Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
LetterLETTER

Corticospinal Tract MR Signal-Intensity Pseudonormalization on Magnetization Transfer Contrast Imaging: A Potential Pitfall in the Interpretation of the Advanced Compromise of Upper Motor Neurons in Amyotrophic Lateral Sclerosis

A.J. da Rocha, A.C. Martins Maia and B.C. Oliveira Valério
American Journal of Neuroradiology May 2012, 33 (5) E79-E80; DOI: https://doi.org/10.3174/ajnr.A3114
A.J. da Rocha
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
A.C. Martins Maia Jr
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
B.C. Oliveira Valério
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

We read the article by Carrara et al,1 entitled “A Distinct MR Imaging Phenotype in Amyotrophic Lateral Sclerosis: Correlation between T1 Magnetization Transfer Contrast Hyperintensity along the Corticospinal Tract and Diffusion Tensor Imaging Analysis,” with great interest. The possible recognition of a distinct phenotype of amyotrophic lateral sclerosis (ALS) based on typical corticospinal tract (CST) hyperintensity on T1-weighted images with magnetization transfer contrast (T1 MTC) reinforces the applicability of MR imaging in confirming upper motor neuron (UMN) involvement in ALS. However, previous reports have described false-negative MR imaging results that were attributed to progressive CST degeneration in the advanced stages of the disease.2,3 Nevertheless, to the best of our knowledge, this theoretic “pseudonormalization” has never been documented in the MR imaging follow-up of a patient with ALS.

We describe imaging follow-up of a young-adult patient with ALS (a 20-year-old woman) who was examined in the 6th and 30th months after the initial clinical manifestations of UMN involvement. The MR imaging protocol included T1 MTC (TR/TE, 512 ms/minimum full; MT pulse, 1200 Hz; off resonance). For quantitative assessment, we obtained axial proton density sequences (TR/TE, 2200/30 ms) with and without MTC to determine the magnetization transfer ratios (MTRs). All MR images were obtained in the same 1.5T scanner with identical parameters for monitoring. On the first MR imaging scan, there was a marked abnormal CST hyperintensity on the T1 MTC images, which became almost inconspicuous on follow-up MR imaging (Fig 1). The MTRs of a 3-mm-diameter circular region of interest were measured in the bilateral CST in the subcortical precentral regions, the posterior segment of the internal capsules, and the extramotor bilateral frontal white matter (Table). It is possible to realize a significant reduction of MTR values in all different regions, consistent with the findings of the conventional sequence.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

First MR imaging scan (6th month after the initial clinical manifestations of UMN involvement). A and B, Axial T1 MTC images show symmetric abnormal hyperintensity along the CST in the internal capsules (arrowheads) and in the cortical and subcortical precentral regions. C and D, Imaging follow-up (30th month). Axial T1 MTC images indicate a “pseudonormalization” of the CST signal intensity at the same locations.

View this table:
  • View inline
  • View popup

CST and white matter MTR

Our findings are consistent with those previously reported and reinforce the utility of T1 MTC sequences for the early diagnosis of UMN degeneration based on qualitative analysis of the CST.4 The typical hyperintensity on T1 MTC likely reflects the abnormalities that are restricted to the CST in the initial UMN degeneration events in definite ALS. This likely reflects the abnormalities that are restricted to the CST in the initial UMN degeneration events in definite ALS. However, pseudonormalization limits this sequence applicability in advanced ALS, likely as a consequence of the gliosis that is secondary to axonal loss and CST degeneration.2,3 Our quantitative results support this argument to explain the pseudonormalization documented on T1 MTC signal intensity. Disease progression is presumably followed by some changes in the microstructural tissue environment that modify the exchange basis of magnetization transfer; furthermore, this progression leads to widespread abnormalities beyond the CST limits, as confirmed on DTI.3 As shown here, MTR is useful to estimate the structural damage in different brain regions, including motor and extramotor ALS progression, particularly in advanced stages of UMN compromise in patients with ALS.2,3

References

  1. 1.↵
    1. Carrara G,
    2. Carapelli C,
    3. Venturi F,
    4. et al
    . A distinct MR imaging phenotype in amyotrophic lateral sclerosis: correlation between T1 magnetization transfer contrast hyperintensity along the corticospinal tract and diffusion tensor imaging analysis. AJNR Am J Neuroradiol 2012;33:733–39
    Abstract/FREE Full Text
  2. 2.↵
    1. Charil A,
    2. Corbo M,
    3. Filippi M,
    4. et al
    . Structural and metabolic changes in the brain of patients with upper motor neuron disorders: a multiparametric MRI study. Amyotroph Lateral Scler 2009;10:269–79
    CrossRefPubMed
  3. 3.↵
    1. Agosta F,
    2. Chio A,
    3. Cosottini M,
    4. et al
    . The present and the future of neuroimaging in amyotrophic lateral sclerosis. AJNR Am J Neuroradiol 2010;31:1769–77
    Abstract/FREE Full Text
  4. 4.↵
    1. da Rocha AJ,
    2. Oliveira AS,
    3. Fonseca RB,
    4. et al
    . Detection of corticospinal tract compromise in amyotrophic lateral sclerosis with brain MR imaging: relevance of the T1-weighted spin-echo magnetization transfer contrast sequence. AJNR Am J Neuroradiol 2004;25:1509–15
    Abstract/FREE Full Text
  • © 2012 by American Journal of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 33 (5)
American Journal of Neuroradiology
Vol. 33, Issue 5
1 May 2012
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Corticospinal Tract MR Signal-Intensity Pseudonormalization on Magnetization Transfer Contrast Imaging: A Potential Pitfall in the Interpretation of the Advanced Compromise of Upper Motor Neurons in Amyotrophic Lateral Sclerosis
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Corticospinal Tract MR Signal-Intensity Pseudonormalization on Magnetization Transfer Contrast Imaging: A Potential Pitfall in the Interpretation of the Advanced Compromise of Upper Motor Neurons in Amyotrophic Lateral Sclerosis
A.J. da Rocha, A.C. Martins Maia, B.C. Oliveira Valério
American Journal of Neuroradiology May 2012, 33 (5) E79-E80; DOI: 10.3174/ajnr.A3114

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Corticospinal Tract MR Signal-Intensity Pseudonormalization on Magnetization Transfer Contrast Imaging: A Potential Pitfall in the Interpretation of the Advanced Compromise of Upper Motor Neurons in Amyotrophic Lateral Sclerosis
A.J. da Rocha, A.C. Martins Maia, B.C. Oliveira Valério
American Journal of Neuroradiology May 2012, 33 (5) E79-E80; DOI: 10.3174/ajnr.A3114
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Purchase

Jump to section

  • Article
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Reply:
  • The Complementary Role of CT Perfusion and Transcranial Doppler in the Assessment of Delayed Cerebral Ischemia after Aneurysmal SAH
  • Dilator-Dotter Technique for Acute Ischemic Stroke: Further Applications in the Vertebral Arteries
Show more Letters

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2021 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2022 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire