HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Graham, J. M. Articles by Griffiths, P. D. Search for Related Content PubMed PubMed Citation Articles by Graham, J. M. Articles by Griffiths, P. D. Related Collections All Imaging MRI Spastic paraplegia Amyotrophic lateral sclerosis

Diffusion tensor imaging for the assessment of upper motor neuron integrity in ALS

From the Academic Unit of Radiology (Drs. Graham, Paley, Wallis, Wilkinson, and Griffiths), Academic Neurology Unit (Drs. Graham and Shaw, and J. Evans), and Department of Psychology (Dr. Papadakis), University of Sheffield; and Department of Radiology (Drs. Widjaja and Romanowski), Royal Hallamshire Hospital, Sheffield, UK.

Address correspondence and reprint requests to Professor Paul D. Griffiths, Academic Unit of Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, South Yorkshire, S10 2JF, UK; e-mail: p.griffiths{at}sheffield.ac.uk

Background: High angular resolution diffusion tensor imaging (HARD) is an MRI technique that exploits the mobility of water molecules to yield maps of structural order and directionality of white matter tracts with greater precision than six-direction diffusion tensor imaging (DTI) schemes.

Objective: To assess whether HARD is more sensitive than conventional MRI or neurologic assessment in detecting the upper motor neuron (UMN) pathology of patients with ALS.

Methods: Twenty-five patients with definite UMN clinical signs and 23 healthy volunteers underwent conventional MRI. HARD datasets were collected from a subset of these participants plus four patients with isolated lower motor neuron (LMN) signs. ALS symptom severity was assessed by a neurologist, the conventional MR images were reviewed by neuroradiologists, and the DTI maps were subject to quantitative region of interest analysis.

Results: Motor cortex hypointensity on T2-weighted images and corona radiata hyperintensity on proton density-weighted images distinguished patients with UMN involvement from volunteers with 100% specificity, but only 20% sensitivity. Fractional anisotropy (FA) was reduced in the posterior limb of the internal capsule in patients with UMN involvement compared to volunteers. A FA threshold value with a sensitivity of 95% to detect patients with ALS (including those with isolated LMN signs) had a specificity of 71%.

Conclusions: High angular resolution diffusion tensor imaging may be more sensitive than conventional MRI or neurologic assessment to the upper motor neuron (UMN) pathology of ALS, but it lacks the specificity required of a diagnostic marker. Instead, it is potentially useful as a quantitative tool for monitoring the progression of UMN pathology.

Received March 4, 2004. Accepted in final form August 12, 2004.

This article has been cited by other articles:

				P. G. P. Nucifora, R. Verma, S.-K. Lee, and E. R. Melhem Diffusion-Tensor MR Imaging and Tractography: Exploring Brain Microstructure and Connectivity Radiology, November 1, 2007; 245(2): 367 - 384. [Abstract] [Full Text] [PDF]

				O.A. Glenn, N.A. Ludeman, J.I. Berman, Y.W. Wu, Y. Lu, A.I. Bartha, D.B. Vigneron, S.W. Chung, D.M. Ferriero, A.J. Barkovich, et al. Diffusion Tensor MR Imaging Tractography of the Pyramidal Tracts Correlates with Clinical Motor Function in Children with Congenital Hemiparesis AJNR Am. J. Neuroradiol., October 1, 2007; 28(9): 1796 - 1802. [Abstract] [Full Text] [PDF]

				L. Thivard, P.-F. Pradat, S. Lehericy, L. Lacomblez, D. Dormont, J. Chiras, H. Benali, and V. Meininger Diffusion tensor imaging and voxel based morphometry study in amyotrophic lateral sclerosis: relationships with motor disability J. Neurol. Neurosurg. Psychiatry, August 1, 2007; 78(8): 889 - 892. [Abstract] [Full Text] [PDF]

				P Valsasina, F Agosta, B Benedetti, D Caputo, M Perini, F Salvi, A Prelle, and M Filippi Diffusion anisotropy of the cervical cord is strictly associated with disability in amyotrophic lateral sclerosis J. Neurol. Neurosurg. Psychiatry, May 1, 2007; 78(5): 480 - 484. [Abstract] [Full Text] [PDF]

				H. Mitsumoto, A. M. Ulug, S. L. Pullman, C. L. Gooch, S. Chan, M. -X. Tang, X. Mao, A. P. Hays, A. G. Floyd, V. Battista, et al. Quantitative objective markers for upper and lower motor neuron dysfunction in ALS Neurology, April 24, 2007; 68(17): 1402 - 1410. [Abstract] [Full Text] [PDF]

				S.K. Schimrigk, B. Bellenberg, M. Schluter, B. Stieltjes, R. Drescher, J. Rexilius, C. Lukas, H.K. Hahn, H. Przuntek, and O. Koster Diffusion Tensor Imaging-Based Fractional Anisotropy Quantification in the Corticospinal Tract of Patients with Amyotrophic Lateral Sclerosis Using a Probabilistic Mixture Model AJNR Am. J. Neuroradiol., April 1, 2007; 28(4): 724 - 730. [Abstract] [Full Text] [PDF]

				S. Ngai, Y.M. Tang, L. Du, and S. Stuckey Hyperintensity of the Precentral Gyral Subcortical White Matter and Hypointensity of the Precentral Gyrus on Fluid-Attenuated Inversion Recovery: Variation with Age and Implications for the Diagnosis of Amyotrophic Lateral Sclerosis AJNR Am. J. Neuroradiol., February 1, 2007; 28(2): 250 - 254. [Abstract] [Full Text] [PDF]

				J.A. Butman and M.K. Floeter Decreased Thickness of Primary Motor Cortex in Primary Lateral Sclerosis AJNR Am. J. Neuroradiol., January 1, 2007; 28(1): 87 - 91. [Abstract] [Full Text] [PDF]

				A. J. da Rocha, A. C. M. Maia Jr, R. B. Fonseca, M. Cosottini, M. Giannelli, and M. C. Michelassi MR Imaging of Upper Motor Neuron Compromise in Amyotrophic Lateral Sclerosis Radiology, October 1, 2006; 241(1): 321 - 324. [Full Text] [PDF]

				Y. Assaf, L. Ben-Sira, S. Constantini, L.C. Chang, and L. Beni-Adani Diffusion tensor imaging in hydrocephalus: initial experience. AJNR Am. J. Neuroradiol., September 1, 2006; 27(8): 1717 - 1724. [Abstract] [Full Text] [PDF]

				K. Yamada, H. Matsuzawa, M. Uchiyama, I. L. Kwee, and T. Nakada Brain Developmental Abnormalities in Prader-Willi Syndrome Detected by Diffusion Tensor Imaging Pediatrics, August 1, 2006; 118(2): e442 - e448. [Abstract] [Full Text] [PDF]

				O. Ciccarelli, T. E. Behrens, D. R. Altmann, R. W. Orrell, R. S. Howard, H. Johansen-Berg, D. H. Miller, P. M. Matthews, and A. J. Thompson Probabilistic diffusion tractography: a potential tool to assess the rate of disease progression in amyotrophic lateral sclerosis Brain, July 1, 2006; 129(7): 1859 - 1871. [Abstract] [Full Text] [PDF]

				S. Wang, H. Poptani, J. H. Woo, L. M. Desiderio, L. B. Elman, L. F. McCluskey, J. Krejza, and E. R. Melhem Amyotrophic Lateral Sclerosis: Diffusion-Tensor and Chemical Shift MR Imaging at 3.0 T Radiology, June 1, 2006; 239(3): 831 - 838. [Abstract] [Full Text] [PDF]