Value of fluid-attenuated inversion recovery MRI data analyzed by the lesion segmentation toolbox in amyotrophic lateral sclerosis.

Abstract

BackgroundMRI fluid‐attenuated inversion recovery (FLAIR) studies reported hyperintensity in the corticospinal tract and corpus callosum of patients with amyotrophic lateral sclerosis (ALS).PurposeTo evaluate the lesion segmentation toolbox (LST) for the objective quantification of FLAIR lesions in ALS patients.Study TypeRetrospective.PopulationTwenty‐eight ALS patients (eight females, mean age: 50 range: 24–73, mean ALSFRS‐R sum score: 36) were compared with 31 age‐matched healthy controls (12 females, mean age: 45, range: 25–67). ALS patients were treated with riluzole and additional G‐CSF (granulocyte‐colony stimulating factor) on a named patient basis.Field Strength/Sequence1.5 T, FLAIR, T1‐weighted MRI.AssessmentThe lesion prediction algorithm (LPA) of the LST enabled the extraction of individual binary lesion maps, total lesion volume (TLV), and number (TLN). Location and overlap of FLAIR lesions across patients were investigated by registration to FLAIR average space and an atlas. ALS‐specific functional rating scale revised (ALSFRS‐R), disease progression, and survival since diagnosis served as clinical correlates.Statistical TestsUnivariate analysis of variance (ANOVA), repeated‐measures ANOVA, t‐test, Bravais‐Pearson correlation, Chi‐square test of independence, Kaplan–Meier analysis, Cox‐regression analysis.ResultsBoth ALS patients and healthy controls exhibited FLAIR alterations. TLN significantly depended on age (F(1,54) = 24.659, P < 0.001) and sex (F(1,54) = 5.720, P = 0.020). ALS patients showed higher TLN than healthy controls depending on sex (F(1, 54) = 5.076, P = 0.028). FLAIR lesions were small and most pronounced in male ALS patients. FLAIR alterations were predominantly detected in the superior and posterior corona radiata, anterior capsula interna, and posterior thalamic radiation. Patients with pyramidal tract (PT) lesions exhibited significantly inferior survival than patients without PT lesions (P = 0.013). Covariate age exhibited strong prognostic value for survival (P = 0.015).Data ConclusionLST enables the objective quantification of FLAIR alterations and is a potential prognostic biomarker for ALS. Level of Evidence: 3 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2019;50:552–559.