The corticospinal tract in amyotrophic lateral sclerosis: An MRI study

Abstract

Cortical motor neurone loss and corticospinal tract (CST) degeneration are typical of amyotrophic lateral sclerosis (ALS). It is a matter of debate whether qualitative assessment of the CST by MRI is useful in the diagnosis. It is also an open question whether quantitative determination of the T2 relaxation times can improve its value. Signal intensity along the CST on 14 consecutive slices was assessed using arbitrary visual rating on double-echo T2-weighted and proton-density spin-echo images of 21 patients with ALS and 21 age- and sex-matched controls. T2 was determined quantitatively. On the T2-weighted images the patients' ratings did not differ from that of controls. The T2 of patients and controls showed no statistical difference in any slice. There was no correlation between T2 and patient age, duration of the disease, or predominant bulbar, lower or upper motor neurone signs. The only correlation between MRI findings and disease was on the proton-density images: all cases in which the CST was poorly seen were controls; a clearly high-signal CST was seen only in the patients. High conspicuity of the CST was thus specific but not sensitive for the diagnosis of ALS. T2-weighted images and measurement of T2 were not useful for diagnosis.

Combined 3T Diffusion Tensor Tractography and1H-MR Spectroscopy in Motor Neuron Disease

“…The previously mentioned techniques not only hold the promise of a more specific and potentially objective MR imaging measure but may even lead to a biomarker of disease severity. In contrast, most characteristics observed on structural MR imaging, such as corticospinal tract (CST) hyperintensities in T2-weighted, proton density, and fluid-attenuated inversion recovery (FLAIR) imaging [27][28][29][30][31][32] ; hypointense precentral gyrus changes 33,34 ; or marked frontal or callosal atrophy, 35 are rather uncertain. 31,32 CST hyperintensities are frequently found in healthy individuals, whereas the hypointense precentral gyrus sign apparently is motor neuron disease-specific according to Ishikawa et al 33 but occurs only in a minority of patients with ALS.…”

Early detection and longitudinal changes in amyotrophic lateral sclerosis by 1 H MRSI

“…2,3 Thus, NAA is considered a neuron-specific marker that could provide an index of neuronal density. In addition, reversible changes in NAA levels measured by 1 H MRS have been reported in ALS following treatment trials 4 as well as in temporal lobe epilepsy after surgery, 5 suggesting that NAA concentrations reflect neuronal metabolism in addition to neuron density. Therefore, MRS measurements of NAA may provide a sensitive indicator of upper motor neuron degeneration that can be used as an early marker of ALS and to monitor progression and effects of treatment.…”

“…In addition to NAA, 1 H MRS measures resonances from choline (Cho)-and creatine (Cre)-containing compounds in the brain. Cre represents a combination of creatine and phosphocreatine, a putative marker of gliosis, 3,6 and Cho is thought to be a marker associated with membrane phospholipids.…”

“…Furthermore, because the selected regions of interest were generally large, including unavoidably some white matter and nonmotor tissue, results from these studies may have been skewed to the extent that white matter and nonmotor regions contributed to the metabolite signal from the motor cortex. With use of a multiplanar 1 …”

Olgu Sunumu: Amyotrofik Lateral Sklerozda Kranial MRG Bulguları

“…Kranial MR görüntüleme bulguları ile üst motor lezyon bulguları olan hastalarda yapılan klinik korrelasyonlarda zayıf bir ilişki ortaya çıkmıştır (1,(5)(6)(7). Hastamızda üst motor nöron tutulumu belirgindir ve kranial MR incelemede üst motor nöron tutulumunu destekler şekilde sinyal intensite değişiklik-leri tespit edilmiştir.…”