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Accuracy of Conventional MRI in ALS

Published online by Cambridge University Press:  23 September 2014

Aparna Gupta ,
Thanh Binh Nguyen ,
Santanu Chakraborty  and
Pierre R. Bourque
Aparna Gupta
Affiliation:
Departments of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada
Thanh Binh Nguyen
Affiliation:
Diagnostic Imaging, University of Ottawa, Ottawa, Ontario, Canada
Santanu Chakraborty
Affiliation:
Diagnostic Imaging, University of Ottawa, Ottawa, Ontario, Canada
Pierre R. Bourque*
Affiliation:
Departments of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada
*
The Ottawa Hospital (Civic Campus), Room C2178, 1053 Carling Ave , Ottawa, Ontario, K1Y-4E9, Canada. Email: pbourque@toh.on.ca.
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Abstract

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Background:

There is currently no definite neuroimaging test to detect amyotrophic lateral sclerosis (ALS), which leads to significant delay in diagnosis, particularly if one takes into account the rapidity of disease evolution. Hyperintensity of the corticospinal tracts (CST) on T2 or fluid-attenuated inversion recovery (FLAIR) weighted magnetic resonance imaging (MRI) has been well described, but data on sensitivity and specificity in larger series is lacking to help guide its application to clinical care.

Methods:

We analyzed clinical and MRI data from 64 patients with a definite retrospective diagnosis of ALS. In this case-control study, two experienced blinded neuroradiologists systematically assessed defined rostrocaudal segments of the intracranial course of the CST.

Results:

The overall sensitivity and specificity of conventional MRI for the diagnosis of ALS were 48% and 76% respectively. Highest specificities for CST hyperintensity were noted for the subcortical white matter (92%), centrum semiovale (88%) and medullary pyramids (92%). The lowest specificities were found for the cerebral peduncle (36%) and internal capsule (32%). We did not find a correlation with the rate of clinical progression, age of onset or the presence of upper motor neuron signs on examination.

Conclusion:

Conventional MRI was not found to be a reliable diagnostic tool for ALS and it did not help predict clinical characteristics such as speed of evolution or prominence of upper motor neuron signs. Its main role in the setting of ALS should remain to help exclude alternative diagnostic considerations. A multimodal approach relying on newer functional and structural MRI techniques still needs to be developed and validated.

Résumé

RÉSUMÉ

Précision de PIRM conventionnelle dans la SLA.

Contexte:

Il n'existe pas actuellement de test de neuroimagerie pour détecter la SLA, ce qui occasionne des délais importants dans le diagnostic de la maladie, particulièrement si on tient compte de la rapidité d'évolution de celle-ci. Une hyperintensité des faisceaux pyramidaux (FP) sur les séquences pondérées en T2 ou FLAIR de l'imagerie par résonance magnétique (IRM) a été bien décrite, mais il n'existe pas de données sur sa sensibilité et sa spécificité chez de plus grandes séries de patients pour guider son application en clinique.

Méthode:

Nous avons analysé les données cliniques et d'IRM de 64 patients chez qui un diagnostic rétrospectif définitif de SLA avait été posé. Dans cette étude cas-témoin, deux neuroradiologistes d'expérience ont évalué systématiquement en aveugle des segments rostrocaudaux bien défmis de la portion intracrânienne des FP.

Résultats:

La sensibilité et la spécificité globales de l'IRM conventionnelle pour le diagnostic de la SLA étaient respectivement de 48% et 76%. Les spécificités les plus élevées pour l'hyperintensité des FP ont été observées pour la substance blanche sous-corticale (92%), le centre ovale de Vieussens (88%) et les pyramides médullaires (92%). Les spécificités les plus faibles ont été observées pour le pédoncule cérébral (36%) et la capsule interne (32%). Nous n'avons pas observé de corrélation avec la rapidité de progression clinique, l'âge de début ou la présence de signes du neurone moteur supérieur à l'examen.

Conclusion:

Selon nos observations, PIRM conventionnel n'était pas un outil diagnostic fiable dans la SLA et n'aidait pas à prédire les caractéristiques cliniques telles la rapidité d'évolution ou l'importance des signes du neurone moteur supérieur. Son principal rôle dans le contexte de la SLA devrait se limiter à l'exclusion d'autres pathologies. Une approche multimodale fondée sur des techniques plus récentes d'IRM fonctionnelle et structurelle devra être développée et validée.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 41 , Issue 1 , January 2014 , pp. 53 - 57
Copyright
Copyright © The Canadian Journal of Neurological 2014

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