Gray Matter Volume Changes over the Whole Brain in the Bulbar- and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study

Chen Zhiye; Liu Mengqi; Ma Lin

doi:10.24920/11804

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Gray Matter Volume Changes over the Whole Brain in the Bulbar- and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study

Chinese Medicine Science Journal Vol. 33, Issue 1, Pages: 20-28(2018)

ORIGINAL ARTICLE | Updated：2024-04-10

- Gray Matter Volume Changes over the Whole Brain in the Bulbar- and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study
- Affiliations：
  
  1. Department of Radiology, Chinese PLA General Hospital, Beijing 100853, China
  2. Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Sanya, Hainan 572013, China
- Author bio：
- Funds：
- DOI：10.24920/11804
  CLC：
- Received：14 June 2017，
  
  Published Online：13 February 2018，
  
  Published：01 April 2018
- Accepted：
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Chen Zhiye, Liu Mengqi, Ma Lin. Gray Matter Volume Changes over the Whole Brain in the Bulbar- and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study[J]. Chinese medicine science journal, 2018, 33(1): 20-28.
DOI：

Chen Zhiye, Liu Mengqi, Ma Lin. Gray Matter Volume Changes over the Whole Brain in the Bulbar- and Spinal-onset Amyotrophic Lateral Sclerosis: a Voxel-based Morphometry Study[J]. Chinese medicine science journal, 2018, 33(1): 20-28. DOI： 10.24920/11804.

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van der Graaff MM , de Jong JM , Baas F , et al . Upper motor neuron and extra-motor neuron involvement in amyotrophic lateral sclerosis: a clinical and brain imaging review . Neuromuscul Disord , 2009 ; 19 ( 1 ): 53 - 8 . doi: 10.1016/j.nmd.2008.10.002 https://doi.org/10.1016/j.nmd.2008.10.002 . DOI: 10.1016/j.nmd.2008.10.002 http://doi.org/10.1016/j.nmd.2008.10.002 http://linkinghub.elsevier.com/retrieve/pii/S0960896608006676 http://linkinghub.elsevier.com/retrieve/pii/S0960896608006676

Hartung V , Prell T , Gaser C , et al . Voxel-based MRI intensitometry reveals extent of cerebral white matter pathology in amyotrophic lateral sclerosis . PLoS One , 2014 ; 9 ( 8 ): e104894 . doi: 10.1371/journal.pone.0104894 https://doi.org/10.1371/journal.pone.0104894 . DOI: 10.1371/journal.pone.0104894 http://doi.org/10.1371/journal.pone.0104894 http://dx.plos.org/10.1371/journal.pone.0104894 http://dx.plos.org/10.1371/journal.pone.0104894

Kalra S , Arnold D . Neuroimaging in amyotrophic lateral sclerosis . Amyotrophic Lateral Scler Other Motor Neuron Disord , 2003 ; 4 ( 4 ): 243 - 8 . doi: 10.1080/14660820310011269 https://doi.org/10.1080/14660820310011269 . DOI: 10.1080/14660820310011269 http://doi.org/10.1080/14660820310011269 http://www.tandfonline.com/doi/full/10.1080/14660820310011269 http://www.tandfonline.com/doi/full/10.1080/14660820310011269

Grosskreutz J , Kaufmann J , Frädrich J , et al . Widespread sensorimotor and frontal cortical atrophy in Amyotrophic Lateral Sclerosis . BMC Neurol , 2006 ; 6 : 17 . doi: 10.1186/1471-2377-6-17 https://doi.org/10.1186/1471-2377-6-17 . DOI: 10.1186/1471-2377-6-17 http://doi.org/10.1186/1471-2377-6-17 http://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-6-17 http://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-6-17

Abrahams S , Goldstein LH , Suckling J , et al . Frontotemporal white matter changes in amyotrophic lateral sclerosis . J Neurol , 2005 ; 252 ( 3 ): 321 - 31 . doi: 10.1007/s00415-005-0646-x https://doi.org/10.1007/s00415-005-0646-x . DOI: 10.1007/s00415-005-0646-x http://doi.org/10.1007/s00415-005-0646-x http://link.springer.com/10.1007/s00415-005-0646-x http://link.springer.com/10.1007/s00415-005-0646-x

Kassubek J , Unrath A , Huppertz HJ , et al . Global brain atrophy and corticospinal tract alterations in ALS, as investigated by voxel-based morphometry of 3-D MRI . Amyotroph Lateral Scler Other Motor Neuron Disord , 2005 ; 6 ( 4 ): 213 - 20 . doi: 10.1080/14660820510038538 https://doi.org/10.1080/14660820510038538 . DOI: 10.1080/14660820510038538 http://doi.org/10.1080/14660820510038538 http://www.tandfonline.com/doi/full/10.1080/14660820510038538 http://www.tandfonline.com/doi/full/10.1080/14660820510038538

Yamauchi H , Fukuyama H , Ouchi Y , et al . Corpus callosum atrophy in amyotrophic lateral sclerosis . J Neurol Sci , 1995 ; 134 ( 1-2 ): 189 - 96 . doi: 10.1016/0022-510X(95)00220-6 https://doi.org/10.1016/0022-510X(95)00220-6 . DOI: 10.1016/0022-510X(95)00220-6 http://doi.org/10.1016/0022-510X(95)00220-6 http://linkinghub.elsevier.com/retrieve/pii/0022510X95002206 http://linkinghub.elsevier.com/retrieve/pii/0022510X95002206

Pinkhardt EH , van Elst LT , Ludolph AC , et al . Amygdala size in amyotrophic lateral sclerosis without dementia: an in vivo study using MRI volumetry . BMC Neurol , 2006 ; 6 : 48 . doi: 10.1186/1471-2377-6-48 https://doi.org/10.1186/1471-2377-6-48 . DOI: 10.1186/1471-2377-6-48 http://doi.org/10.1186/1471-2377-6-48 http://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-6-48 http://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-6-48

Masuda M , Senda J , Watanabe H , et al . Involvement of the caudate nucleus head and its networks in sporadic amyotrophic lateral sclerosis-frontotemporal dementia continuum . Amyotroph Lateral Scler Frontotemporal Degener , 2016 ; 17 ( 7-8 ): 571 - 9 . doi: 10.1080/21678421.2016.1211151 https://doi.org/10.1080/21678421.2016.1211151 . DOI: 10.1080/21678421.2016.1211151 http://doi.org/10.1080/21678421.2016.1211151 https://www.tandfonline.com/doi/full/10.1080/21678421.2016.1211151 https://www.tandfonline.com/doi/full/10.1080/21678421.2016.1211151

Mezzapesa DM , Ceccarelli A , Dicuonzo F , et al . Whole-brain and regional brain atrophy in amyotrophic lateral sclerosis . AJNR Am J Neuroradiol , 2007 ; 28 ( 2 ): 255 - 9 . doi: 10.1186/1471-2377-6-17 https://doi.org/10.1186/1471-2377-6-17 . DOI: 10.1055/s-2006-951799 http://doi.org/10.1055/s-2006-951799 http://europepmc.org/abstract/MED/17296989 http://europepmc.org/abstract/MED/17296989

Shen D , Cui L , Fang J , et al . Voxel-wise meta-analysis of gray matter changes in amyotrophic lateral sclerosis . Front Aging Neurosci , 2016 ; 8 : 64 . doi: 10.3389/fnagi.2016.00064 https://doi.org/10.3389/fnagi.2016.00064 . DOI: 10.3389/fnagi.2016.00064 http://doi.org/10.3389/fnagi.2016.00064 http://www.ncbi.nlm.nih.gov/pubmed/27065078 http://www.ncbi.nlm.nih.gov/pubmed/27065078

Sheng L , Ma H , Zhong J , et al . Motor and extra-motor gray matter atrophy in amyotrophic lateral sclerosis: quantitative meta-analyses of voxel-based morphometry studies . Neurobiol Aging , 2015 ; 36 ( 12 ): 3288 - 99 . doi: 10.1016/j.neurobiolaging.2015.08.018 https://doi.org/10.1016/j.neurobiolaging.2015.08.018 . DOI: 10.1016/j.neurobiolaging.2015.08.018 http://doi.org/10.1016/j.neurobiolaging.2015.08.018 http://linkinghub.elsevier.com/retrieve/pii/S0197458015004297 http://linkinghub.elsevier.com/retrieve/pii/S0197458015004297

Chen Z , Ma L . Grey matter volume changes over the whole brain in amyotrophic lateral sclerosis: a voxel-wise meta-analysis of voxel based morphometry studies . Amyotroph Lateral Scler , 2010 ; 11 ( 6 ): 549 - 54 . doi: 10.3109/17482968.2010.516265 https://doi.org/10.3109/17482968.2010.516265 . DOI: 10.3109/17482968.2010.516265 http://doi.org/10.3109/17482968.2010.516265 http://www.tandfonline.com/doi/full/10.3109/17482968.2010.516265 http://www.tandfonline.com/doi/full/10.3109/17482968.2010.516265

Brooks BR , Miller RG , Swash M , et al . . El Escorial ####: FFFF criteria for the diagnosis of amyotrophic lateral sclerosis . Amyotroph Lateral Scler Other Motor Neuron Disord 2000 ; 1 ( 5 ): 293 - 9 . doi: 10.1080/146608200300079536 https://doi.org/10.1080/146608200300079536 . DOI: 10.1080/146608200300079536 http://doi.org/10.1080/146608200300079536 http://www.tandfonline.com/doi/full/10.1080/146608200300079536 http://www.tandfonline.com/doi/full/10.1080/146608200300079536

Swash M . New ideas on the ALS functional rating scale . J Neurol Neurosurg Psychiatry 2017 ; 88 ( 5 ): 371 - 2 . doi: 10.1136/jnnp-2016-315116 https://doi.org/10.1136/jnnp-2016-315116 . DOI: 10.1136/jnnp-2016-315116 http://doi.org/10.1136/jnnp-2016-315116 http://jnnp.bmj.com/lookup/doi/10.1136/jnnp-2016-315116 http://jnnp.bmj.com/lookup/doi/10.1136/jnnp-2016-315116

Herndon RM . Handbook of Neurologic Rating Scales . New York: Demos Vermande ; 1997 . p. 27 - 79 . DOI: 10.1136/jnnp.65.4.615a http://doi.org/10.1136/jnnp.65.4.615a http://ci.nii.ac.jp/ncid/BA33157555?l=en http://ci.nii.ac.jp/ncid/BA33157555?l=en

Galea M , Woodward M . Mini-Mental State Examination (MMSE) . Aust J Physiother 2005 ; 51 ( 3 ): 198 . doi: 10.1016/S0004-9514(05)70034-9 https://doi.org/10.1016/S0004-9514(05)70034-9 . DOI: 10.1016/S0004-9514(05)70034-9 http://doi.org/10.1016/S0004-9514(05)70034-9 http://linkinghub.elsevier.com/retrieve/pii/S0004951405700349 http://linkinghub.elsevier.com/retrieve/pii/S0004951405700349

Ashburner J , Friston KJ . Voxel-based morphometry—the methods . Neuroimage 2000 ; 11 ( 6 Pt 1 ): 805 - 21 . doi: 10.1006/nimg.2000.0582 https://doi.org/10.1006/nimg.2000.0582 . DOI: 10.1006/nimg.2000.0582 http://doi.org/10.1006/nimg.2000.0582 http://linkinghub.elsevier.com/retrieve/pii/S1053811900905822 http://linkinghub.elsevier.com/retrieve/pii/S1053811900905822

Gredal O , Pakkenberg H , Karlsborg M , et al . . Unchanged total number of neurons in motor cortex and neocortex in amyotrophic lateral sclerosis: a stereological study . J Neurosci Methods 2000 ; 95 ( 2 ): 171 - 6 . doi: 10.1016/S0165-0270(99)00175-2 https://doi.org/10.1016/S0165-0270(99)00175-2 . DOI: 10.1016/S0165-0270(99)00175-2 http://doi.org/10.1016/S0165-0270(99)00175-2 http://linkinghub.elsevier.com/retrieve/pii/S0165027099001752 http://linkinghub.elsevier.com/retrieve/pii/S0165027099001752

Kiernan JA , Hudson AJ . Changes in shapes of surviving motor neurons in amyotrophic lateral sclerosis . Brain 1993 ; 116 ( Pt 1 ): 203 - 15 . doi: 10.1093/brain/116.1.203 https://doi.org/10.1093/brain/116.1.203 . DOI: 10.1093/brain/116.1.203 http://doi.org/10.1093/brain/116.1.203 https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/116.1.203 https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/116.1.203

Schreiber H , Gaigalat T , Wiedemuth-Catrinescu U , et al . . Cognitive function in bulbar- and spinal-onset amyotrophic lateral sclerosis. a longitudinal study in 52 patients . J Neurol 2005 ; 252 ( 7 ): 772 - 81 . doi: 10.1007/s00415-005-0739-6 https://doi.org/10.1007/s00415-005-0739-6 . DOI: 10.1007/s00415-005-0739-6 http://doi.org/10.1007/s00415-005-0739-6 http://link.springer.com/10.1007/s00415-005-0739-6 http://link.springer.com/10.1007/s00415-005-0739-6

Butman JA , Floeter MK . Decreased thickness of primary motor cortex in primary lateral sclerosis . AJNR Am J Neuroradiol 2007 ; 28 ( 1 ): 87 - 91 . DOI: 10.1007/978-3-540-45456-4_43 http://doi.org/10.1007/978-3-540-45456-4_43 http://europepmc.org/abstract/med/17213431 http://europepmc.org/abstract/med/17213431

Roccatagliata L , Bonzano L , Mancardi G , et al . . Detection of motor cortex thinning and corticospinal tract involvement by quantitative MRI in amyotrophic lateral sclerosis . Amyotroph Lateral Scler 2009 ; 10 ( 1 ): 47 - 52 . doi: 10.1080/17482960802267530 https://doi.org/10.1080/17482960802267530 . DOI: 10.1080/17482960802267530 http://doi.org/10.1080/17482960802267530 http://www.tandfonline.com/doi/full/10.1080/17482960802267530 http://www.tandfonline.com/doi/full/10.1080/17482960802267530

Chang JL , Lomen-Hoerth C , Murphy J , et al . . A voxel-based morphometry study of patterns of brain atrophy in ALS and ALS/FTLD . Neurology 2005 ; 65 ( 1 ): 75 - 80 . doi: 10.1212/01.wnl.0000167602.38643.29 https://doi.org/10.1212/01.wnl.0000167602.38643.29 . DOI: 10.1212/01.wnl.0000167602.38643.29 http://doi.org/10.1212/01.wnl.0000167602.38643.29 http://www.neurology.org/cgi/doi/10.1212/01.wnl.0000167602.38643.29 http://www.neurology.org/cgi/doi/10.1212/01.wnl.0000167602.38643.29

Kato S , Hayashi H , Yagishita A . Involvement of the frontotemporal lobe and limbic system in amyotrophic lateral sclerosis: as assessed by serial computed tomography and magnetic resonance imaging . J Neurol Sci 1993 ; 116 ( 1 ): 52 - 8 . doi: 10.1016/0022- 510X(93)90089-H https://doi.org/10.1016/0022- 510X(93)90089-H . DOI: 10.1016/0022-510X(93)90089-H http://doi.org/10.1016/0022-510X(93)90089-H http://linkinghub.elsevier.com/retrieve/pii/0022510X9390089H http://linkinghub.elsevier.com/retrieve/pii/0022510X9390089H

Hamilton RL , Bowser R . Alzheimer disease pathology in amyotrophic lateral sclerosis . Acta Neuropathol 2004 ; 107 ( 6 ): 515 - 22 . doi: 10.1007/s00401-004-0843-1 https://doi.org/10.1007/s00401-004-0843-1 . DOI: 10.1007/s00401-004-0843-1 http://doi.org/10.1007/s00401-004-0843-1 http://link.springer.com/10.1007/s00401-004-0843-1 http://link.springer.com/10.1007/s00401-004-0843-1

Hughes JT . Pathology of amyotrophic lateral sclerosis . Adv Neurol 1982 ; 36 : 61 - 74 . http://www.ncbi.nlm.nih.gov/pubmed/7180695 http://www.ncbi.nlm.nih.gov/pubmed/7180695

Chan S , Shungu DC , Douglas-Akinwande A , et al . . Motor neuron diseases: comparison of single-voxel proton MR spectroscopy of the motor cortex with MR imaging of the brain . Radiology 1999 ; 212 ( 3 ): 763 - 9 . doi: 10.1148/radiology.212.3.r99au35763 https://doi.org/10.1148/radiology.212.3.r99au35763 . DOI: 10.1148/radiology.212.3.r99au35763 http://doi.org/10.1148/radiology.212.3.r99au35763 http://pubs.rsna.org/doi/10.1148/radiology.212.3.r99au35763 http://pubs.rsna.org/doi/10.1148/radiology.212.3.r99au35763

Ellis CM , Suckling J , Amaro E , Jr., et al. Volumetric analysis reveals corticospinal tract degeneration and extramotor involvement in ALS . Neurology 2001 ; 57 ( 9 ): 1571 - 8 . doi: 10.1212/WNL.57.9.1571 https://doi.org/10.1212/WNL.57.9.1571 . DOI: 10.1212/WNL.57.9.1571 http://doi.org/10.1212/WNL.57.9.1571 http://www.neurology.org/cgi/doi/10.1212/WNL.57.9.1571 http://www.neurology.org/cgi/doi/10.1212/WNL.57.9.1571

Toft MH , Gredal O , Pakkenberg B . The size distribution of neurons in the motor cortex in amyotrophic lateral sclerosis . J Anat 2005 ; 207 ( 4 ): 399 - 407 . doi: 10.1111/j.1469-7580.2005.00465.x https://doi.org/10.1111/j.1469-7580.2005.00465.x . DOI: 10.1111/j.1469-7580.2005.00465.x http://doi.org/10.1111/j.1469-7580.2005.00465.x http://www.blackwell-synergy.com/toc/joa/207/4 http://www.blackwell-synergy.com/toc/joa/207/4

Swick D , Ashley V , Turken AU . Left inferior frontal gyrus is critical for response inhibition . BMC Neurosci 2008 ; 9 : 102 . doi: 10.1186/1471-2202-9-102 https://doi.org/10.1186/1471-2202-9-102 . DOI: 10.1186/1471-2202-9-102 http://doi.org/10.1186/1471-2202-9-102 http://bmcneurosci.biomedcentral.com/articles/10.1186/1471-2202-9-102 http://bmcneurosci.biomedcentral.com/articles/10.1186/1471-2202-9-102

Winhuisen L , Thiel A , Schumacher B , et al . . Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia: a combined repetitive transcranial magnetic stimulation and positron emission tomography study . Stroke 2005 ; 36 ( 8 ): 1759 - 63 . doi: 10.1161/01.STR.0000174487.81126.ef https://doi.org/10.1161/01.STR.0000174487.81126.ef . DOI: 10.1161/01.STR.0000174487.81126.ef http://doi.org/10.1161/01.STR.0000174487.81126.ef http://stroke.ahajournals.org/cgi/doi/10.1161/01.STR.0000174487.81126.ef http://stroke.ahajournals.org/cgi/doi/10.1161/01.STR.0000174487.81126.ef

Zhu Z , Zhang JX , Wang S , et al . . Involvement of left inferior frontal gyrus in sentence-level semantic integration . Neuroimage 2009 ; 47 ( 2 ): 756 - 63 . doi: 10.1016/j.neuroimage.2009.04.086 https://doi.org/10.1016/j.neuroimage.2009.04.086 . DOI: 10.1016/j.vetimm.2005.02.019 http://doi.org/10.1016/j.vetimm.2005.02.019 http://linkinghub.elsevier.com/retrieve/pii/S1053811909004753 http://linkinghub.elsevier.com/retrieve/pii/S1053811909004753

Paulesu E , Goldacre B , Scifo P , et al . . Functional heterogeneity of left inferior frontal cortex as revealed by fMRI . Neuroreport 1997 ; 8 ( 8 ): 2011 - 7 . doi: 10.1097/00001756-199705260-00042 https://doi.org/10.1097/00001756-199705260-00042 . DOI: 10.1097/00001756-199705260-00042 http://doi.org/10.1097/00001756-199705260-00042 http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00001756-199705260-00042 http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00001756-199705260-00042

Lomen-Hoerth C , Murphy J , Langmore S , et al . . Are amyotrophic lateral sclerosis patients cognitively normal? Neurology 2003 ; 60 ( 7 ): 1094 - 7 . doi: 10.1212/01.WNL.0000055861.95202.8D https://doi.org/10.1212/01.WNL.0000055861.95202.8D . DOI: 10.1212/01.WNL.0000055861.95202.8D http://doi.org/10.1212/01.WNL.0000055861.95202.8D http://www.neurology.org/cgi/doi/10.1212/01.WNL.0000055861.95202.8D http://www.neurology.org/cgi/doi/10.1212/01.WNL.0000055861.95202.8D

Mantovan MC , Baggio L , Dalla Barba G , et al . Memory deficits and retrieval processes in ALS . Eur J Neurol 2003 ; 10 ( 3 ): 221 - 7 . doi: 10.1046/j.1468-1331.2003.00607.x https://doi.org/10.1046/j.1468-1331.2003.00607.x . DOI: 10.1046/j.1468-1331.2003.00607.x http://doi.org/10.1046/j.1468-1331.2003.00607.x http://doi.wiley.com/10.1046/j.1468-1331.2003.00607.x http://doi.wiley.com/10.1046/j.1468-1331.2003.00607.x

Abrahams S , Goldstein LH , Simmons A , et al . . Word retrieval in amyotrophic lateral sclerosis: a functional magnetic resonance imaging study . Brain 2004 ; 127 ( Pt 7 ): 1507 - 17 . doi: 10.1093/brain/awh170 https://doi.org/10.1093/brain/awh170 . DOI: 10.1093/brain/awh170 http://doi.org/10.1093/brain/awh170 https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awh170 https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awh170

Wijesekera LC , Leigh PN . Amyotrophic lateral sclerosis . Orphanet J Rare Dis 2009 ; 4 : 3 . doi: 10.1186/1750-1172-4-3 https://doi.org/10.1186/1750-1172-4-3 . DOI: 10.1186/1750-1172-4-3 http://doi.org/10.1186/1750-1172-4-3 http://ojrd.biomedcentral.com/articles/10.1186/1750-1172-4-3 http://ojrd.biomedcentral.com/articles/10.1186/1750-1172-4-3

Portet F , Cadilhac C , Touchon J , Camu W . Cognitive impairment in motor neuron disease with bulbar onset . Amyotroph Lateral Scler Other Motor Neuron Disord 2001 ; 2 ( 1 ): 23 - 9 . doi: 10.1080/14660820152415708 https://doi.org/10.1080/14660820152415708 . DOI: 10.1080/146608201300079382 http://doi.org/10.1080/146608201300079382 http://test.europepmc.org/abstract/MED/11465929 http://test.europepmc.org/abstract/MED/11465929

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