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Cortico-efferent tract involvement in primary lateral sclerosis and amyotrophic lateral sclerosis: A two-centre tract of interest-based DTI analysis. | LitMetric

AI Article Synopsis

  • Neuropathological studies have shown that ALS displays a specific corticoefferent propagation pattern, which can be used for in vivo patient staging through diffusion tensor imaging (DTI) techniques, applicable to both classical ALS and primary lateral sclerosis (PLS).
  • The study aimed to determine if the microstructural changes in PLS patients matched those of classical ALS, confirming consistency in their DTI data across different locations and analysis methods for potential standardization in clinical trials.
  • Results showed that alterations in white matter integrity were similar for both PLS and ALS patients, indicating that both conditions follow the same staging pattern, although PLS may involve a different progression in neuropathology.

Article Abstract

Background: After the demonstration of a corticoefferent propagation pattern in amyotrophic lateral sclerosis (ALS) by neuropathological studies, this concept has been used for in vivo staging of individual patients by diffusion tensor imaging (DTI) techniques, both in `classical` ALS and in restricted phenotypes such as primary lateral sclerosis (PLS).

Objective: The study was designed to investigate that microstructural changes according to the neuropathologically defined ALS alteration pattern in PLS patients could be confirmed to be identical to ´classical´ ALS patients. The novelty in this approach is that the results were independent of the subject samples and the data acquisition parameters (as was validated in two samples from two different centres). That way, reproducibility across (international) centres in addition to harmonisation/standardisation of data analysis has been addressed, for the possible use of MRI-based staging to stratify patients in clinical trials.

Methods: Tractwise analysis of fractional anisotropy (FA) maps according to the ALS-staging pattern was applied to DTI data (pooled from two ALS centres) of 88 PLS patients and 88 ALS patients with a 'classical' phenotype in comparison to 88 matched controls in order to identify white matter integrity alterations.

Results: In the tract-specific analysis, alterations were identical for PLS and ALS in the tract systems corresponding to the ALS staging pattern, independent of the subject samples and the data acquisition parameters. The individual categorisation into ALS stages did not differ between PLS and ALS patients.

Conclusions: This DTI study in a two-centre setting demonstrated that the neuropathological stages can be mapped in vivo in PLS with high reproducibility and that PLS-associated cerebral propagation, although showing the same corticofugal patterns as ALS, might have a different time course of neuropathology, in analogy to its much slower clinical progression rates.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198122PMC
http://dx.doi.org/10.1016/j.nicl.2018.10.005DOI Listing

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