Imaging

Amytrophic Lateral Sclerosis

Preliminary Diagnosis: Amytrophic Lateral Sclerosis

I. What imaging technique is first-line for this diagnosis?

  • MRI of the brain with dIffusion tension imaging (DTI), noncontrast

II. Describe the advantages and disadvantages of this technique for diagnosis of amytrophic lateral sclerosis (ALS).

Advantages

  • Highly specific and sensitive for detailing abnormalities in the corticospinal tracts seen in ALS patients.

  • Able to detail and differentiate gray and white matter exquisitely and is able to detail the extent of white matter abnormality.

  • DTI is highly useful in detailing findings specific to ALS.

Disadvantages

  • MRI is subject to motion artifact, which degrades image quality due to the length of the exam.

III. What are the contraindications for the first-line imaging technique?

  • MRI is contraindicated in patients with non-MR-compatible hardware.

IV. What alternative imaging techniques are available?

  • Positive emission tomography (PET) Imaging

  • Technetium-99m HMPAO SPECT imaging

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of amyotrophic lateral sclerosis.

PET Imaging

Advantages

  • Can aid in diagnosis and determining extent of the disease

Disadvantages

  • Nuclear medicine exams are less sensitive and specific when compared to MR imaging

  • Exposure to ionizing radiation (minimal)

Technetium-99m HMPAO SPECT Imaging

Advantages

  • Can aid in diagnosis and determining extent of the disease

Disadvantages

  • Nuclear medicine exams are less sensitive and specific than MRI.

  • Exposure to ionizing radiation (minimal)

VI. What are the contraindications for the alternative imaging techniques?

PET Imaging

  • May be contraindicated in pregnant and breast feeding patients.

Technetium-99m HMPAO SPECT Imaging

  • May be contraindicated in pregnant and breastfeeding patients.

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