Amyotrophic lateral sclerosis (ALS) is a heterogeneous condition showing variable progression rates. Conventional MRI lacks sensitivity and specificity to detect abnormalities in ALS and is mainly used to exclude ALS-mimics. Non-conventional MRI has gradually characterized specific neurodegeneration features in ALS.The present brain DTI and sodium MRI study evidenced combined microstructural and sodium homeostasis alterations in ALS and widespread damage in fast progressors. Our results confirm previous reports showing that non-conventional MRI technics might contribute to the diagnostic work-up of patients with different clinical profiles, especially when combined with mathematical modeling enabling predicting disease progression trajectory of a single patient.
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