Abstract Details

Title MRI Alterations in the Brachial Plexus of ALS Patients

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 12-012

Objective To investigate brachial plexus MRI abnormalities in a large cohort of patients with amyotrophic lateral sclerosis (ALS).

Background Peripheral axonal loss has a key role in the pathogenesis of ALS. In vivo damage to the peripheral nervous system has not been examined in detail using MRI, and previous reports are contradictory and based on relatively small samples.

Design/Methods Brachial plexus MRI scans were obtained from 43 ALS patients and 12 healthy controls. Nerve roots and limb girdle muscles were evaluated for the presence of signal alterations (T2, T1 and STIR) and volume changes. C5, C6 and C7 roots were delineated on axial, T2-weighted volumetric images. Nerve root volumes and T2-signal intensities were measured. Adipose tissue thickness between trapezius and supraspinatus muscles was measured on T1-weighted images. Quantitative measures were compared using Mann-Whitney U tests. Correlations between clinical and MRI features were assessed using the Pearson correlation test.

Results At visual inspection, T2 hyperintensity and volume alterations of C5, C6, C7 nerve roots were observed in ALS patients. Muscle signal alterations and bilateral fat infiltration were also observed. The quantitative analysis showed increased T2-signal intensity in C5, C6 (p<0.001) and C7 roots (p=0.001, bilaterally) of ALS patients compared with healthy controls. Patients also showed increased C6 and C7 root volumes (p ranging 0.001-0.02). Adipose tissue thickness between trapezius and supraspinatus muscles was increased in patients (p<0.001, bilaterally). Disease progression rate measured using ALS Functional Rating Scale correlated with T2-signal intensity of left C6 and right C7 (r=0.45, p=0.03; and r=0.50, p=0.02, respectively).

Conclusions T2-hyperintensity and increased volume of brachial plexus roots likely reflect lower motor neuron and axonal degeneration in ALS, and might represent a tool to monitor disease evolution. Muscle structural abnormalities are consistent with denervation atrophy.

Authors/Disclosures
PRESENTER	No disclosure on file
Federica Agosta (San Raffaele Scientific Institute)	Federica Agosta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Philips. Federica Agosta has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier INC.
	No disclosure on file
Edoardo G. Spinelli, MD	Dr. Spinelli has nothing to disclose.
	No disclosure on file
Elisabetta Pagani	Elisabetta Pagani has nothing to disclose.
	No disclosure on file
Andrea Falini	No disclosure on file
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

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