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. 2020:26:102233.
doi: 10.1016/j.nicl.2020.102233. Epub 2020 Mar 2.

Sonographic and 3T-MRI-based evaluation of the tongue in ALS

Nathalie Hensiek  1 , Frank Schreiber  2 , Thomas Wimmer  1 , Jörn Kaufmann  1 , Judith Machts  2 , Laura Fahlbusch  1 , Cornelia Garz  2 , Susanne Vogt  2 , Johannes Prudlo  3 , Reinhard Dengler  4 , Susanne Petri  4 , Peter J Nestor  5 , Stefan Vielhaber  6 , Stefanie Schreiber  7
Affiliations

Sonographic and 3T-MRI-based evaluation of the tongue in ALS

Nathalie Hensiek et al. Neuroimage Clin. 2020.

Abstract

A few systematic imaging studies employing ultrasound (HRUS) and magnetic resonance imaging (MRI) have suggested tongue measures to aid in diagnosis of amyotrophic lateral sclerosis (ALS). The relationship between structural tongue alterations and the ALS patients' bulbar and overall motor function has not yet been elucidated. We here thus aimed to understand how in-vivo tongue alterations relate to motor function and motor function evolution over time in ALS. Our study included 206 ALS patients and 104 age- and sex-matched controls that underwent HRUS and 3T MRI of the tongue at baseline. Sonographic measures comprised coronal tongue echointensity, area, height, width and height/width ratio, while MRI measures comprised sagittal T1 intensity, tongue area, position and shape. Imaging-derived markers were related to baseline and longitudinal bulbar and overall motor function. Baseline T1 intensity was lower in ALS patients with more severe bulbar involvement at baseline. Smaller baseline coronal (HRUS) and sagittal (MRI) tongue area, smaller coronal height (HRUS) and width (HRUS) as well as more rounded sagittal tongue shape predicated more rapid functional impairment - not only of bulbar, but also of overall motor function - in ALS. Our results suggest that in-vivo sonography und MRI tongue measures could aid as biomarkers to reflect bulbar and motor function impairment.

Keywords: Amyotrophic lateral sclerosis; Biomarker; Intensity; MRI; Prognosis; Tongue; Ultrasound.

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Conflict of interest statement

Declaration of Competing Interests None of the authors have potential conflicts of interest to be disclosed.

Figures

Image, graphical abstract
Graphical abstract
Fig. 1
Fig. 1
Sonographic examination of the tongue (coronal plane). Subfigure (a) demonstrates the anatomical boundaries of the tongue while (b) shows the tongue as a region of interest (ROI) obtained after manual delineation and then used to calculate various tongue measures (mean echointensity, area, coronal width, coronal height, height/width).
Fig. 2
Fig. 2
T1 weighted 3T MRI of the tongue (sagittal plane). Subfigure (a) shows the tongue ROI (TR) and the reference ROI (RR) as well as the latter's anatomical boundaries. Subfigure (b) demonstrates indicators of abstracted properties used for the evaluation of the tongue's shape and position.
Fig. 3
Fig. 3
MRI-based T1 intensity at baseline (sagittal plane). Subfigure (a) demonstrates the correlation between T1 intensity and ALSFRS-R bulbar sub-score. Subfigure (b) demonstrates the mean [SD] T1 intensity of bulbar- compared to limb-onset ALS patients. *p < 0.001.
Fig. 4
Fig. 4
Longitudinal ALSFRS-R total score as a function of baseline sonographic tongue measures. Graphs demonstrate significant time interaction effects of baseline sonographic tongue area (a), width (b) and height (c) on longitudinal ALSFRS-R total score. ALS patients revealing larger baseline sonographic measures (black) compared to patients displaying smaller baseline sonographic measures (red) declined slower when considering the longitudinal ALSFRS-R total score. ALSFRS-R, revised ALS functional rating scale.
See this image and copyright information in PMC

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