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Research ArticleFunctional

MR Spectroscopy Findings in Early Stages of Motor Neuron Disease

M.M. van der Graaff, C. Lavini, E.M. Akkerman, Ch.B. Majoie, A.J. Nederveen, A.H. Zwinderman, F. Brugman, L.H. van den Berg, J.M.B.V. de Jong and M. de Visser
American Journal of Neuroradiology November 2010, 31 (10) 1799-1806; DOI: https://doi.org/10.3174/ajnr.A2217
M.M. van der Graaff
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C. Lavini
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E.M. Akkerman
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Ch.B. Majoie
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A.J. Nederveen
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A.H. Zwinderman
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F. Brugman
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L.H. van den Berg
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J.M.B.V. de Jong
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M. de Visser
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    Voxel position in the precentral gyrus at baseline in the transverse (A), sagittal (B), and coronal (C) planes.

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    Fig 2.

    Voxel position in the precentral gyrus in the same patient as in Fig 1, six months later, in the transverse (A), sagittal (B), and coronal (C) planes.

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    Fig 3.

    Spectroscopy of the primary motor cortex (example).

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    Fig 4.

    Scatterplots of levels of NAAx (A) and mIns (B) per cohort at baseline.

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    Fig 5.

    ROC curves for NAAx, NAAx/mIns, and finger-tapping speed. A and B, Curves are based on properties of parameters to discriminate patients from controls (A) and ALS from PMA (B).

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    Table 1:

    Baseline data of 4 cohorts of MND phenotypes and healthy controlsa

    PLS (n = 12)ALS-L (n = 12)ALS-B (n = 12)PMA (n = 12)Controls (n= 12)
    Male/female7:510:25:711:17:5
    Age (yr) (median/range)59.0 (48–74)58.0 (41–78)56.5 (42–72)60.5 (44–72)56.5 (46–80)
    Duration symptoms (mo)50.2 ± 24.810.5 ± 2.59.8 ± 3.210.8 ± 2.0NA
    Diagnostic delay (mo)24.4 ± 16.06.6 ± 2.56.7 ± 2.76.6 ± 2.9NA
    Disease progression rateb0.010 ± 0.0050.027 ± 0.0160.026 ± 0.0180.020 ± 0.010NA
    VC (%)91.5 ± 23.3.028101.3 ± 23.898.5 ± 17.9.043102.5 ± 14.9114.6 ± 18.5
    ALSFRS-R35.0 ± 4.6<.00140.1 ± 3.9<.00140.1 ± 4.7<.001.41.8 ± 3.7<.00148.0 ± 0
    Finger tapping/sc2.3 ± 1.2<.0013.3 ± 1.3.0024.0 ± 1.3.0134.8 ± 0.75.1 ± 0.6
    Foot tapping/sc1.4 ± 0.9<.0012.4 ± 1.1.192.9 ± 1.32.4 ± 1.43.4 ± 0.7
    NAAx7.46 ± 0.80<.0018.56 ± 1.168.78 ± 1.129.58 ± 0.789.32 ± 0.84
    Glx8.06 ± 1.348.75 ± 1.687.99 ± 1.857.68 ± 1.668.42 ± 1.47
    mIns4.78 ± 0.80.0244.56 ± 0.944.28 ± 0.814.26 ± 0.913.93 ± 0.74
    NAAx/mIns1.62 ± 0.38.0011.97 ± 0.59.0242.12 ± 0.492.35 ± 0.552.46 ± 0.56
    • a Data are given as mean ± SD, unless otherwise indicated. Statistical significance compared with controls was set at P < .05 (P values in superscript).

    • b Disease progression rate = (48 − ALSFRS-R score at baseline) / disease duration (days).

    • c Finger and foot tapping: (L + R) / 2.

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    Table 2:

    Clinical and MRS data: changes with time (6 months)a

    ALS-L (n = 7) Baseline → Follow-UpALS-B (n = 9) Baseline → Follow-UpPMA (n = 10) Baseline → Follow-UpControls (n = 12) Baseline → Follow-Up
    VC (%)106.9 → 101.9101.4 → 84.4.013101.0 → 91.3.028114.6 → 117.2
    ALSFRS-R42.6 → 39.3.02641.3 → 36.4.01141.8 → 36.8.00848.0 → 47.8
    Finger tapping/sb3.32 → 2.49.0464.29 → 3.77.0384.83 → 4.285.10 → 4.98
    Foot tapping/sb2.80 → 2.133.17 → 2.732.37 → 1.883.44 → 3.74
    NAAx8.79 → 9.078.65 → 8.219.72 → 9.18.0229.32 → 9.25
    Glx8.54 → 7.508.12 → 8.547.72 → 8.008.42 → 8.07
    mIns4.29 → 4.544.25 → 4.614.30 → 3.923.93 → 3.90
    NAAx/mIns2.11 → 2.042.08 → 1.862.37 → 2.392.45 → 2.40
    • a Values are means. P values (superscript) result from the Wilcoxon paired test for nonparametric data. Statistical significance was set at P < .05.

    • b Finger- and foot-tapping speed: (L + R) / 2.

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    Table 3:

    Mutual comparisons of NAAx levels at baseline (P values)a

    PLSALS-LALS-B
    ALS-LP = .024NANS
    ALS-BP = .002NSNA
    PMAP < .001P = .033P = .043
    • a P values result from the Mann-Whitney U test for nonparametric data. Statistical significance was set at P <.05. Mean values ± SD of NAAx level per group at baseline are shown in Table 1.

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    Table 4:

    Areas under the ROC curve for NAAx, NAAx/mIns, and finger-tapping speed at baseline

    Accuracy to Differentiate Controls from Patients: Area (CI)aAccuracy to Differentiate Patients with ALS from Patients with PMA: Area (CI)
    NAAx0.663 (0.510–0.816)0.750 (0.582–0.918).016
    Finger-tapping speedb0.820 (0.709–0.932).0010.764 (0.608–0.919).011
    NAAx/mIns0.712 (0.573–0.850).0240.649 (0.463–0.836)
    • a All patient groups included.

    • b Finger-tapping speed: (L + R) / 2.

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American Journal of Neuroradiology: 31 (10)
American Journal of Neuroradiology
Vol. 31, Issue 10
1 Nov 2010
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MR Spectroscopy Findings in Early Stages of Motor Neuron Disease
M.M. van der Graaff, C. Lavini, E.M. Akkerman, Ch.B. Majoie, A.J. Nederveen, A.H. Zwinderman, F. Brugman, L.H. van den Berg, J.M.B.V. de Jong, M. de Visser
American Journal of Neuroradiology Nov 2010, 31 (10) 1799-1806; DOI: 10.3174/ajnr.A2217
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M.M. van der Graaff, C. Lavini, E.M. Akkerman, Ch.B. Majoie, A.J. Nederveen, A.H. Zwinderman, F. Brugman, L.H. van den Berg, J.M.B.V. de Jong, M. de Visser
MR Spectroscopy Findings in Early Stages of Motor Neuron Disease
American Journal of Neuroradiology Nov 2010, 31 (10) 1799-1806; DOI: 10.3174/ajnr.A2217

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