Iron quantitative analysis of motor combined with bulbar region in M1 cortex may improve diagnosis performance in ALS.

OBJECTIVES: To explore whether the combined analysis of motor and bulbar region of M1 on susceptibility-weighted imaging (SWI) can be a valid biomarker for amyotrophic lateral sclerosis (ALS). METHODS: Thirty-two non-demented ALS patients and 35 age- and gender-matched healthy controls (HC) were retrospectively recruited. SWI and 3D-T1-MPRAGE images were obtained from all individuals using a 3.0-T MRI scan. The bilateral posterior band of M1 was manually delineated by three neuroradiologists on phase images and subdivided into the motor and bulbar regions. We compared the phase values in two groups and performed a stratification analysis (ALSFRS-R score, duration, disease progression rate, and onset). Receiver operating characteristic (ROC) curves were also constructed. RESULTS: ALS group showed significantly increased phase values in M1 and the two subregions than the HC group, on the all and elderly level (p < 0.001, respectively). On all-age level comparison, negative correlations were found between phase values of M1 and clinical score and duration (p < 0.05, respectively). Similar associations were found in the motor region (p < 0.05, respectively). On both the total (p < 0.01) and elderly (p < 0.05) levels, there were positive relationships between disease progression rate and M1 phase values. In comparing ROC curves, the entire M1 showed the best diagnostic performance. CONCLUSIONS: Combining motor and bulbar analyses as an integral M1 region on SWI can improve ALS diagnosis performance, especially in the elderly. The phase value could be a valuable biomarker for ALS evaluation. KEY POINTS: • Integrated analysis of the motor and bulbar as an entire M1 region on SWI can improve the diagnosis performance in ALS. • Quantitative analysis of iron deposition by SWI measurement helps the clinical evaluation, especially for the elderly patients. • Phase value, when combined with the disease progression rate, could be a valuable biomarker for ALS.

Effects of antidepressant treatment on N-acetyl aspartate and choline levels in the hippocampus and thalami of post-stroke depression patients: a study using (1)H magnetic resonance spectroscopy.

Previous studies in patients with a major depressive disorder show functional abnormalities in the medial frontal cortex. Functional and structural abnormalities in patients with post-stroke depression (PSD) are not well studied. The major goals of this study were to determine the biochemical abnormalities that occur in PSD and to assess the effect of antidepressants in patients with PSD at the biochemical level. We used magnetic resonance imaging to detect structural or functional abnormalities in PSD patients. In a prospective study, we included 30 patients with PSD and 20 age-matched subjects as controls. Magnetic resonance spectroscopy (MRS) of the brain was conducted in all subjects at the beginning of the study. Patients with PSD were treated with the antidepressant paroxetine (20-40mg/days) for 6 months. After the 6-month period, all PSD subjects underwent MRS again. PSD patients were evaluated with the Hamilton Depression Scale (HAMD) both before and after treatment with the antidepressant. The mean age of the PSD patients was 70.0+/-4.2 years and that of the controls was 67.2+/-5.4 years. Before treatment, N-acetyl aspartate/creatine (NAA/Cr) ratios in the bilateral hippocampus and thalami were significantly lower in PSD patients than in controls. Choline/creatine (Cho/Cr) ratios were significantly higher in the bilateral hippocampus and left thalamus in PSD patients than in controls. The Cho/Cr ratios were significantly higher in the left thalamus than in the right in PSD patients. The HAMD scores were significantly correlated with the Cho/Cr ratios in the left and right hippocampus. Compared with PSD patients before antidepressant treatment, the PSD subjects after treatment had significantly higher NAA/Cr ratios in the left hippocampus and bilateral thalami. They had significantly lower Cho/Cr ratios in bilateral hippocampus and left thalamus. Our study suggests that metabolic abnormalities in the hippocampus and thalamus are implicated in PSD. Antidepressants may alter the local metabolic abnormalities in these areas.