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Research ArticleAdult Brain
Open Access

Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T

G. Donatelli, A. Retico, E. Caldarazzo Ienco, P. Cecchi, M. Costagli, D. Frosini, L. Biagi, M. Tosetti, G. Siciliano and M. Cosottini
American Journal of Neuroradiology January 2018, 39 (1) 63-69; DOI: https://doi.org/10.3174/ajnr.A5423
G. Donatelli
aFrom the Department of Translational Research and New Technologies in Medicine and Surgery (G.D., P.C., M. Cosottini)
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A. Retico
cNational Institute for Nuclear Physics (A.R.), Pisa Division, Pisa, Italy
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E. Caldarazzo Ienco
bNeurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy
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P. Cecchi
aFrom the Department of Translational Research and New Technologies in Medicine and Surgery (G.D., P.C., M. Cosottini)
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M. Costagli
dImago7 Research Foundation (M. Costagli, L.B., M.T.), Pisa, Italy
eLaboratory of Medical Physics and Biotechnologies for Magnetic Resonance (M. Costagli, L.B., M.T.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy.
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D. Frosini
bNeurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy
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L. Biagi
dImago7 Research Foundation (M. Costagli, L.B., M.T.), Pisa, Italy
eLaboratory of Medical Physics and Biotechnologies for Magnetic Resonance (M. Costagli, L.B., M.T.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy.
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M. Tosetti
dImago7 Research Foundation (M. Costagli, L.B., M.T.), Pisa, Italy
eLaboratory of Medical Physics and Biotechnologies for Magnetic Resonance (M. Costagli, L.B., M.T.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy.
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G. Siciliano
bNeurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy
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M. Cosottini
aFrom the Department of Translational Research and New Technologies in Medicine and Surgery (G.D., P.C., M. Cosottini)
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Abstract

BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis is a neurodegenerative disease involving the upper and lower motor neurons. In amyotrophic lateral sclerosis, pathologic changes in the primary motor cortex include Betz cell depletion and the presence of reactive iron-loaded microglia, detectable on 7T MR images as atrophy and T2*-hypointensity. Our purposes were the following: 1) to investigate the signal hypointensity-to-thickness ratio of the primary motor cortex as a radiologic marker of upper motor neuron involvement in amyotrophic lateral sclerosis with a semiautomated method at 3T, 2) to compare 3T and 7T results, and 3) to evaluate whether semiautomated measurement outperforms visual image assessment.

MATERIALS AND METHODS: We investigated 27 patients and 13 healthy subjects at 3T, and 19 patients and 18 healthy subjects at 7T, performing a high-resolution 3D multiecho T2*-weighted sequence targeting the primary motor cortex. The signal hypointensity-to-thickness ratio of the primary motor cortex was calculated with a semiautomated method depicting signal intensity profiles of the cortex. Images were also visually classified as “pathologic” or “nonpathologic” based on the primary motor cortex signal intensity and thickness.

RESULTS: The signal hypointensity-to-thickness ratio of the primary motor cortex was greater in patients than in controls (P < .001), and it correlated with upper motor neuron impairment in patients (ρ = 0.57, P < .001). The diagnostic accuracy of the signal hypointensity-to-thickness ratio was high at 3T (area under the curve = 0.89) and even higher at 7T (area under the curve = 0.94). The sensitivity of the semiautomated method (0.81) outperformed the sensitivity of the visual assessment (0.56–0.63) at 3T.

CONCLUSIONS: The signal hypointensity-to-thickness ratio of the primary motor cortex calculated with a semiautomated method is suggested as a radiologic marker of upper motor neuron burden in patients with amyotrophic lateral sclerosis. This semiautomated method may be useful for improving the subjective radiologic evaluation of upper motor neuron pathology in patients suspected of having amyotrophic lateral sclerosis.

ABBREVIATIONS:

ALS
amyotrophic lateral sclerosis
HS
healthy subjects
M1
primary motor cortex
ROC
receiver operating characteristic
SH/Thk
signal hypointensity-to-thickness ratio
UMN
upper motor neuron
  • © 2018 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 39 (1)
American Journal of Neuroradiology
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1 Jan 2018
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Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T
G. Donatelli, A. Retico, E. Caldarazzo Ienco, P. Cecchi, M. Costagli, D. Frosini, L. Biagi, M. Tosetti, G. Siciliano, M. Cosottini
American Journal of Neuroradiology Jan 2018, 39 (1) 63-69; DOI: 10.3174/ajnr.A5423

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Semiautomated Evaluation of the Primary Motor Cortex in Patients with Amyotrophic Lateral Sclerosis at 3T
G. Donatelli, A. Retico, E. Caldarazzo Ienco, P. Cecchi, M. Costagli, D. Frosini, L. Biagi, M. Tosetti, G. Siciliano, M. Cosottini
American Journal of Neuroradiology Jan 2018, 39 (1) 63-69; DOI: 10.3174/ajnr.A5423
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