Neuroimaging in amyotrophic lateral sclerosis: current and emerging uses

ABSTRACT

Introduction: Several neuroimaging techniques have been used to define in vivo markers of pathological alterations underlying amyotrophic lateral sclerosis (ALS). Growing evidence supports the use of magnetic resonance imaging (MRI) and positron emission tomography (PET) for the non-invasive detection of central nervous system involvement in patients with ALS.

Areas covered: A comprehensive overview of structural and functional neuroimaging applications in ALS is provided, focusing on motor and extra-motor involvement in the brain and the spinal cord. Implications for pathogenetic models, patient diagnosis, prognosis, monitoring, and the design of clinical trials are discussed.

Expert commentary: State-of-the-art neuroimaging techniques provide fundamental instruments for the detection and quantification of upper motor neuron and extra-motor brain involvement in ALS, with relevance for both pathophysiologic investigation and clinical practice. Network-based analysis of structural and functional connectivity alterations and multimodal approaches combining several neuroimaging measures are promising tools for the development of novel diagnostic and prognostic markers to be used at the individual patient level.

KEYWORDS:

• Amyotrophic lateral sclerosis
• magnetic resonance imaging
• atrophy
• white matter damage
• resting state functional connectivity
• positron emission tomography
• spinal cord imaging
• network analysis

Declaration of interest

F Agosta is Section Editor of NeuroImage: Clinical, has received speaker honoraria from Biogen Idec, Novartis, and ExceMED – Excellence in Medical Education and receives or has received research support from the Italian Ministry of Health, Fondazione Italiana di Ricerca per la SLA (AriSLA), and the European Research Council. M Filippi is Editor-in-Chief for the Journal of Neurology; serves on a scientific advisory board for Teva Pharmaceutical Industries; has received compensation for consulting and/or speaking activities from Biogen Idec, Merck-Serono, Novartis, Teva Pharmaceuticals; and receives research support from Biogen Idec, Merck-Serono, Teva Pharmaceuticals, Novartis, Roche, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, Cure PSP, Alzheimer’s Drug Discovery Foundation, the Jacques and Gloria Gossweiler Foundation, and AriSLA. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by Ministero della Salute, Italy [RF-2011-02351193].