Diagnostic Accuracy of Diffusion Tensor Imaging in Amyotrophic Lateral Sclerosis

Abstract

Rationale and Objectives There have been a large number of case-control studies using diffusion tensor imaging (DTI) in amyotrophic lateral sclerosis (ALS). The objective of this study was to perform an individual patient data (IPD) meta-analysis for the estimation of the diagnostic accuracy measures of DTI in the diagnosis of ALS using corticospinal tract data. Materials and Methods MEDLINE, EMBASE, CINAHL, and Cochrane databases (1966–April 2011) were searched. Studies were included if they used DTI region of interest or tractography techniques to compare mean cerebral corticospinal tract fractional anisotropy values between ALS subjects and healthy controls. Corresponding authors from the identified articles were contacted to collect individual patient data. IPD meta-analysis and meta-regression were performed using Stata. Meta-regression covariate analysis included age, gender, disease duration, and Revised Amyotrophic Lateral Sclerosis Functional Rating Scale scores. Results Of 30 identified studies, 11 corresponding authors provided IPD and 221 ALS patients and 187 healthy control subjects were available for study. Pooled area under the receiver operating characteristic curve (AUC) was 0.75 (95% CI: 0.66–0.83), pooled sensitivity was 0.68 (95% CI: 0.62–0.75), and pooled specificity was 0.73 (95% CI: 0.66–0.80). Meta-regression showed no significant differences in pooled AUC for each of the covariates. There was moderate to high heterogeneity of pooled AUC estimates. Study quality was generally high. Data from 19 of the 30 eligible studies were not ascertained, raising possibility of selection bias. Conclusion Using corticospinal tract individual patient data, the diagnostic accuracy of DTI appears to lack sufficient discrimination in isolation. Additional research efforts and a multimodal approach that also includes ALS mimics will be required to make neuroimaging a critical component in the workup of ALS.

Cortical thickness in ALS: towards a marker for upper motor neuron involvement

“…The present results on cortical thickness should be viewed in light of other candidate imaging markers for UMN involvement in ALS. Diffusion-weighted imaging is currently regarded as a promising candidate marker,35 but a recent meta-analysis showed only a modest discriminatory capability of fractional anisotropy within the corticospinal tract, with a sensitivity of 0.65 and specificity of 0.67 36 37. Additionally, compared to the latter study, the present results on the diagnostic accuracy of cortical thickness appear promising, with an ROC analysis showing a sensitivity of 0.72 and specificity of 0.76.…”

Prospective Validation of 18F-FDG Brain PET Discriminant Analysis Methods in the Diagnosis of Amyotrophic Lateral Sclerosis

“…The best results in single-center studies have been obtained by combined MR imaging approaches (15,16). Combined diffusion tensor imaging and spectroscopy resulted in a sensitivity of 93% and a specificity of 85% (17), whereas diffusion tensor imaging in combination with voxel-based morphometry resulted in a sensitivity of 92% and a specificity of 88% (18).…”

A large-scale multicentre cerebral diffusion tensor imaging study in amyotrophic lateral sclerosis

“…Then, voxelwise statistical comparison (whole-brain-based spatial statistics, WBSS) was performed between the ALS patient group and the corresponding control group (refer to subsection ‘statistics’). Single-centre cross-sectional comparisons have already been reported in various studies 25 26…”