: Preparing For Clinical Trialsmentioning

confidence: 99%

Section: Magnetic Resonance Imaging Guidelinesmentioning

confidence: 99%

Section: Computer-based Magnetic Resonance Imaging: Functional Magnetmentioning

confidence: 99%

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Neuroimaging of motor neuron diseases

Kassubek¹,

Ludolph²,

Müller³

2012

Ther Adv Neurol Disord

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“…"the specific search for these abnormalities for the purpose of making a firm diagnosis of ALS is not recommended" 1 .…”

Section: Original Articlementioning

confidence: 99%

Accuracy of Conventional MRI in ALS

Gupta

Nguyen

Chakraborty

et al. 2014

Can. J. Neurol. Sci.

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Conventional magnetic resonance imaging (MRI) of brain and spinal cord is an essential diagnostic tool to exclude amyotrophic lateral sclerosis (ALS) "mimics", when a plausible alternative neuroanatomical localization is suspected 1 . The finding of hyperintensities along the course of corticospinal tracts (CST) on T2, Proton density (PD) or fluid-attenuated inversion recovery (FLAIR) was documented over 25 years ago in case reports and subsequent small series. The sensitivity of such changes has commonly been estimated to be less than 40% and the specificity is also poor, typically less than 70% 2-12 . Poor specificity values reflect the occurrence of similar hyperintensities in normal controls 13,14 , as well as widely varying conditions, such as leukodystrophies 15,16 , X-linked CharcotMarie-Tooth disease 17 , end stage cirrhosis and liver transplantation 18 . A 2010 guideline from the European Federation of Neurological Societies states that such hyperintensities may help to support a suspicion of ALS but that ABSTRACT: Background: There is currently no definite neuroimaging test to detect amyotrophic lateral sclerosis (ALS), which leads to significant delay in diagnosis, particularly if one takes into account the rapidity of disease evolution. Hyperintensity of the corticospinal tracts (CST) on T2 or fluid-attenuated inversion recovery (FLAIR) weighted magnetic resonance imaging (MRI) has been well described, but data on sensitivity and specificity in larger series is lacking to help guide its application to clinical care. Methods:We analyzed clinical and MRI data from 64 patients with a definite retrospective diagnosis of ALS. In this case-control study, two experienced blinded neuroradiologists systematically assessed defined rostrocaudal segments of the intracranial course of the CST. Results: The overall sensitivity and specificity of conventional MRI for the diagnosis of ALS were 48% and 76% respectively. Highest specificities for CST hyperintensity were noted for the subcortical white matter (92%), centrum semiovale (88%) and medullary pyramids (92%). The lowest specificities were found for the cerebral peduncle (36%) and internal capsule (32%). We did not find a correlation with the rate of clinical progression, age of onset or the presence of upper motor neuron signs on examination. Conclusion: Conventional MRI was not found to be a reliable diagnostic tool for ALS and it did not help predict clinical characteristics such as speed of evolution or prominence of upper motor neuron signs. Its main role in the setting of ALS should remain to help exclude alternative diagnostic considerations. A multimodal approach relying on newer functional and structural MRI techniques still needs to be developed and validated. RÉSUMÉ: Précision de l'IRM conventionnelle dans la SLA. Contexte : Il n'existe pas actuellement de test de neuroimagerie pour détecter la SLA, ce qui occasionne des délais importants dans le diagnostic de la maladie, particulièrement si on tient compte de la rapidité d'évolution de celle-ci. Un...

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“…Proton magnetic resonance spectroscopy (MRS) studies have consistently shown evidence of neuronal dysfunction in the primary motor cortex (PMC) of ALS (Filippi et al 2010). However, no consensus has been reached on the standard protocols for performing MRS scans in ALS.…”

Section: Introductionmentioning

confidence: 99%

Detecting neuronal dysfunction of hand motor cortex in ALS: A MRSI study

Wang

Chen

et al. 2017

Somatosensory & Motor Research

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Background: Although hand motor cortex (HMC) has been constantly used for identification of primary motor cortex in magnetic resonance spectroscopy (MRS) studies of amyotrophic lateral sclerosis (ALS), neurochemical profiles of HMC have never been assessed independently. As HMC has a constant location and the clinic-anatomic correlation between hand motor function and HMC has been established, we hypothesize that HMC may serve as a promising region of interest in diagnosing ALS. Patients and methods: Fourteen ALS patients and 14 age-and gender-matched healthy controls (HC) were recruited in this study. An optimized magnetic resonance spectroscopic imaging (MRSI) method was developed and for each subject bilateral HMC areas were scanned separately (two-dimensional multi-voxel MRSI, voxel size 0.56 cm 3 ). N-acetyl aspartate (NAA)-creatine (Cr) ratio was measured from HMC and the adjacent postcentral gyrus. Results: Compared with HC, NAA/Cr ratios from HMC and the postcentral gyrus were significantly reduced in ALS. However, in each group the difference of NAA/Cr ratios between HMC and the postcentral gyrus was not significant. Limb predominance of HMC was not found in either ALS or HC. In ALS, there was a significant difference in NAA/Cr ratio between the most affected HMC and the less affected HMC. A positive relationship between NAA/Cr ratio of HMC and the severity of hand strength (assessed by finger tapping speed) was demonstrated. Conclusion: Neuronal dysfunction of HMC can differentiate ALS patients from HC when represented as reduced NAA/Cr ratio. Postcentral gyrus could not serve as normal internal reference tissue in diagnosing ALS. Asymmetrical NAA/Cr ratios from bilateral HMC may serve as a promising diagnostic biomarker of ALS at the individual level.

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EFNS guidelines on the use of neuroimaging in the management of motor neuron diseases

Cited by 77 publications

References 122 publications

Neuroimaging of motor neuron diseases

Neuroimaging of motor neuron diseases

Accuracy of Conventional MRI in ALS

Detecting neuronal dysfunction of hand motor cortex in ALS: A MRSI study

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