Background: Ongoing efforts have been made to identify new neuroimaging markers to track amyotrophic lateral sclerosis (ALS) progression. This study aimed to explore the monitoring value of multimodal magnetic resonance imaging (MRI) in the disease progression of ALS.
Methods: From September 2015 to March 2017, ten patients diagnosed with ALS in Peking Union Medical College Hospital completed head MRI scans at baseline and during follow-up. Multimodal MRI analyses, including gray matter (GM) volume measured by voxel-based morphometry; cerebral blood flow (CBF) evaluated by arterial spin labeling; functional connectivity, including low-frequency fluctuation (fALFF) and regional homogeneity (ReHo), measured by resting-state functional MRI; and integrity of white-matter (WM) fiber tracts evaluated by diffusion tensor imaging, were performed in these patients. Comparisons of imaging metrics were made between baseline and follow-up using paired t-test.
Results: In the longitudinal comparisons, the brain structure (GM volume of the right precentral gyri, left postcentral gyri, and right thalami) and perfusion (CBF of the bilateral temporal poles, left precentral gyri, postcentral gyri, and right middle temporal gyri) in both motor and extramotor areas at follow-up were impaired to different extents when compared with those at baseline (all P < 0.05, false discovery rate adjusted). Functional connectivity was increased in the motor areas (fALFF of the right precentral gyri and superior frontal gyri, and ReHo of right precentral gyri) and decreased in the extramotor areas (fALFF of the bilateral middle frontal gyri and ReHo of the right precuneus and cingulate gyri) (all P < 0.001, unadjusted). No significant changes were detected in terms of brain WM measures.
Conclusion: Multimodal MRI could be used to monitor short-term brain changes in ALS patients.
多模态磁共振成像对肌萎缩侧索硬化病情进展的监测价值:一项前瞻性观察研究 摘要 背景: 探索多模态磁共振成像对肌萎缩侧索硬化（ALS）病情进展的监测价值。 方法: 2015年9 月至2017 年3 月，于北京协和医院神经科诊断的10例ALS患者完成了基线及随访的磁共振扫描，多模态分析技术包括基于体素的形态学分析测量灰质体积、动脉自旋标记评价脑血流量、静息态功能磁共振成像测定功能连接性(包括分数低频振幅与局部一致性）及弥散张量成像评价脑白质纤维束完整性。应用配对t检验对随访与基线的影像学数据进行对比。 结果: 在纵向比较中，ALS患者6月后的运动区与运动外区域的脑结构（右侧中央前回、左侧中央后回与右侧丘脑的灰质体积）及血流灌注（双侧颞极、左侧中央前回、中央后回与右侧颞中回的脑血流量）均较基线时有不同程度的进一步损害（所有均P＜0.05，经错误发现率校正）。运动区（右侧中央前回与额上回的分数低频振幅，右侧中央前回的局部一致性）的功能连接性较基线显著增加，运动区外（双侧额中回的分数低频振幅，右侧楔前叶与扣带回的局部一致性）的功能连接性较基线显著降低（所有均P＜0.001，未校正）。患者随访时全脑的白质相关指标较基线无显著改变。 结论: 多模态磁共振技术可用于监测短期内ALS患者的脑内变化。.
Keywords: Amyotrophic Lateral Sclerosis; Disease Progression; Monitoring Value; Multimodal Magnetic Resonance Imaging.