Evaluating the cerebral correlates of survival in amyotrophic lateral sclerosis

Abstract

ObjectiveTo evaluate cerebral degenerative changes in ALS and their correlates with survival using 3D texture analysis.MethodsA total of 157 participants were included in this analysis from four neuroimaging studies. Voxel‐wise texture analysis on T1‐weighted brain magnetic resonance images (MRIs) was conducted between patients and controls. Patients were divided into long‐ and short‐survivors using the median survival of the cohort. Neuroanatomical differences between the two survival groups were also investigated.ResultsWhole‐brain analysis revealed significant changes in image texture (FDR P < 0.05) bilaterally in the motor cortex, corticospinal tract (CST), insula, basal ganglia, hippocampus, and frontal regions including subcortical white matter. The texture of the CST correlated (P < 0.05) with finger‐ and foot‐tapping rate, measures of upper motor neuron function. Patients with a survival below the media of 19.5 months demonstrated texture change (FDR P < 0.05) in the motor cortex, CST, basal ganglia, and the hippocampus, a distribution which corresponds to stage 4 of the distribution TDP‐43 pathology in ALS. Patients with longer survival exhibited texture changes restricted to motor regions, including the motor cortex and the CST.InterpretationWidespread gray and white matter pathology is evident in ALS, as revealed by texture analysis of conventional T1‐weighted MRI. Length of survival in patients with ALS is associated with the spatial extent of cerebral degeneration.

Reliability of 3D texture analysis: A multicenter MRI study of the brain

“…However, voxelwise 3D TA instead computes the statistical differences in texture values. This technique has shown to be highly sensitive and specific in both Alzheimer's disease and ALS, supporting its potential as an imaging biomarker and diagnostic tool …”

“…TA has potential for clinical use, providing information on many neurological disorders. Indeed, it has been used to study intracranial brain tumors, epilepsy, multiple sclerosis, Alzheimer's disease, and amyotrophic lateral sclerosis (ALS) …”

“…Indeed, it has been used to study intracranial brain tumors, 3,4 epilepsy, 5,6 multiple sclerosis, 1,7,8 Alzheimer's disease, [9][10][11][12][13] and amyotrophic lateral sclerosis (ALS). [14][15][16][17] Previous methods of using TA have been limited to 2D region-of-interest (ROI)-based approaches. To address this limitation, a novel 3D TA technique based on the popular gray-level co-occurrence matrix (GLCM) method was previously developed.…”

“…This technique has shown to be highly sensitive and specific in both Alzheimer's disease and ALS, supporting its potential as an imaging biomarker and diagnostic tool. [12][13][14][15][16][17] The study of neurological disorders has been facilitated by growing multicenter collaborative efforts, such as the Alzheimer's Disease Neuroimaging Initiative (ADNI). 18 Such consortia have been successful in increasing the pool of MRI data, and thus statistical power allowing for increased sensitivity to subtle changes in neuroimaging metrics.…”

Upper motor neuron burden measurement in motor neuron diseases: Does one scale fit all?

“…Some clinical UMN burden scales used in amyotrophic lateral sclerosis (ALS), primary lateral sclerosis (PLS), multiple sclerosis, and other CNS disorders research include (1) timed tests of fine and gross motor movement such as timed peg (eg, Nine‐Hole Peg Test), time and distance‐based walk tests, finger/foot tapping speed tests; (2) tests for measuring spastic dysarthria such as the automated speech pause analysis, auditory‐perceptual dysarthria assessment, and Frenchay dysarthria test; (3) limb spasticity assessments, including various modifications of the Ashworth scale, 0 to 10 numeric rating scale, Multiple Sclerosis Spasticity Scale‐8, Rekand spasticity score, adductor tone rating scale, and pendulum test, among others; and (4) assessments of stretch reflexes including Ellis and Massachusetts General Hospital Upper Motor Neuron Burden (MGH‐UMNB) scales …”