Diffusion tensor imaging and quantitative susceptibility mapping as diagnostic tools for motor neuron disorders

• Published in: Clinical imaging Vol. 53; pp. 6 - 11
• Main Authors: Weidman, Elizabeth K., Schweitzer, Andrew D., Niogi, Sumit N., Brady, Emily J., Starikov, Anna, Askin, Gulce, Shahbazi, Mona, Wang, Yi, Lange, Dale, Tsiouris, Apostolos John
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2019; Elsevier Limited
• Subjects: Aged; Amyotrophic lateral sclerosis; Amyotrophic Lateral Sclerosis - diagnosis; Amyotrophic Lateral Sclerosis - pathology; Anisotropy; Cortex (motor); Diagnosis; Diagnostic software; Diagnostic systems; Diffusion Tensor Imaging; Diseases; Disorders; Female; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetic susceptibility; Male; Mapping; Mathematical analysis; Medical imaging; Middle Aged; Motor Cortex - pathology; Motor neuron disease; Motor Neuron Disease - diagnosis; Motor Neuron Disease - pathology; Motor neuron diseases; Motor neurone disease; Motor Neurons - pathology; Motors; Neuroimaging; Neurology; Neurons; Patients; Pyramidal tracts; Pyramidal Tracts - pathology; Quantitative susceptibility mapping; Retrospective Studies; ROC Curve; Studies; Tensors; Amyotrophic lateral sclerosis; Quantitative susceptibility mapping; Motor neuron disease; Diffusion tensor imaging
• ISSN: 0899-7071; 1873-4499; 1873-4499
• DOI: 10.1016/j.clinimag.2018.09.015

Diffusion tensor imaging (DTI) and quantitative susceptibility mapping (QSM) have been proposed as methods to aid in the diagnosis of amyotrophic lateral sclerosis (ALS) and primary lateral sclerosis (PLS), both diseases affecting upper motor neurons. We test the performance of DTI and QSM alone and in combination to distinguish patients with diseases affecting upper motor neurons (ALS/PLS) from patients with other motor symptom-predominant neurologic disorders. 3.0 Tesla MRI with DTI and QSM in patients referred to a subspecialty neurology clinic for evaluation of motor symptom-predominant neurologic disorders were retrospectively reviewed. Corticospinal tract fractional anisotropy and maximum motor cortex susceptibility were measured. Subjects were categorized by diagnosis and imaging metrics were compared between groups using Student's t-tests. Receiver operating characteristic curves were generated for imaging metrics alone and in combination. MRI scans for 43 patients with ALS or PLS and 15 patients with motor symptom predominant, non-upper motor neuron disease (mimics) were reviewed. Fractional anisotropy was lower (0.57 vs. 0.60, p < 0.01) and maximum motor cortex magnetic susceptibility higher (64.4 vs. 52.7, p = 0.01) in patients with ALS/PLS compared to mimics. There was no significant difference in area under the curve for these metrics alone (0.73, 0.63; p > 0.05) or in combination (0.75; p > 0.05). We found significant differences in DTI and QSM metrics in patients with diseases affecting upper motor neurons (ALS/PLS) compared to mimics, but no significant difference in the performance of these metrics in diagnosing ALS/PLS compared to mimics. •QSM maximum motor cortex susceptibility is higher in ALS/PLS compared to mimics.•DTI fractional anisotropy is lower in patients with ALS/PLS compared to mimics.•No significant difference in the performance of DTI vs QSM in diagnosing ALS/PLS