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Published on: July 19, 2019
Structural magnetic resonance imaging findings and histopathological correlations in motor neuron diseases-A
Charlotte Zejlon1,2, Dominik Nakhostin3, Sebastian Winklhofer3
1Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Objectives:
The lack of systematic evidence on neuroimaging findings in motor neuron diseases (MND) hampers the diagnostic utility of magnetic resonance imaging (MRI). Thus, we aimed at performing a systematic review and meta-analysis of MRI features in MND including their histopathological correlation.
Methods:
In a comprehensive literature search, out of 5941 unique publications, 223 records assessing brain and spinal cord MRI findings in MND were eligible for a qualitative synthesis. 21 records were included in a random effect model meta-analysis.
Results:
Our meta-analysis shows that both T2-hyperintensities along the corticospinal tracts (CST) and motor cortex T2*-hypointensitites, also called "motor band sign", are more prevalent in ALS patients compared to controls [OR 2.21 (95%-CI: 1.40-3.49) and 10.85 (95%-CI: 3.74-31.44), respectively]. These two imaging findings correlate to focal axonal degeneration/myelin pallor or glial iron deposition on histopathology, respectively. Additionally, certain clinical MND phenotypes such as amyotrophic lateral sclerosis (ALS) seem to present with distinct CNS atrophy patterns.
Conclusions:
Although CST T2-hyperintensities and the "motor band sign" are non-specific imaging features, they can be leveraged for diagnostic workup of suspected MND cases, together with certain brain atrophy patterns. Collectively, this study provides high-grade evidence for the usefulness of MRI in the diagnostic workup of suspected MND cases.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42020182682.
Insights
Magnetic resonance imaging (MRI) can aid in diagnosing motor neuron diseases (MND). Key MRI findings like corticospinal tract T2-hyperintensities and the "motor band sign" show promise for diagnosis.
Area of Science:
- Neuroimaging
- Neurology
- Radiology
Background:
- Systematic evidence on neuroimaging in motor neuron diseases (MND) is lacking.
- This limits the diagnostic utility of magnetic resonance imaging (MRI).
Conclusions:
- CST T2-hyperintensities and the "motor band sign" are valuable, though non-specific, MRI features for diagnosing suspected MND.
- Combined with brain atrophy patterns, MRI offers high-grade evidence for MND diagnostic workup.
