MRI cortical thickness of bulbar region and impacts on survival in amyotrophic lateral sclerosis patients

Fangfang HU; Jiaoting Jin; Qiuli Zhang; Ming Zhang; Qiaoyi Chen; Haining LI; Qianqian Duan; Xing Qin; Li Kang; Rui Jia; Xiao Liu; Jingxia Dang

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MRI cortical thickness of bulbar region and impacts on survival in amyotrophic lateral sclerosis patients

VernacularTitle:肌萎缩侧索硬化症患者延髓区域MRI皮质厚度特点及对生存的影响
Author: Fangfang HU ¹ ; Jiaoting JIN ¹ ; Qiuli ZHANG ² ; Ming ZHANG ² ; Qiaoyi CHEN ³ ; Haining LI ² ; Qianqian DUAN ² ; Xing QIN ¹ ; Li KANG ¹ ; Rui JIA ¹ ; Xiao LIU ¹ ; Jingxia DANG ¹
Author Information

1. Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061
2. Department of imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061
3. Department of Cell Biology and Genetics, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an 710061, China
Publication Type:Journal Article
Keywords: amyotrophic lateral sclerosis; bulbar involvement; bulbar subgroup score; cortical thickness; survival analysis
From: Journal of Xi'an Jiaotong University(Medical Sciences) 2023;44(5):681-687
CountryChina
Language:Chinese
Abstract: 【Objective】 To investigate cortical thickness changes in the face-head region of the primary motor cortex (PMC) and its effect on survival in amyotrophy lateral sclerosis (ALS) patients. 【Methods】 A retrospective analysis was performed on 105 ALS patients who underwent head MRI scan at the same time. The A4hf (face-head) region of PMC was used as the region of interest (ROI). According to clinical symptoms, patients were divided into two groups: bulbar involvement and non-bulbar involvement. The differences of clinical features and cortical thickness in ROI were analyzed. According to the symptoms of bulbar palsy, physical examination of nervous system and EMG of tongue muscle, the patients with bulbar palsy were divided into lower motor neuron (LMN), upper motor neuron (UMN) and LMN+UMN groups. The differences of bulbar subgroup score and ROI of cortical thickness were analyzed. Age at onset, body mass index, delayed time of diagnosis, bulbar subgroup score, and ROI cortical thickness were included in survival analysis. 【Results】 ① The ROI cortical thickness was significantly lower in bulbar involvement group than non-bulbar involvement group (-0.198±0.87 vs. 0.235±0.95, P=0.017). ② There were no significant differences in the bulbar subgroup scores or cortical thickness of ROI between LMN, UMN and LMN+UMN groups (P>0.05). ③ Survival analysis showed age of onset (HR=3.296, 95% CI:1.63-6.664, P=0.001), delayed time of diagnosis (HR=0.361, 95% CI:0.184-0.705, P=0.003), bulbar subgroup score (HR 0.389, 95% CI:0.174-0.868, P=0.021), and ZRE_ROI cortical thickness (HR=2.309, 95% CI:1.046-5.096, P=0.038) were independent influencing factors of ALS survival. 【Conclusion】 Cortical thickness in A4hf (face-head) region can more objectively reflect UMN signs of region bulbar. In addition to age of onset and delayed time of diagnosis, bulbar subgroup score and cortical thickness of face-head region are also independent influencing factors, and cortical thinning in face-head region is a protective factor for survival of ALS patients.