Diagnostic and Prognostic Value of Conventional Brain MRI in the Clinical Work-Up of Patients with Amyotrophic Lateral Sclerosis

• Published in: Journal of clinical medicine Vol. 9; no. 8; p. 2538
• Main Authors: Rizzo, Giovanni, Marliani, Anna, Battaglia, Stella, Albini Riccioli, Luca, De Pasqua, Silvia, Vacchiano, Veria, Infante, Rossella, Avoni, Patrizia, Donadio, Vincenzo, Passaretti, Massimiliano, Bartolomei, Ilaria, Salvi, Fabrizio, Liguori, Rocco
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 06.08.2020; MDPI
• Subjects: Amyotrophic lateral sclerosis; Clinical medicine; Genotype & phenotype; Magnetic resonance imaging; Medical prognosis; Mutation; Nutrition; Ostomy; Parenteral nutrition; Patients; Restless legs syndrome; Ventilation; United States > US; Italy
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9082538

Clinical signs of upper motor neuron (UMN) involvement are important in the diagnosis of amyotrophic lateral sclerosis (ALS) though are often difficult to analyze. Many studies using both qualitative and quantitative evaluations have reported abnormal Magnetic Resonance Imaging (MRI) findings at the level of the pyramidal pathway in patients with ALS. Although the most interesting results were obtained by quantitative studies using advanced MR techniques, the qualitative evaluation of MRI images remains the most-used in clinical practice. We evaluated the diagnostic and prognostic contribution of conventional 3T-MRI in the clinical work-up of ALS patients. Two neuroradiologists retrospectively assessed 3T-MRI data of 93 ALS patients and 89 controls. The features of interest were corticospinal tract (CST) T2/FLAIR hyperintensity, motor cortex (MC) T2*/SWI hypointensity, and selective MC atrophy. All MRI features were significantly more prevalent in ALS patients than in controls. The simultaneous presence of CST FLAIR hyperintensity and MC SWI hypointensity was associated with the highest diagnostic accuracy (sensitivity: 70%; specificity: 81%; positive predictive value, PPV: 90%; negative predictive value, NPV: 51%; accuracy: 73%) and a shorter survival (HR: 6.56, p = 0.002). Conventional 3T-MRI can be a feasible tool to detect specific qualitative changes based on UMN involvement and to support clinical diagnosis of ALS. Importantly, CST FLAIR hyperintensity and MC SWI hypointensity are predictors of shorter survival in ALS patients.