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Low signal intensity in motor cortex on susceptibility-weighted MR imaging is correlated with clinical signs of amyotrophic lateral sclerosis: a pilot study

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Abstract

There is no reliable objective indicator for upper motor neuron dysfunction in amyotrophic lateral sclerosis (ALS). To determine the clinical significance and potential utility of magnetic resonance (MR) signals, we investigated the relationship between clinical symptoms and susceptibility changes in the motor cortex measured using susceptibility-weighted MR imaging taken by readily available 3-T MRI in clinical practice. Twenty-four ALS patients and 14 control subjects underwent 3-T MR T1-weighted imaging and susceptibility-weighted MR imaging with the principles of echo-shifting with a train of observations (PRESTO) sequence. We analysed relationships between relative susceptibility changes in the motor cortex assessed using voxel-based analysis (VBA) and clinical scores, including upper motor neuron score, ALS functional rating scale revised score, and Medical Research Council sum score on physical examination. Patients with ALS exhibited significantly lower signal intensity in the precentral gyrus on susceptibility-weighted MR imaging compared with controls. Clinical scores were significantly correlated with susceptibility changes. Importantly, the extent of the susceptibility changes in the bilateral precentral gyri was significantly correlated with upper motor neuron scores. The results of our pilot study using VBA indicated that low signal intensity in motor cortex on susceptibility-weighted MR imaging may correspond to clinical symptoms, particularly upper motor neuron dysfunction. Susceptibility-weighted MR imaging may be a useful diagnostic tool as an objective indicator of upper motor neuron dysfunction.

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Acknowledgements

The authors thank all of the participants in the present study, members of the Division of Neurology, Kobe University Graduate School of Medicine, and the hospital staff, including Katsusuke Kyotani at the Department of Radiology, Kobe University Hospital. We thank Edanz Group (http://www.edanzediting.com) for editing a draft of this manuscript. We also thank Dr. Takahiro Nakano for confirming the inter-rater reliability of volumes of interest in lateral ventricle cerebrospinal fluid space.

Funding

This work received financial support from the Japan Society for the Promotion of Science KAKENHI Grant number 16K09717. This work was also supported by Development, the Japan Advanced Molecular Imaging Program and Grants-in-Aid for Young Scientists (A) (26713031) and Mochida Memorial Foundation for Medical Pharmaceutical Research to HS.

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Authors and Affiliations

  1. Division of Neurology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Hironobu Endo, Kenji Sekiguchi, Takehiro Ueda, Hisatomo Kowa, Fumio Kanda & Tatsushi Toda

  2. Department of Functional Brain Imaging Research (DOFI), Brain Disorder Translational Research Team, National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST), Chiba, Japan

    Hitoshi Shimada

  3. Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan

    Hisatomo Kowa

  4. Department of Neurology, University of Tokyo Graduate School of Medicine, Tokyo, Japan

    Tatsushi Toda

Authors
  1. Hironobu Endo
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  2. Kenji Sekiguchi
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  3. Hitoshi Shimada
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  4. Takehiro Ueda
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  5. Hisatomo Kowa
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  6. Fumio Kanda
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  7. Tatsushi Toda
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Contributions

HE was involved in the conception and design of the study, acquiring, analysing, and interpreting the data; and writing the manuscript. KS and HS contributed to interpreting the data and substantially revising the manuscript. TU, HK, FK, and TT contributed to revising and approving the manuscript.

Corresponding author

Correspondence to Kenji Sekiguchi.

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The authors declare that there is no conflict of interest.

Ethical standard statement

The medical ethical committee of the Kobe University Graduate School of Medicine allowed this study without sign by the patient. We collected data from medical record which were a part of general medical examination for research purposes. The patient information sufficiently anonymised. In addition, if the patient recognize by any chance, we have been posted the information on the hospital website. On the website, we are providing patients with the opportunity to opt out.

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Endo, H., Sekiguchi, K., Shimada, H. et al. Low signal intensity in motor cortex on susceptibility-weighted MR imaging is correlated with clinical signs of amyotrophic lateral sclerosis: a pilot study. J Neurol 265, 552–561 (2018). https://doi.org/10.1007/s00415-017-8728-0

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  • DOI: https://doi.org/10.1007/s00415-017-8728-0

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