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Updated: Mar 1, 2026
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
Quantitative FLAIR MRI in Amyotrophic Lateral Sclerosis
Jeremy Fabes1, Lucy Matthews2, Nicola Filippini3
1Centre for Functional Magnetic Resonance Imaging of the Brain, Oxford University, John Radcliffe Hospital, West Wing Level 6, Oxford OX3 9DU, UK.
Rationale And Objectives:
T2-weighted magnetic resonance imaging (MRI) hyperintensity assessed visually in the corticospinal tract (CST) lacks sensitivity for a diagnosis of amyotrophic lateral sclerosis (ALS). We sought to explore a quantitative approach to fluid-attenuated inversion recovery (FLAIR) MRI intensity across a range of ALS phenotypes.
Materials And Methods:
Thirty-three classical ALS patients, 10 with a flail arm presentation, and six with primary lateral sclerosis underwent MRI at 3 Tesla. Comparisons of quantitative FLAIR intensity in the CST and corpus callosum were made between 21 healthy controls and within patient phenotypic subgroups, some of whom were studied longitudinally.
Results:
Mean FLAIR intensity was greater in patient groups. The cerebral peduncle intensity provided the strongest subgroup classification. FLAIR intensity increased longitudinally. The rate of change of FLAIR within CST correlated with rate of decline in executive function and ALS functional rating score.
Conclusions:
FLAIR MRI encodes quantifiable information of potential diagnostic, stratification, and monitoring value.
Insights
Quantitative fluid-attenuated inversion recovery (FLAIR) MRI intensity in the corticospinal tract (CST) shows promise for diagnosing amyotrophic lateral sclerosis (ALS). This method offers potential for disease monitoring and stratification across ALS phenotypes.
Area of Science:
- Neuroimaging
- Neurology
- Biomedical Engineering
Background:
- T2-weighted MRI visual assessment of corticospinal tract (CST) hyperintensity has limited sensitivity for amyotrophic lateral sclerosis (ALS) diagnosis.
- A quantitative approach using FLAIR MRI may improve diagnostic accuracy and disease monitoring in ALS.
- Exploring FLAIR MRI intensity across diverse ALS phenotypes is crucial for understanding its clinical utility.
Purpose of the Study:
- To investigate the quantitative FLAIR MRI intensity in the CST and corpus callosum in patients with various ALS phenotypes.
- To compare FLAIR MRI intensity between ALS patient subgroups and healthy controls.
- To assess the longitudinal changes in FLAIR MRI intensity and its correlation with clinical outcomes.
Main Methods:
- 3 Tesla MRI scans were acquired for 33 classical ALS patients, 10 with flail arm presentation, 6 with primary lateral sclerosis, and 21 healthy controls.
- Quantitative FLAIR MRI intensity was measured in the CST and corpus callosum.
- Longitudinal analysis was performed on a subset of patients, and correlations with executive function and ALS Functional Rating Scale (ALSFRS) scores were examined.
Main Results:
- Mean FLAIR intensity was significantly higher in ALS patient groups compared to controls.
- Cerebral peduncle FLAIR intensity demonstrated the strongest ability to classify ALS subgroups.
- FLAIR intensity showed a longitudinal increase, and the rate of change in the CST correlated with the decline in executive function and ALSFRS scores.
Conclusions:
- Quantitative FLAIR MRI provides valuable, quantifiable information for ALS.
- FLAIR MRI has potential for diagnostic, patient stratification, and disease monitoring applications in ALS.
- This imaging technique may aid in understanding disease progression and treatment response in ALS.
