Detection of Corticospinal Tract Compromise in Amyotrophic Lateral Sclerosis with Brain MR Imaging: Relevance of the T1-Weighted Spin-Echo Magnetization Transfer Contrast Sequence
Antônio J. da Rochaa,d,
Acary S.B. Oliveirab,
Ricardo B. Fonsecad,e,
Antônio C. M. Maia, Jrd,
Renata P. Buainainb and
Henrique M. Ledermanc
a Section of Radiology, Santa Casa de Misericordia de Sao Paulo
b Department of Neurology, Universidade Federal de Sao Paulo
c Department of Imaging, Universidade Federal de Sao Paulo
d Section of Radiology, Fleury Centro de Medicina Diagnóstica, Sao Paulo, Brazil
e Department of Radiology and Radiological Sciences, Vanderbilt University School of Medicine, Nashville, TN
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FIG 1. Time of MR imaging in relation to onset of symptoms in patients with clinically suspected ALS. Boxes indicate final clinical diagnoses according to revised El Escorial criteria.
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FIG 2. MR images of the precentral gyri.
A and B, Control subject. Cortical and subcortical precentral gyral isointensity on FLAIR image (arrows in A) and precentral subcortical hypointensity on T1-weighted SE MTC image (arrows in B) .
C, Patient with definite ALS. Pathologic hyperintensity (arrows) in the cortical and subcortical regions of the precentral gyri on T1-weighted SE MTC image.
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FIG 3. MR images of the CST in the centrum semiovale.
A and B, Control subject. Hyperintensity on FLAIR image (arrows in A) and hypointensity on T1-weighted SE MTC image (arrows in B) in the region of the CST in the centrum semiovale.
C–E, Patient with definite ALS. FLAIR image is unremarkable (C). Pathologic hyperintensity in the regions of the centrum semiovale, periventricular regions on T1-weighted SE MTC images (arrows in D and E).
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FIG 4. MR images of the CST in the internal capsule.
A and B, Control subject. Hyperintensity on FLAIR image (arrows in A) and hypointensity on T1-weighted SE MTC image (arrows in B) in the region of the CST in the internal capsule.
C, Patient with definite ALS. Pathologic hyperintensity (arrows) in the same region on a T1-weighted SE MTC image.
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FIG 5. MR images of the CST in the brain stem.
A and B, Control subject. Hypointensity in the region of the CST in the brain stem on T1-weighted SE MTC image (arrows in A). CST is not visible on FLAIR image (B).
C and D, Patient with definite ALS. Abnormal lack of hypointensity in the brain stem on T1-weighted SE MTC image (C). FLAIR image does not show any abnormality (D).
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