Quantitative brainstem and spinal MRI in amyotrophic lateral sclerosis: implications for predicting noninvasive...

Area of Science:

• Neurology
• Radiology
• Pulmonology

Background:

• Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease.
• Respiratory failure due to motor neuron degeneration is the primary cause of mortality in ALS.
• Predicting the need for non-invasive ventilation (NIV) is crucial for patient management and clinical trial design.

Purpose of the Study:

• To evaluate the predictive potential of quantitative MRI of the brainstem and spinal cord for NIV requirement in ALS patients.
• To compare the performance of MRI-based models with clinical variables for predicting NIV need within six months of diagnosis.

Main Methods:

• Forty-one ALS patients underwent MRI and spirometry post-diagnosis.
• The need for NIV was monitored for six months.
• Four regression models were developed and compared: clinical variables, brainstem volumes, cervical spinal cord measurements, and a combined model.

Main Results:

• Clinical and brainstem volume models showed good predictive performance for NIV need (AUCs ≈ 0.85).
• Cervical spinal cord measurements also demonstrated similar predictive capabilities (AUC ≈ 0.87).
• A combined model integrating all predictors achieved the highest performance (R² = 0.60, AUC = 0.959), correlating with lung volumes.

Conclusions:

• Brainstem volumes and spinal cord cross-sectional area are promising quantitative MRI biomarkers.
• These imaging measures can effectively predict the need for respiratory intervention in ALS.
• Quantitative MRI offers valuable insights for predicting respiratory decline in ALS patients.