Evaluation of corticospinal tracts in ALS with diffusion tensor MRI and brainstem stimulation
Evaluation of corticospinal tracts in ALS with diffusion tensor MRI and brainstem stimulation
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DOI：
10.1212/01.wnl.0000299186.72374.19
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发表时间：
2008-02-12
期刊：
影响因子：
9.9
通讯作者：
Ugawa, Y.
中科院分区：
文献类型：
--
作者：
Iwata, N. K.;Aoki, S.;Ugawa, Y.
目的：目的：探讨肌萎缩侧索硬化（ALS）患者皮质脊髓束受累的磁共振扩散张量成像（DTI）与颅内外中枢运动传导时间（CMCT）及临床特征的相关性。方法：对31例ALS患者和31例正常志愿者进行DTI检查，测量皮质脊髓束及运动外白色物质的各向异性分数（FA）。我们测量了第一骨间背侧肌的CMCT，并通过枕大孔水平的磁脑干刺激将其分割为皮质脑干（CTX-BS CT）和脑干-颈根（BS-CV CT）传导时间。每个病人的临床状态进行了评估与ALS功能评定量表修订版（ALSFRS-R）和上运动神经元（UMN）的评分设计本study.Results：我们发现一个显着减少的平均FA在所有地区的皮质脊髓束的ALS患者与对照组相比。我们发现，FA沿着皮质脊髓束下降显着较高的UMN评分。FA和ALSFRS-R之间没有显著相关性，上下运动神经元参与都有贡献。FA与颅内部分中枢运动传导（CTX-BS CT）呈显著相关，而与颅外传导时间无相关性。结论：各向异性分数反映了颅内皮质脊髓束的功能异常，可用于客观评价肌萎缩侧索硬化患者上运动神经元的损害。
Objective: To assess corticospinal tract involvement in patients with amyotrophic lateral sclerosis (ALS) by correlating diffusion tensor imaging (DTI) measures with intra- and extracranial central motor conduction time (CMCT) and clinical features of the patients.Methods: We investigated 31 patients with ALS and 31 normal volunteers by DTI and measured fractional anisotropy (FA) within the corticospinal tracts and in the extramotor white matter. We measured CMCT for the first dorsal interosseous muscle and segmented it into corticalbrainstem (CTX-BS CT) and brainstem-cervical root (BS-CV CT) conduction times by magnetic brainstem stimulation at the foramen magnum level. Clinical status of each patient was evaluated with the ALS Functional Rating Scale-Revised (ALSFRS-R) and upper motor neuron (UMN) score devised for this study.Results: We found a significant decrease of mean FA in all regions of the corticospinal tracts in patients with ALS as compared with controls. We found that FA along the corticospinal tract decreased significantly with higher UMN scores. There was no significant correlation between FA and ALSFRS-R, to which both upper and lower motoneuron involvements contribute. FA showed a significant correlation with the intracranial part of the central motor conduction (CTX-BS CT) but not with the extracranial conduction time.Conclusions: Fractional anisotropy reflects functional abnormality of intracranial corticospinal tracts and can be used for objective evaluation of upper motor neuron impairment in amyotrophic lateral sclerosis.