Detection of upper motor neuron damage in amyotrophic lateral sclerosis
Upload time：2017-02-23 Browse：
Author: Cui Liying Pan Hua Fan Jian Xing Yan Li Xiaoguang Liu Mingsheng
Abstract: Objective To investigate the proton magnetic resonance spectroscopy (proton magnetic resonance spectroscopy, 1H-MRS) detection of amyotrophic lateral sclerosis (amyotrophic lateral, sclerosis, ALS) on motor neuron damage (upper motor, neuron, UMN) features and diagnostic accuracy. Methods 31 patients with ALS and 32 healthy controls was detected by 1H-MRS cerebral precentral cortex, posterior limb of the internal capsule and brain regions of interest Juegan metabolite N- acetyl aspartic acid (NAA), choline (Cho), creatine (Cr) level, NAA/Cr, NAA/ (Cho+ Cr calculation), ratio of Cho/Cr. The receiver operating characteristic (receiver operating, characteristic, ROC) 1H-MRS diagnostic value in patients with ALS UMN damage analysis curve. Results the NAA/Cr and NAA/ (Cho+Cr) of the pyramidal tract in patients with ALS were significantly lower than those in the control group (P<0.05). ROC curve area ratio of NAA predict UMN damage under the ALS (area under the curve, AUC) from 0.67 to 0.91, of which two parts of posterior limb of internal capsule, cerebral peduncle average NAA/ (Cho+Cr) NAA/ on average and three parts (Cho+ Cr) AUC, the sensitivity and specificity were respectively 0.91, 0.828, and 0.906 0.90, 0.769, 0.875. Conclusion 1H-MRS can detect biochemical metabolism in patients with ALS pyramidal traveling is abnormal, objective evaluation of UMN image of ALS, the diagnostic accuracy of medium, multi level detection and comprehensive selection index is helpful to improve the diagnosis efficiency.
Key words: amyotrophic lateral sclerosis; pyramidal tract; magnetic resonance spectroscopy; ROC curve
CLC number: R744.8 document code: A article number: 1006-2963 (2017)
Magnetic resonance spectroscopy in the diagnosis of upper motor neuron involvement in amyotrophic lateral sclerosis JIAN Fan, CUI Liying*, PAN Hua, XING Yan, LI Xiaoguang, LIU Mingsheng. of Peking Union * Department Neurology, Medical College Hospital, Chinese Academy of Medical Science Beijing, 100730, China
Corresponding author: CUI Liying, Email: firstname.lastname@example.org
ABSTRACT: Objective To evaluate the feature and diagnostic accuracy of proton magnetic resonance spectroscopy (1H-MRS) in detecting upper motor neuron (UMN) involvement in amyotrophic lateral sclerosis (ALS). Methods The study included 31 ALS patients and 32 healthy controls and measured the concentration of N-acetylaspartate (NAA), choline (Cho) and creatine (Cr) by 1H-MRS in subcortical white matter of precentral gyrus, posterior limb of internal capsule (PLIC) and cerebral peduncle (CP). Ratios of NAA/Cr NAA/ (Cho+Cr) and Cho/Cr were calculated from these measurements. The diagnostic value of NAA ratios for ALS lesions was analyzed by receiver operating characteristic (ROC) curves. Results Compared with the controls ALS group, had signific Antly decreased NAA/Cr and NAA/ (Cho+Cr) ratios at the three levels along the corticospinal tract (CST) (P<0.05). In ROC analysis, areas under the curves (AUC) ranged from 0.67 to 0.91. The average NAA/ (Cho+Cr) ratio of PLIC and CP showed the best performance with an AUC of 0.91, a sensitivity of 0.828 and a specificity of followed by the average 0.906, NAA/ (Cho+Cr) ratio of all the three levels, with the corresponding data as and 0.875. Conclusions 0.90, 0.769 1H-MRS can reveal metabolite abnormalities in the intracranial CTS of ALS patients and serve as a neuroimaging biomarker for UMN involvement. Regarding its moderate diagnostic accuracy, multilevel measurements and synthetically using parameters will help to improve its efficacy.
Key words: lateral sclerosis; corticospinal tract; magnetic resonance spectroscopy; ROC curve; Amyotrophic
Amyotrophic lateral sclerosis (amyotrophic lateral sclerosis, ALS) is a progressive neurodegenerative disease, characterized by upper and lower motor neuron damage and pyramidal tract degeneration. Clinical and pathological changes of lower motor neurons were confirmed by routine electromyography. The upper motor neuron (upper motor, UMN) damage, in addition to check in vitro, there is still lack of objective and effective detection index (neuron). Proton magnetic resonance spectroscopy (proton magnetic resonance spectroscopy, 1H-MRS) using magnetic resonance phenomena and chemical shift, N- acetyl aspartic noninvasive in vivo tissues (N-acetylaspartate, NAA) acid, choline (Choline, Cho), creatine (Creatine, Cr) and other metabolites in the pathophysiological process of biochemical changes, through metabolic measurements of nervous tissue may reveal disease, UMN damage will be applied to the evaluation of patients with ALS has become a hot research topic at home and abroad. The ALS patients and control group for multiple sites for 1H-MRS detection in cone beam, analysis of the correlation between MRS index and clinical application, the receiver operating characteristic (receiver operating, characteristic, ROC) curve to evaluate the accuracy of MRS detection of UMN damage, in order to choose the MRS index and the value of clinical application in ALS to explore.
1 objects and methods
1.1 subjects collected 2004-06 - 2006-03 in Peking Union Medical College Hospital and Beijing Tiantan Hospital of sporadic ALS patients, according to the revised El Escorial diagnostic criteria , in line with confirmed or suspected ALS patients. There were 24 males and females, aged from 27 to 74 years, with an average of (48.7 +) years old. The duration of the disease was from 3 to 59 months, with an average of 18 months. There were no more than 4 cases of the disease in the medulla oblongata, and of the patients with limb diseases in 27 cases (n = 11.1). Exclusion criteria: cerebrovascular disease or other