Amyotrophic lateral sclerosis MRI: Difference between revisions
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==Overview== | ==Overview== | ||
[[Magnetic resonance imaging|Magnetic resonance imaging (MRI)]] studies of the [[brain]] and [[spinal cord]] are the most useful neuroimaging technique in ALS mainly to exclude syndromes that mimic ALS. New chromosome 9p-linked [[frontotemporal dementia]] (FTD)-ALS shows a distinct pattern of brain [[atrophy]] and [[neuropathological]] findings that can help differentiate from classical ALS. | [[Magnetic resonance imaging|Magnetic resonance imaging (MRI)]] studies of the [[brain]] and [[spinal cord]] are the most useful neuroimaging technique in ALS mainly to exclude syndromes that mimic ALS. New chromosome 9p-linked [[frontotemporal dementia]] (FTD)-ALS shows a distinct pattern of brain [[atrophy]] and [[neuropathological]] findings that can help differentiate from classical ALS. Other findings on MRI suggestive of [disease name] include: hyperintensity in the [[Corticospinal tract|corticospinal tracts]] (specificity <70% and sensitivity <40%) in '''T2,''' hypointensity in the precentral [[gyrus]] bilaterally, known as the "motor band sign" in '''GRE/SWI,''' decreased NAA, decreased [[glutamate]], increased [[choline]] and increased [[myo-inositol]] in '''MR spectroscopy'''. | ||
==MRI== | ==MRI== | ||
* [[Magnetic resonance imaging|Magnetic resonance imaging (MRI)]] studies of the [[brain]] and [[spinal cord]] are the most useful neuroimaging technique in ALS mainly to exclude syndromes that mimic ALS.<ref name="pmid26629397">{{cite journal| author=Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF et al.| title=A comprehensive review of amyotrophic lateral sclerosis. | journal=Surg Neurol Int | year= 2015 | volume= 6 | issue= | pages= 171 | pmid=26629397 | doi=10.4103/2152-7806.169561 | pmc=4653353 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629397 }} </ref><ref name="pmid21989247">{{cite journal| author=Hardiman O, van den Berg LH, Kiernan MC| title=Clinical diagnosis and management of amyotrophic lateral sclerosis. | journal=Nat Rev Neurol | year= 2011 | volume= 7 | issue= 11 | pages= 639-49 | pmid=21989247 | doi=10.1038/nrneurol.2011.153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21989247 }} </ref> | * [[Magnetic resonance imaging|Magnetic resonance imaging (MRI)]] studies of the [[brain]] and [[spinal cord]] are the most useful neuroimaging technique in ALS mainly to exclude syndromes that mimic ALS.<ref name="pmid26629397">{{cite journal| author=Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF et al.| title=A comprehensive review of amyotrophic lateral sclerosis. | journal=Surg Neurol Int | year= 2015 | volume= 6 | issue= | pages= 171 | pmid=26629397 | doi=10.4103/2152-7806.169561 | pmc=4653353 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629397 }} </ref><ref name="pmid21989247">{{cite journal| author=Hardiman O, van den Berg LH, Kiernan MC| title=Clinical diagnosis and management of amyotrophic lateral sclerosis. | journal=Nat Rev Neurol | year= 2011 | volume= 7 | issue= 11 | pages= 639-49 | pmid=21989247 | doi=10.1038/nrneurol.2011.153 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21989247 }} </ref> | ||
*New chromosome 9p-linked [[frontotemporal dementia]] (FTD)-ALS shows a distinct pattern of brain [[atrophy]] and [[neuropathological]] findings that can help differentiate from classical ALS.<ref name="pmid26629397">{{cite journal| author=Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF et al.| title=A comprehensive review of amyotrophic lateral sclerosis. | journal=Surg Neurol Int | year= 2015 | volume= 6 | issue= | pages= 171 | pmid=26629397 | doi=10.4103/2152-7806.169561 | pmc=4653353 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629397 }} </ref><ref name="pmid20562461">{{cite journal| author=Boxer AL, Mackenzie IR, Boeve BF, Baker M, Seeley WW, Crook R et al.| title=Clinical, neuroimaging and neuropathological features of a new chromosome 9p-linked FTD-ALS family. | journal=J Neurol Neurosurg Psychiatry | year= 2011 | volume= 82 | issue= 2 | pages= 196-203 | pmid=20562461 | doi=10.1136/jnnp.2009.204081 | pmc=3017222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20562461 }} </ref> | *New chromosome 9p-linked [[frontotemporal dementia]] (FTD)-ALS shows a distinct pattern of brain [[atrophy]] and [[neuropathological]] findings that can help differentiate from classical ALS.<ref name="pmid26629397">{{cite journal| author=Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF et al.| title=A comprehensive review of amyotrophic lateral sclerosis. | journal=Surg Neurol Int | year= 2015 | volume= 6 | issue= | pages= 171 | pmid=26629397 | doi=10.4103/2152-7806.169561 | pmc=4653353 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26629397 }} </ref><ref name="pmid20562461">{{cite journal| author=Boxer AL, Mackenzie IR, Boeve BF, Baker M, Seeley WW, Crook R et al.| title=Clinical, neuroimaging and neuropathological features of a new chromosome 9p-linked FTD-ALS family. | journal=J Neurol Neurosurg Psychiatry | year= 2011 | volume= 82 | issue= 2 | pages= 196-203 | pmid=20562461 | doi=10.1136/jnnp.2009.204081 | pmc=3017222 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20562461 }} </ref> | ||
* IN patients with ALS, the earliest MR manifestation is hyperintensity on T2-weighted imaging in the corticospinal tracts, seen earliest in the internal capsule, as the fibres are most concentrated here. Eventually, the entire tract from motor strip to the spinal cord is affected by increased T2 signal and volume loss . | |||
* Iron deposition in the [[cortex]], most notably in the precentral [[gyrus]], is demonstrated as loss of signal on GRE and SWI , but may also be seen on T2-weighted imaging in ~50%. | |||
* It is important to note that both of these features are present in varying degrees in normal control patients, and as such an appreciation of what is too much is essential if MRI is to be of benefit. | |||
* Other findings on MRI suggestive of [disease name] include: | |||
** '''T2:''' hyperintensity in the [[Corticospinal tract|corticospinal tracts]] (specificity <70% and sensitivity <40%) | |||
** '''GRE/SWI:''' hypointensity in the precentral [[gyrus]] bilaterally, known as the "motor band sign" | |||
** '''MR spectroscopy''' | |||
*** decreased NAA | |||
*** decreased [[glutamate]] | |||
*** increased [[choline]] | |||
*** increased [[myo-inositol]] | |||
==References== | ==References== | ||
Latest revision as of 16:21, 4 October 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
Magnetic resonance imaging (MRI) studies of the brain and spinal cord are the most useful neuroimaging technique in ALS mainly to exclude syndromes that mimic ALS. New chromosome 9p-linked frontotemporal dementia (FTD)-ALS shows a distinct pattern of brain atrophy and neuropathological findings that can help differentiate from classical ALS. Other findings on MRI suggestive of [disease name] include: hyperintensity in the corticospinal tracts (specificity <70% and sensitivity <40%) in T2, hypointensity in the precentral gyrus bilaterally, known as the "motor band sign" in GRE/SWI, decreased NAA, decreased glutamate, increased choline and increased myo-inositol in MR spectroscopy.
MRI
- Magnetic resonance imaging (MRI) studies of the brain and spinal cord are the most useful neuroimaging technique in ALS mainly to exclude syndromes that mimic ALS.[1][2]
- New chromosome 9p-linked frontotemporal dementia (FTD)-ALS shows a distinct pattern of brain atrophy and neuropathological findings that can help differentiate from classical ALS.[1][3]
- IN patients with ALS, the earliest MR manifestation is hyperintensity on T2-weighted imaging in the corticospinal tracts, seen earliest in the internal capsule, as the fibres are most concentrated here. Eventually, the entire tract from motor strip to the spinal cord is affected by increased T2 signal and volume loss .
- Iron deposition in the cortex, most notably in the precentral gyrus, is demonstrated as loss of signal on GRE and SWI , but may also be seen on T2-weighted imaging in ~50%.
- It is important to note that both of these features are present in varying degrees in normal control patients, and as such an appreciation of what is too much is essential if MRI is to be of benefit.
- Other findings on MRI suggestive of [disease name] include:
- T2: hyperintensity in the corticospinal tracts (specificity <70% and sensitivity <40%)
- GRE/SWI: hypointensity in the precentral gyrus bilaterally, known as the "motor band sign"
- MR spectroscopy
- decreased NAA
- decreased glutamate
- increased choline
- increased myo-inositol
References
- ↑ 1.0 1.1 Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF; et al. (2015). "A comprehensive review of amyotrophic lateral sclerosis". Surg Neurol Int. 6: 171. doi:10.4103/2152-7806.169561. PMC 4653353. PMID 26629397.
- ↑ Hardiman O, van den Berg LH, Kiernan MC (2011). "Clinical diagnosis and management of amyotrophic lateral sclerosis". Nat Rev Neurol. 7 (11): 639–49. doi:10.1038/nrneurol.2011.153. PMID 21989247.
- ↑ Boxer AL, Mackenzie IR, Boeve BF, Baker M, Seeley WW, Crook R; et al. (2011). "Clinical, neuroimaging and neuropathological features of a new chromosome 9p-linked FTD-ALS family". J Neurol Neurosurg Psychiatry. 82 (2): 196–203. doi:10.1136/jnnp.2009.204081. PMC 3017222. PMID 20562461.