Table 1:

Results of the combination MR Spectroscopy/DTI*

Patient No.	UMN^†	MRS	DTI	MRS/DTI	TMS^‡	DENERV^§
Group IV
1	+	++	++	true pos.	NA	+
2	+	+	+	true pos.	–	+
3	+	++	++	true pos.	–	–
4	+	++	++	true pos.	+	–
5	+	++	++	true pos.	+	+
6	+	+	+	true pos.	–	+
7	+	++	++	true pos.	+	+
Group III
1	+	++	++	true pos.	+	–
2	–	++	++	false pos.	NA	+
3	–	–	–	true neg.	–	–
4	–	–	–	true neg.	+	+
5	–	+	–	true neg.	–	+
6	–	–	–	true neg.	+	+
7	–	–	+	true neg.	NA	+
Group II
1	–	–	–	true neg.	+	–
2	–	–	–	true neg.	–	–
3	–	++	–	true neg.	–	+
4	–	–	–	true neg.	–	–

Note:—MRS indicates MR spectroscopy; UMN, upper motor neuron; TMS, transcranial magnetic stimulation; DENERV, denervation; true pos., true-positive; false pos., false positive; true neg., true negative; NA, not applicable; DTI, diffusion tensor imaging.
* ++ for MRS indicates NAA/Cho reduction beyond double SD; + beyond single SD. For DTI, ++ indicates 2 or more regions with FA below double SD; + just 1 region, respectively. −indicates a negative result. Reduction beyond the single SD threshold for MRS and beyond the double SD threshold in 1 region for DTI is regarded as a pathologic result of the MRS/DTI combination; discordance is graded as negative. Note that patient III/1 had primary lateral sclerosis but was subgrouped into the “clinically possible” group (III) due to his initial EE rating. DTI and MRS concurrently are false-positive in 1 patient with lower motor neuron involvement only (patient III/2).
† Clinical evidence for upper motor neuron involvement.
‡ Pathologic central conduction times in transcranial magnetic stimulation.
§ Presence or absence of generalized denervation.