Dual MRI technique leads to more accurate ALS diagnosis

A technique that uses two different types of magnetic resonance imaging (MRI) on the brain can more accurately diagnose amyotrophic lateral sclerosis  (ALS) than using a single type of MRI alone, a finding that could lead to earlier diagnoses of the deadly disease and ultimately to more effective treatments for patients. (Watch video here)

The study, “Multi-modal MRI as a Diagnostic Biomarker for Amyotrophic Lateral Sclerosis,” was performed by a research team from the University of Michigan’s Program for Neurology Research & Discovery, led by University of Michigan neuro-radiologist Bradley R. Foerster, M.D., Ph.D., an Emerging Scholar in the A. Alfred Taubman Medical research Institute.

Dr. FoersterThe article was published in the open-access Annals of Clinical and Translational Neurology, an official journal of the American Neurological Association.

The diagnosis of ALS, also known as Lou Gehrig’s Disease, is challenging to physicians because different patients show a wide range of symptoms. By adding proton magnetic resonance spectroscopy to diffusion tensor imaging, researchers found that diagnostic accuracy was significantly improved over that of DTI alone. Researchers hope that multi-modal MRI can help them identify biomarkers specific to ALS, and in earlier stages of the disease.

“We’re going to enroll patients with earlier-onset disease,” Dr. Foerster said. “And then we’re also going to include patients with other types of disease to make sure we have a signature that’s specific. What we’re trying to do is create an imaging fingerprint of this disease, just like you have a fingerprint that’s unique to you.”

In the study, Foerster and his team compared 29 ALS patients with 30 age- and gender-matched healthy controls. The subjects underwent brain MRI that collected thousands of data points, which Foerster and his colleagues will use to identify imaging characteristics of patients with early ALS.

“Analyzing this data is quite challenging,” Dr. Foerster said. “We’re trying to hone down the statistical models to say ‘what are the definitive characteristics of this imaging set for these disease patients?’”

ALS is a debilitating motor neuron disease that causes the loss of nerve cells in the brainstem and spinal cord that control movement. Also known as Lou Gehrig’s disease, it usually strikes people in midlife and is relentlessly progressive, typically resulting in death within five years of the first sign of symptoms. Patients lose the ability to control their limbs, facial muscles, swallowing, and eventually, the ability to breathe. While the causes of ALS are largely unknown, most cases likely arise through a combination of genetic factors and environmental stress.

Cross-discipline research can help researchers expand their understanding of disease mechanisms and treatment, according to Eva Feldman, M.D., Ph.D., Director of the Program for Neurology Research & Discovery and the A. Alfred Taubman Medical Research Institute, both at the University of Michigan.

“These types of collaborations are extremely important to the work we’re doing in our lab and in the Taubman Institute,” Dr. Feldman said. “By working with researchers in other areas, like Dr. Foerster, we can really expand the scope of our discovery. And that ultimately leads us more quickly to more effective treatments for patients of neurologic diseases like ALS.”

The Program for Neurology Research & Discovery (PNR&D) is the laboratory of Dr. Eva Feldman, M.D., Ph.D., the Russell N. DeJong Professor of Neurology at the University of Michigan Medical School and the director of the A. Alfred Taubman Medical Research Institute. Under Dr. Feldman’s direction, the PNR&D’s 30-plus scientists, clinicians, and students are working toward the common aim of understanding and curing neurological diseases.

Dr. Feldman is the principal investigator for a national phase 2 clinical trial that has injected millions of stem cells into the spinal cords of seven ALS patients in an effort to slow or stop the progression of ALS.

Foerster’s research is in part supported by an Emerging Scholar Grant from the A. Alfred Taubman Medical Research Institute.  Emerging Scholar grants are intended to help  junior clinician-scientists at the University of Michigan make progress in their medical research while establishing the credentials required to obtain funding from more traditional sources.