Structural imaging differences and longitudinal changes in primary lateral sclerosis and amyotrophic lateral sclerosis
Structural imaging differences and longitudinal changes in primary lateral sclerosis and amyotrophic lateral sclerosis
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DOI：
10.1016/j.nicl.2012.12.003
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发表时间：
2013-01-01
影响因子：
4.2
通讯作者：
Floeter, Mary Kay
中科院分区：
文献类型：
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作者：
Kwan, Justin Y.;Meoded, Avner;Floeter, Mary Kay
磁共振成像测量已被提议作为研究运动神经元疾病中上运动神经元丢失的客观标志物。横断面研究已经确定了健康对照组与肌萎缩侧索硬化症（ALS）或原发性侧索硬化症（PLS）患者之间的影像学差异，这些差异与疾病严重程度相关，但尚不清楚影像学指标是否随疾病进展而变化。此外，在PLS和ALS中，成像测量是否以类似的方式随着疾病进展而变化尚不清楚。为了解决这些问题，临床和影像学评价首先进行了前瞻性横断面研究的23 ALS和22 PLS患者相似的运动障碍和19个年龄匹配的健康对照。临床评价包括神经系统检查、ALS功能评定量表修订版以及手指敲击、步态和定时言语测量。年龄和ALSFRS评分无差异，但PLS患者症状持续时间较长。检查的影像学指标包括皮质厚度、局部脑体积、皮质脊髓束和胼胝体的扩散张量成像。在横截面顶点分析中不同于对照的成像测量被用作纵向分析的感兴趣区域，这在9名ALS患者（间隔1.26 +/- 0.72年）和12名PLS患者（间隔2.08 +/- 0.93年）中进行。在横断面研究中，两组都有皮质变薄的区域，在PLS患者的运动区域更广泛。在随访中，ALS患者的临床指标下降幅度大于PLS患者。皮质变薄和中央前回的灰质体积损失在随访期间进展。ALS患者皮质脊髓束的各向异性分数保持稳定，但横截面积下降。临床指标的变化与中央前皮质厚度和灰质体积的变化相关。病程较短的ALS患者的皮质变薄率更高，表明厚度以非线性方式降低。因此，皮质厚度变化是个体患者疾病进展的潜在成像标记，但变化的幅度可能取决于疾病持续时间和进展速度。PLS和ALS患者在横断面研究中变薄程度的差异可能反映了更长的疾病持续时间。我们的结论是，有一个演变的结构成像变化与疾病的进展，运动神经元疾病。一些变化，如皮质脊髓束的扩散特性，发生在早期，而皮质变薄和体积损失发生在后期。(C)2012作者爱思唯尔公司出版
Magnetic resonance imaging measures have been proposed as objective markers to study upper motor neuron loss in motor neuron disorders. Cross-sectional studies have identified imaging differences between groups of healthy controls and patients with amyotrophic lateral sclerosis (ALS) or primary lateral sclerosis (PLS) that correlate with disease severity, but it is not known whether imaging measures change as disease progresses. Additionally, whether imaging measures change in a similar fashion with disease progression in PLS and ALS is unclear. To address these questions, clinical and imaging evaluations were first carried out in a prospective cross-sectional study of 23 ALS and 22 PLS patients with similar motor impairment and 19 age-matched healthy controls. Clinical evaluations consisted of a neurological examination, the ALS Functional rating scale-revised, and measures of finger tapping, gait, and timed speech. Age and ALSFRS score were not different, but PLS patients had longer duration of symptoms. Imaging measures examined were cortical thickness, regional brain volumes, and diffusion tensor imaging of the corticospinal tract and callosum. Imaging measures that differed from controls in a cross-sectional vertex-wise analysis were used as regions of interest for longitudinal analysis, which was carried out in 9 of the ALS patients (interval 1.26 +/- 0.72 years) and 12 PLS patients (interval 2.08 +/- 0.93 years). In the cross-sectional study both groups had areas of cortical thinning, which was more extensive in motor regions in PLS patients. At follow-up, clinical measures declined more in ALS than PLS patients. Cortical thinning and grey matter volume loss of the precentral gyri progressed over the follow-up interval. Fractional anisotropy of the corticospinal tracts remained stable, but the cross-sectional area declined in ALS patients. Changes in clinical measures correlated with changes in precentral cortical thickness and grey matter volume. The rate of cortical thinning was greater in ALS patients with shorter disease durations, suggesting that thickness decreases in a non-linear fashion. Thus, cortical thickness changes are a potential imaging marker for disease progression in individual patients, but the magnitude of change likely depends on disease duration and progression rate. Differences between PLS and ALS patients in the magnitude of thinning in cross-sectional studies are likely to reflect longer disease duration. We conclude that there is an evolution of structural imaging changes with disease progression in motor neuron disorders. Some changes, such as diffusion properties of the corticospinal tract, occur early while cortical thinning and volume loss occur later. (C) 2012 The Authors. Published by Elsevier Inc.