Deterministic-tractography-based approach for diagnosis and disease monitoring of amyotrophic lateral sclerosis

• Published in: Clinical neurology and neurosurgery 2019-06, Vol.181, p.73-75
• Main Authors: Sako, Wataru, Abe, Takashi, Izumi, Yuishin, Harada, Masafumi, Kaji, Ryuji
• Format: Article
• Language: English
• Subjects: Amyotrophic lateral sclerosis; Biomarkers; Corticospinal tract; Diagnosis; Diffusion tensor imaging; Laboratories; Magnetic resonance imaging; Methods; Neurology; Neurons; Pyramidal tracts; Software; Studies; Tractography; Trends; Upper motor neuron signs
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2019.04.015

•We investigated the potential of deterministic tractography for a surrogate biomarker.•The number of corticospinal tract was reduced in ALS relative to controls.•The sensitivity and specificity were 0.67 and 0.9, respectively.•The track number correlated with disease severity. Upper and lower motor neuron signs are required for the diagnosis of amyotrophic lateral sclerosis. The detection of upper motor neuron signs is key for the diagnosis, as quite a few patients with amyotrophic lateral sclerosis lack upper motor neuron signs during the course of disease. This study sought to investigate whether deterministic tractography of the corticospinal tract, reflecting upper motor neuron signs, could be a surrogate biomarker for amyotrophic lateral sclerosis. Fifteen patients with amyotrophic lateral sclerosis and ten controls underwent imaging on a 3.0 T MRI. The corticospinal tract was reconstructed using deterministic tractography, and the track number was calculated. We analyzed the differences between the groups and the relationship between the track number and disease severity, disease duration, progression rate or upper motor neuron signs. A reduction in the track number of the corticospinal tract was found in amyotrophic lateral sclerosis compared with controls (Student’s t test, P =  0.008). The sensitivity and specificity were 0.67 and 0.9, respectively. The track number correlated with disease severity alone (r = 0.71, P =  0.003), and significantly associated with upper motor neuron signs (P =  0.004). These findings suggest that the deterministic-tractography-based approach is a potential biomarker for the diagnosis and disease monitoring of amyotrophic lateral sclerosis.