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Beyond fractional anisotropy in amyotrophic lateral sclerosis: the value of mean, axial, and radial diffusivity and its correlation with electrophysiological conductivity changes

  • Functional Neuroradiology
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Abstract

Purpose

This paper aims to analyze the contribution of mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in the detection of microstructural abnormalities in amyotrophic lateral sclerosis (ALS) and to evaluate the degree of agreement between structural and functional changes through concomitant diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), and clinical assessment.

Methods

Fourteen patients with ALS and 11 healthy, age- and gender-matched controls were included. All participants underwent magnetic resonance imaging including DTI. TMS was additionally performed in ALS patients. Differences in the distribution of DTI-derived measures were assessed using tract-based spatial statistical (TBSS) and volume of interest (VOI) analyses. Correlations between clinical, imaging, and neurophysiological findings were also assessed through TBSS.

Results

ALS patients showed a significant increase in AD and MD involving the corticospinal tract (CST) and the pre-frontal white matter in the right posterior limb of the internal capsule (p < 0.05) when compared to the control group using TBSS, confirmed by VOI analyses. VOI analyses also showed increased AD in the corpus callosum (p < 0.05) in ALS patients. Fractional anisotropy (FA) in the right CST correlated significantly with upper motor neuron (UMN) score (r = − 0.79, p < 0.05), and right abductor digiti minimi central motor conduction time was highly correlated with RD in the left posterior internal capsule (r = − 0.81, p < 0.05). No other significant correlation was found.

Conclusion

MD, AD, and RD, besides FA, are able to further detect and characterize neurodegeneration in ALS. Furthermore, TMS and DTI appear to have a role as complementary diagnostic biomarkers of UMN dysfunction.

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Abbreviations

AD:

Axial diffusivity

ADM:

Abductor digiti minimi

AH:

Abductor hallucis

ALS:

Amyotrophic lateral sclerosis

ALSFRS-R:

Amyotrophic lateral sclerosis functional rate scale revisited

CMAP:

Compound motor action potentials

CCMCT:

Central motor conduction time

CSP:

Cortical silent period

CST:

Corticospinal tract

DTI:

Diffusion tensor imaging

FA:

Fractional anisotropy

LMN:

Lower motor neuron

MD:

Mean diffusivity

MEP:

Motor evoked potential

MRI:

Magnetic resonance imaging

MT:

Motor threshold

RD:

Radial diffusivity

TBSS:

Tract-based spatial statistical

TMS:

Transcranial magnetic stimulation

UMN:

Upper motor neuron

VOI:

Volume of interest

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Authors and Affiliations

  1. Department of Neuroradiology, CHLN-Hospital de Santa Maria, Lisbon, Portugal

    Ana Filipa Geraldo, Pedro Nunes, Sofia Reimão, Rita Sousa & Jorge Guedes Campos

  2. Department of Radiology, Neuroradiology Unit, CHVNG/E-Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal

    Ana Filipa Geraldo

  3. Institute for Nuclear Sciences Applied to Health (ICNAS), and Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    João Pereira & Miguel Castelo-Branco

  4. Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Sofia Reimão, Rita Sousa & Jorge Guedes Campos

  5. Institute of Physiology, Institute of Molecular Medicine (IMM), Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Susana Pinto & Mamede de Carvalho

  6. Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Lisbon, Portugal

    Mamede de Carvalho

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  1. Ana Filipa Geraldo
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Correspondence to Ana Filipa Geraldo.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Geraldo, A.F., Pereira, J., Nunes, P. et al. Beyond fractional anisotropy in amyotrophic lateral sclerosis: the value of mean, axial, and radial diffusivity and its correlation with electrophysiological conductivity changes. Neuroradiology 60, 505–515 (2018). https://doi.org/10.1007/s00234-018-2012-6

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  • DOI: https://doi.org/10.1007/s00234-018-2012-6

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