ALS患者颈脊髓MRI：一项系统回顾和荟萃分析

IF 3.6 2区医学 Q2 NEUROIMAGING

Neuroimage-Clinical Pub Date : 2025-01-01 DOI:10.1016/j.nicl.2025.103832

Taravat Yazdanian , Parisa Azimi , Suma Babu

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引用次数: 0

摘要

由于中枢神经系统疾病生物学的复杂性，肌萎缩性侧索硬化症（ALS）患者的疾病追踪和预后可能相当具有挑战性。本系统综述和荟萃分析旨在总结ALS患者颈脊髓定量MRI （qMRI）生物标志物的变化。方法检索截至2023年8月的spubmed、Scopus、Cochrane Library和Web of Science数据库。使用的术语有“ALS”、“颈脊髓”、“MRI”、“弥散张量成像（DTI）”、“分数各向异性（FA）”、“平均扩散率（MD）”、“磁化传递比（MTR）”、“横截面积（CSA）”、“径向扩散率（RD）”和“萎缩”。采用纽卡斯尔-渥太华量表（NOS）评价研究质量。我们计算了合并：1)标准化平均差（SMD）和95% ci，用于比较评估ALS个体和健康人群的qMRI参数。2)用CMA软件估计两组正规值的qMRI参数均值。异质性和发表偏倚由i平方统计量和漏斗图确定。结果共纳入30项研究，共1817名受试者（女性占35.9%），其中29项研究的NOS≥5，表明总体数据质量较高。SMD分析显示(a)沿整个颈髓长度（C1-C7） CSA显著降低(p值<；0.0001)，宫颈增大区（C4-C6区）优先变薄(p值<；0.0001) (b) FA显著降低(p值<；0.0001)，尤其是FA左外侧皮质脊髓束(p值<；0.0001)和(c) MD显著增加(p值<；0.0001)。合并分析显示，ALS个体与对照组(a) CSA （mm2）的均值（SD）值为C1[73.4(0.75), 78.5(0.67)， 6.9%差异]；C2[70.6(3.1), 71.5(3.5)，差异1.2%]；C3[69.8(1.5), 74.9(1.9)，差异7.3%]；C4[71.9(1.8), 77.6(2.8)， 7.9%差异]；C5[71.8(2.5), 79.5(3.3)，差异10.7%]；C6[66.8(2.7), 73.7(3.7)，差异10.3%]；C7 [56.7 (F2.2), 62.1(2.5)，差异9.5%]；(b) FA [0.54 (0.03), 0.56 (0.03)]；(c) MD[1.11 (0.18), 0.88(0)]；(d) FA LLCST[0.65(0.04), 0.77(0.04)]。ALS个体的MTR和RD均值（SD）分别为40.3（2.3）和0.70（0.0）。结论脊髓mri指标在ALS患者和健康对照者之间具有区别性。在本meta分析中可以看到，颈椎增大（C4-C6）的选择性萎缩在多个研究中是可重复的，因此是量化和跟踪ALS下运动神经元变性的潜在影像学标记。

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Cervical spinal cord MRI in ALS individuals: a systematic review and meta-analysis

Background

Disease tracking and prognostication of amyotrophic lateral sclerosis (ALS) can be quite challenging in people living with ALS, due to the complexity of central nervous system disease biology. This systematic review and meta-analysis aim to summarize cervical spinal cord quantitative MRI (qMRI) biomarker changes in individuals with ALS.

Methods

PubMed, Scopus, Cochrane Library, and Web of Science databases were searched up to August 2023. The terms used were “ALS”, “cervical spinal cord”, “MRI”,“ diffusion tensor imaging (DTI)”, “ fractional anisotropy (FA)”, “ mean diffusivity (MD) ”,“ magnetization transfer ratio (MTR)”, “ cross-sectional area (CSA)”, “ radial diffusivity (RD) ”, and “ atrophy ”. The Newcastle-Ottawa scale (NOS) was used to assess study quality. We calculated the pooled: 1) Standardized mean difference (SMD) and 95% CIs for comparative assessment of qMRI parameters in ALS individuals and the healthy population. 2) Estimate the mean of qMRI parameters for normative values in two groups by CMA software. Heterogeneity and publication bias were determined by the I-squared statistic and funnel plots.

Results

Thirty studies, with 1817 participants (35.9 % female) were included in this review, and 29 had a NOS ≥ 5 which indicates high-quality of data overall. The SMD analysis showed (a) significant decrease in CSA along the whole length of cervical cord (C1-C7) (p value < 0.0001), with a preferential thinning of the cervical enlargement region (C4-C6 region) (p value < 0.0001) (b) significant decrease in FA (p value < 0.0001), particularly FA left lateral corticospinal tract (p value < 0.0001) and (c) a significant increase in MD (p value < 0.0001) in ALS individuals compared to controls. The pooled analysis reveals that the mean (SD) values for ALS individuals versus controls for (a) CSA (in mm²) were C1 [73.4 (0.75), 78.5 (0.67), 6.9 % difference]; C2 [70.6 (3.1), 71.5 (3.5), 1.2 % difference]; C3 [69.8(1.5), 74.9 (1.9), 7.3 % difference]; C4 [71.9 (1.8), 77.6 (2.8), 7.9 % difference]; C5 [71.8 (2.5), 79.5 (3.3), 10.7 % difference]; C6 [66.8 (2.7), 73.7 (3.7), 10.3 % difference]; C7 [56.7 (F2.2), 62.1 (2.5), 9.5 % difference]; (b) FA [0.54 (0.03), 0.56 (0.03)]; (c) MD[1.11 (0.18), 0.88(0)]; and (d) FA LLCST [ 0.65 (0.04), 0.77 (0.04)], respectively. The mean (SD) value of the MTR and RD for ALS individuals was 40.3 (2.3), and 0.70 (0.0).

Conclusions

qMRI metrics of spinal cord show discriminatory potential between ALS and healthy controls. The selective atrophy of the cervical enlargement (C4–C6) is replicable across multiple studies as seen in this metanalysis and hence is a potential imaging marker for quantifying and tracking lower motor neuron degeneration in ALS.

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来源期刊

Neuroimage-Clinical NEUROIMAGING-

CiteScore

7.50

自引率

4.80%

发文量

368

审稿时长

52 days

期刊介绍： NeuroImage: Clinical, a journal of diseases, disorders and syndromes involving the Nervous System, provides a vehicle for communicating important advances in the study of abnormal structure-function relationships of the human nervous system based on imaging. The focus of NeuroImage: Clinical is on defining changes to the brain associated with primary neurologic and psychiatric diseases and disorders of the nervous system as well as behavioral syndromes and developmental conditions. The main criterion for judging papers is the extent of scientific advancement in the understanding of the pathophysiologic mechanisms of diseases and disorders, in identification of functional models that link clinical signs and symptoms with brain function and in the creation of image based tools applicable to a broad range of clinical needs including diagnosis, monitoring and tracking of illness, predicting therapeutic response and development of new treatments. Papers dealing with structure and function in animal models will also be considered if they reveal mechanisms that can be readily translated to human conditions.