This study used atlas-based region of interest analysis to assess WM microstructure in ALS by combining intra-voxel metrics, which included FA and MD, and an inter-voxel metric, i.e., LDH. We found WM abnormalities extending from the motor to the extra-motor regions in ALS and observed a correlation between distinct diffusion metrics and various clinical variables, supporting DTI metrics may be utilized as the diagnostic biomarker of ALS. Meanwhile, the extent of WM abnormalities in several tracts (e.g. ATR and LIFOF) were better revealed by LDH measurement, suggesting the supplementary role in reflecting ALS-related pathological process.
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