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Research ArticleADULT BRAIN
Open Access

High-Resolution 7T MR Imaging of the Motor Cortex in Amyotrophic Lateral Sclerosis

M. Cosottini, G. Donatelli, M. Costagli, E. Caldarazzo Ienco, D. Frosini, I. Pesaresi, L. Biagi, G. Siciliano and M. Tosetti
American Journal of Neuroradiology December 2015, DOI: https://doi.org/10.3174/ajnr.A4562
M. Cosottini
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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G. Donatelli
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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M. Costagli
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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E. Caldarazzo Ienco
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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D. Frosini
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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I. Pesaresi
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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L. Biagi
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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G. Siciliano
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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M. Tosetti
From the Department of Translational Research and New Technologies in Medicine and Surgery (M.Cosottini) and Neurology Unit, Department of Clinical and Experimental Medicine (E.C.I., D.F., G.S.), University of Pisa, Pisa, Italy; Neuroradiology Unit (G.D., I.P.), Department of Diagnostic and Interventional Radiology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy; IMAGO7 Foundation (M.Costagli), Pisa, Italy; and IRCCS Stella Maris (L.B., M.T.), Pisa, Italy.
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Abstract

BACKGROUND AND PURPOSE: Amyotrophic lateral sclerosis is a progressive motor neuron disorder that involves degeneration of both upper and lower motor neurons. In patients with amyotrophic lateral sclerosis, pathologic studies and ex vivo high-resolution MR imaging at ultra-high field strength revealed the co-localization of iron and activated microglia distributed in the deep layers of the primary motor cortex. The aims of the study were to measure the cortical thickness and evaluate the distribution of iron-related signal changes in the primary motor cortex of patients with amyotrophic lateral sclerosis as possible in vivo biomarkers of upper motor neuron impairment.

MATERIALS AND METHODS: Twenty-two patients with definite amyotrophic lateral sclerosis and 14 healthy subjects underwent a high-resolution 2D multiecho gradient-recalled sequence targeted on the primary motor cortex by using a 7T scanner. Image analysis consisted of the visual evaluation and quantitative measurement of signal intensity and cortical thickness of the primary motor cortex in patients and controls. Qualitative and quantitative MR imaging parameters were correlated with electrophysiologic and laboratory data and with clinical scores.

RESULTS: Ultra-high field MR imaging revealed atrophy and signal hypointensity in the deep layers of the primary motor cortex of patients with amyotrophic lateral sclerosis with a diagnostic accuracy of 71%. Signal hypointensity of the deep layers of the primary motor cortex correlated with upper motor neuron impairment (r = −0.47; P < .001) and with disease progression rate (r = −0.60; P = .009).

CONCLUSIONS: The combined high spatial resolution and sensitivity to paramagnetic substances of 7T MR imaging demonstrate in vivo signal changes of the cerebral motor cortex that resemble the distribution of activated microglia within the cortex of patients with amyotrophic lateral sclerosis. Cortical thinning and signal hypointensity of the deep layers of the primary motor cortex could constitute a marker of upper motor neuron impairment in patients with amyotrophic lateral sclerosis.

Abbreviations

ALS
amyotrophic lateral sclerosis
ALSFRS-R
ALS Functional Rating Scale-Revised
DPR
disease progression rate
HS
healthy subjects
M1
primary motor cortex
UHF
ultra-high field
UMN
upper motor neuron
  • © 2016 American Society of Neuroradiology

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High-Resolution 7T MR Imaging of the Motor Cortex in Amyotrophic Lateral Sclerosis
M. Cosottini, G. Donatelli, M. Costagli, E. Caldarazzo Ienco, D. Frosini, I. Pesaresi, L. Biagi, G. Siciliano, M. Tosetti
American Journal of Neuroradiology Dec 2015, DOI: 10.3174/ajnr.A4562

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High-Resolution 7T MR Imaging of the Motor Cortex in Amyotrophic Lateral Sclerosis
M. Cosottini, G. Donatelli, M. Costagli, E. Caldarazzo Ienco, D. Frosini, I. Pesaresi, L. Biagi, G. Siciliano, M. Tosetti
American Journal of Neuroradiology Dec 2015, DOI: 10.3174/ajnr.A4562
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