Combined 3T Diffusion Tensor Tractography and 1H-MR Spectroscopy in Motor Neuron Disease

BACKGROUND AND PURPOSE: Diagnostic confidence in motor neuron disease may be improved by the use of advanced MR imaging techniques. Our aim was to assess the accuracy (sensitivity/specificity) and agreement of combined 1H-MR spectroscopy (proton MR spectroscopy) and diffusion tensor imaging (DTI) at 3T in patients with suspected motor neuron disease regarding detection of upper motor neuron (UMN) dysfunction. MATERIALS AND METHODS: Eighteen patients with suspected motor neuron disease were studied with MR spectroscopy/DTI and clinically rated according to the El-Escorial and ALSFRS-R scales. For MR spectroscopy, absolute N-acetylaspartate (NAA), choline (Cho), and phosphocreatine (PCr) concentrations and relative NAA/Cho and NAA/PCr ratios of corresponding volumes of interest within the primary motor cortex were calculated. For DTI, fractional anisotropy (FA) and mean diffusivity (MD) were measured bilaterally at the level of the precentral gyrus, corona radiata, internal capsule, cerebral peduncles, pons, and pyramid. FA and MD statistics were averaged on the corticospinal tracts (CSTs) as a whole to account for a region-independent analysis. RESULTS: MR spectroscopy indicated NAA reduction beyond the double SD of controls in 6 of 8 patients with clinical evidence for UMN involvement. Congruently, the mean FA of these patients was significantly lower in the upper 3 regions of measurements (P < .01). Overall, MR spectroscopy and DTI were concordant in all except 3 cases: 1 was correctly excluded from motor neuron disease by DTI (genetically proved Kennedy syndrome), whereas MR spectroscopy indicated CST involvement. MR spectroscopy and DTI each were false-positive for CST affection in 1 patient with lower motor neuron involvement only. CONCLUSION: Combined MR spectroscopy/DTI at 3T effectively adds to the detection of motor neuron disease with a high degree of accordance.

• Publication year

  2008

• Venue

  American Journal of Neuroradiology

• Publication date

  2008-10-01

• Fields of study

  Medicine

• Identifiers
  DOI 10.3174/ajnr.A1201PMID 18701582PMCID PMC8118765
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• Combined 1H-MR spectroscopy and diffusion tensor imaging at 3T showed high concordance and improved detection of motor neuron disease-related upper motor neuron dysfunction, with only three discordant cases.

  Confidence 0.90

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• Fractional anisotropy on diffusion tensor imaging was significantly lower in the upper three measurement regions for patients with clinical upper motor neuron involvement.

  Confidence 0.92

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• N-acetylaspartate reduction on 1H-MR spectroscopy was found in 6 of 8 patients with clinical upper motor neuron involvement when compared with controls.

  Confidence 0.95

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review

• 1h-mr spectroscopy

  method

  A proton MR spectroscopy technique used to quantify brain metabolites within the primary motor cortex.

  Aliases: proton MR spectroscopy, MR spectroscopy

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• corticospinal tracts

  anatomical structure

  The major descending motor pathways sampled bilaterally across several brainstem and subcortical regions.

  Aliases: CSTs, CST

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• diffusion tensor imaging

  method

  An MRI diffusion technique used here to assess white-matter tract integrity with regional scalar measures.

  Aliases: DTI

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• fractional anisotropy

  imaging metric

  A diffusion tensor imaging scalar that reflects the directional organization of water diffusion in white matter.

  Aliases: FA

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• motor neuron disease

  condition

  The suspected neurodegenerative disorder being evaluated with MR spectroscopy, diffusion imaging, and clinical scales.

  Aliases: MND

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• n-acetylaspartate

  biomarker

  A neuronal metabolite measured as an absolute concentration and as part of metabolite ratios in the motor cortex.

  Aliases: NAA

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review
• upper motor neuron dysfunction

  clinical finding

  Clinical evidence of upper motor neuron involvement assessed in the suspected motor neuron disease cohort.

  Aliases: UMN dysfunction, UMN involvement

  박진우 (dztg5apj7m) extraction뀨 (7c402c1b98) reviewKiller Whale (322360f1c1) review

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