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Iron quantitative analysis of motor combined with bulbar region in M1 cortex may improve diagnosis performance in ALS

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Abstract

Objectives

To explore whether the combined analysis of motor and bulbar region of M1 on susceptibility-weighted imaging (SWI) can be a valid biomarker for amyotrophic lateral sclerosis (ALS).

Methods

Thirty-two non-demented ALS patients and 35 age- and gender-matched healthy controls (HC) were retrospectively recruited. SWI and 3D-T1-MPRAGE images were obtained from all individuals using a 3.0-T MRI scan. The bilateral posterior band of M1 was manually delineated by three neuroradiologists on phase images and subdivided into the motor and bulbar regions. We compared the phase values in two groups and performed a stratification analysis (ALSFRS-R score, duration, disease progression rate, and onset). Receiver operating characteristic (ROC) curves were also constructed.

Results

ALS group showed significantly increased phase values in M1 and the two subregions than the HC group, on the all and elderly level (p < 0.001, respectively). On all-age level comparison, negative correlations were found between phase values of M1 and clinical score and duration (p < 0.05, respectively). Similar associations were found in the motor region (p < 0.05, respectively). On both the total (p < 0.01) and elderly (p < 0.05) levels, there were positive relationships between disease progression rate and M1 phase values. In comparing ROC curves, the entire M1 showed the best diagnostic performance.

Conclusions

Combining motor and bulbar analyses as an integral M1 region on SWI can improve ALS diagnosis performance, especially in the elderly. The phase value could be a valuable biomarker for ALS evaluation.

Key Points

• Integrated analysis of the motor and bulbar as an entire M1 region on SWI can improve the diagnosis performance in ALS.

• Quantitative analysis of iron deposition by SWI measurement helps the clinical evaluation, especially for the elderly patients.

• Phase value, when combined with the disease progression rate, could be a valuable biomarker for ALS.

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Abbreviations

ALS:

Amyotrophic lateral sclerosis

ALSFRS-R:

Revised ALS functional rating scale

HC:

Healthy controls

ICC:

Interclass correlation coefficient

LMN:

Lower motor neurons

M1:

Primary motor cortex

MPRAGE:

Magnetization prepared rapid acquisition gradient echo

QSM:

Quantitative susceptibility mapping

SWI:

Susceptibility weighted imaging

UMN:

Upper motor neurons

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Acknowledgements

The authors sincerely thank all the ALS patients and the healthy volunteers included in this study.

Funding

This work was supported by the National Key R&D Program of China (2019YFC0120602), the National Natural Science Foundation of China (61672236), the Science and Technology Commission of Shanghai Municipality (19ZR1407900), and the Scientific Research project of Huashan Hospital, Fudan University (2016QD15).

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Author notes

  1. Yifang Bao, Yan Chen, Sirong Piao, Daoying Geng, and Yuxin Li contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Huashan Hospital, Fudan University, No. 12 Middle Wulumuqi Road, Jingan District, Shanghai, 200040, China

    Yifang Bao, Sirong Piao, Bin Hu, Liqin Yang, Haiqing Li, Daoying Geng & Yuxin Li

  2. Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, 200040, China

    Yifang Bao, Sirong Piao, Bin Hu, Liqin Yang, Haiqing Li, Daoying Geng & Yuxin Li

  3. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Yan Chen

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  1. Yifang Bao
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Bao, Y., Chen, Y., Piao, S. et al. Iron quantitative analysis of motor combined with bulbar region in M1 cortex may improve diagnosis performance in ALS. Eur Radiol 33, 1132–1142 (2023). https://doi.org/10.1007/s00330-022-09045-2

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