title: Hyperintensity of the corticospinal tract on FLAIR: A simple and sensitive objective upper motor neuron degeneration marker in clinically verified amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  The involvement of upper motor neuron (UMN) degeneration is crucial to the diagnosis of amyotrophic lateral sclerosis (ALS). However, it is difficult to detect in the early stages, and particularly with predominantly lower motor neuron (LMN) dysfunction. Thus, objective and sensitive UMN degeneration markers are needed for an accurate and early diagnosis. Several studies have investigated the abnormal signal changes in brain MRI for patients with ALS, so we hope to develop a neuroimaging diagnosis method in brain MRI that can evaluate UMN degeneration.
  
  
  METHODS
  We investigated corticospinal tract (CST) hyperintensity on MRI-fluid attenuated inversion recovery (FLAIR) images for 82 clinically verified ALS patients and 38 age-and gender-matched control subjects. Visual evaluation of the FLAIR images was analyzed independently by 3 observers. The clinical examination was implemented by an experienced neurological physician.
  
  
  RESULTS
  The three observers' views were identical regarding CST hyperintensity on FLAIR images in subcortical precentral gyrus, centrum emiovale, internal capsule, and cerebral peduncles levels (p>0.05). The frequency of CST hyperintensity is significantly higher for the ALS group than the control group in subcortical precentral gyrus, centrum semiovale, posterior limbs of internal capsule and cerebral peduncles levels. (p<0.01). The mean areas under the receiver operating characteristic curves (AUC) values were not different among clinical examinations, CST hyperintensity and mixed-examination (CST hyperintensity and clinical examination groups) in subcortical precentral gyrus, centrum semiovale, internal capsule, and cerebral peduncles levels (p>0.05), although AUC values of CST hyperintensity was slightly higher than clinical examination in centrum semiovale level. There was no statistically significant correlation between CST hyperintensity and age of onset, gender, disease duration, region of onset, and clinical UMN manifestation. (p>0.05).
  
  
  CONCLUSIONS
  CST hyperintensity was found more frequently in patients with ALS compared to the matched control group. It can be used to evaluate UMN degeneration effectively in subcortical precentral gyrus, centrum semiovale and cerebral peduncles levels. Combining CST hyperintensity and clinical examination can improve the sensitivity of diagnostic performance for UMN degeneration in ALS.
authors.affiliation: Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
authors.forename: Jiaoting
authors.initials: J
authors.lastname: Jin
authors.affiliation: Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
authors.forename: Fangfang
authors.initials: F
authors.lastname: Hu
authors.affiliation: Department of Medical Imaging, First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
authors.forename: Qiuli
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China.
authors.forename: Rui
authors.initials: R
authors.lastname: Jia
authors.affiliation: Department of Neurology, the First Affiliated Hospital, Medical College, Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi 710061, China. Electronic address: jxdang2000@126.com.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Dang
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000000981:diagnostic imaging*; D019540:Area Under Curve; D001921:Brain / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons; D009410:Nerve Degeneration / Q000000981:diagnostic imaging*; D009460:Neurologic Examination; D011712:Pyramidal Tracts / Q000000981:diagnostic imaging*; D012372:ROC Curve
keywords: Amyotrophic lateral sclerosis; Hyperintensity of corticospinal tract; Upper motor neuron degeneration