Testing the diagnostic accuracy of [18F]FDG-PET in discriminating spinal- and bulbar-onset amyotrophic lateral sclerosis

Purpose: The role for [18F]FDG-PET in supporting amyotrophic lateral sclerosis (ALS) diagnosis is not fully established. In this study, we aim at evaluating [18F]FDG-PET hypo- and hyper-metabolism patterns in spinal- and bulbar-onset ALS cases, at the single-subject level, testing the diagnostic value in discriminating the two conditions, and the correlations with core clinical symptoms severity.
Methods: We included 95 probable-ALS patients with [18F]FDG-PET scan and clinical follow-up. [18F]FDG-PET images were analyzed with an optimized voxel-based-SPM method. The resulting single-subject SPM-t maps were used to: a) assess brain regional hypo- and hyper-metabolism; b) evaluate the accuracy of regional hypo- and hyper metabolism in discriminating spinal vs. bulbar-onset ALS; c) perform correlation analysis with motor symptoms severity, as measured by ALS-FRS-R.
Results: a) Primary motor cortex showed the most frequent hypo-metabolism in both spinal-onset (~57%) and bulbar-onset (~64%) ALS; hyper-metabolism was prevalent in the cerebellum in both spinal-onset (~56.5%) and bulbar-onset (~55.7%) ALS, and in the occipital cortex in bulbar-onset (~62.5%) ALS. b) Regional hypo-and hyper-metabolism at single-subject SPM-t-maps yielded a very low accuracy (AUC<0.63) in discriminating spinal- vs. bulbar-onset ALS; c) Severity of motor symptoms correlated with hypo-metabolism in sensorimotor cortex in spinal-onset ALS, and with cerebellar hyper-metabolism in bulbar-onset ALS.
Conclusions: The high variability in regional hypo- and hyper-metabolism patterns, likely reflecting the heterogeneous pathology and clinical phenotypes, limits the diagnostic potential of [18F]FDG-PET in discriminating spinal and bulbar onset patients.

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Sala A
Iaccarino L
Fania PC
Vanoli EG
Fallanca F
Pagnini C
Cerami C
Calvo A
Canosa A
Pagani M
Chiò A
Cistaro A
Perani D
Springer., Heidelberg;, Germania
European journal of nuclear medicine and molecular imaging (Print) (2019). doi:10.1007/s00259-018-4246-2
info:cnr-pdr/source/autori:Sala A, Iaccarino L, Fania PC, Vanoli EG, Fallanca F, Pagnini C, Cerami C, Calvo A, Canosa A, Pagani M, Chiò A, Cistaro A, Perani D/titolo:Testing the diagnostic accuracy of [18F]FDG-PET in discriminating spinal- and bulbar-onse
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Ritratto di Marco Pagani
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