title: Brain Parenchymal Fraction: A Relatively Simple MRI Measure to Clinically Distinguish ALS Phenotypes.
abstract: Even though neuroimaging and clinical studies indicate that amyotrophic lateral sclerosis (ALS) manifests with distinct clinical phenotypes, no objective test exists to assess upper motor degeneration in ALS. There is great interest in identifying biomarkers of ALS to allow earlier diagnosis and to recognize disease subtypes. Current quantitative neuroimaging techniques such as T2 relaxometry and diffusion tensor imaging are time-consuming to use in clinical settings due to extensive postprocessing requirements. Therefore, we aimed to study the potential role of brain parenchymal fraction (BPF) as a relatively simple quantitative measure for distinguishing ALS phenotypes. T1-weighted MR images of brain were obtained in 15 neurological controls and 88 ALS patients categorized into 4 distinct clinical phenotypes, upper motor neuron- (UMN-) predominant ALS patients with/without corticospinal tract (CST) hyperintensity on T2/PD-weighted images, classic ALS, and ALS with frontotemporal dementia (ALS-FTD). BPF was calculated using intracranial grey matter, white matter, and cerebrospinal fluid volumes obtained in control and ALS subgroups using SPM8 software. Only ALS-FTD patients had significant reduction in BPF when compared to controls and nondemented ALS patients. Correlation of clinical measures such as disease duration with BPF further supports the view that the BPF could be a potential biomarker for clinical diagnosis of ALS-FTD patients.
authors.affiliation: Department of Electrical and Electronics Engineering, Birla Institute of Technology and Science, Pilani, Hyderabad Campus, Hyderabad 500078, India; Department of Biomedical Engineering, ND2, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Venkateswaran
authors.initials: V
authors.lastname: Rajagopalan
authors.affiliation: Neuromuscular Center and Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH 44195, USA; Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Pioro
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000134:cerebrospinal fluid / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001921:Brain; D042241:Early Diagnosis; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D011859:Radiography; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology