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MR spectroscopy and imaging-derived measurements in the supplementary motor area for biomarkers of amyotrophic lateral sclerosis

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Abstract

The diagnosis of amyotrophic lateral sclerosis (ALS) requires both upper and lower motor neuron signs. However, quite a few patients with ALS lack the upper motor neuron sign during the disease. This study sought to investigate whether metabolites, including glutamate (Glu), N-acetyl aspartate (NAA), and gamma aminobutyric acid (GABA), in the supplementary motor area (SMA) measured by magnetic resonance spectroscopy (MRS), could be a surrogate biomarker for ALS. Twenty-five patients with ALS and 12 controls underwent 3.0-T MR scanning, which measured Glu, NAA, and GABA. Finally, receiver operating characteristic (ROC) curves were created and the area under curve (AUC) was calculated to assess the diagnostic power. Logistic regression analysis revealed the usefulness of both Glu and NAA for the differentiation of ALS from controls (Glu, P = 0.009; NAA, P = 0.033). The ratio of Glu to NAA or GABA was significantly increased in patients with ALS (Glu/NAA, P = 0.027; Glu/GABA, P = 0.003). Both the AUCs were more than 0.7, with high specificity but low sensitivity. The present findings might indicate that both the Glu/NAA and the Glu/GABA ratios in the SMA could be potential biomarkers for the diagnosis of ALS.

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Acknowledgements

We would like to thank all the subjects for joining this study.

Funding

This study was supported by the Uehara Memorial Foundation, Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number 20K12670, and Grants-in Aid from the Research Committee of CNS Degenerative Diseases, Research on Policy Planning and Evaluation for Rare and Intractable Diseases, Health, Labour and Welfare Sciences Research Grants, the Ministry of Health, Labour and Welfare, Japan.

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Authors and Affiliations

  1. Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Wataru Sako, Yuishin Izumi, Shotaro Haji, Nagahisa Murakami, Yusuke Osaki & Ryuji Kaji

  2. Department of Radiology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

    Takashi Abe, Yuki Matsumoto & Masafumi Harada

Authors
  1. Wataru Sako
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  2. Yuishin Izumi
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Correspondence to Wataru Sako.

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Ethical approval and informed consent statement

All subjects provided written informed consent, following detailed explanation of the procedures, and the study was approved by the local ethics committee of Tokushima University Hospital. This study was performed according to the Declaration of Helsinki.

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Supplementary Information

Supplementary Figure 1.

Differences in FA and ReHo, and results of correlation analyses. There were no significant differences in FA and ReHo between groups (A). ALS, amyotrophic lateral sclerosis; Ctr, control; FA value was positively correlated with ReHo. FA, fractional anisotropy; ReHo, regional homogeneity. (PNG 90 kb)

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Sako, W., Izumi, Y., Abe, T. et al. MR spectroscopy and imaging-derived measurements in the supplementary motor area for biomarkers of amyotrophic lateral sclerosis. Neurol Sci 42, 4257–4263 (2021). https://doi.org/10.1007/s10072-021-05107-3

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  • DOI: https://doi.org/10.1007/s10072-021-05107-3

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