Research Presentation Session: Neuro

RPS 1511 - Parkinson's, movement disorders, spine and nerve imaging

March 1, 14:00 - 15:30 CET

7 min
Assessment of nerve root compression and dorsal root ganglia in patients with radiculopathy using 7 Tesla MR imaging
Georg Constantin Feuerriegel, Zurich / Switzerland
    Author Block: G. C. Feuerriegel, A. A. Marth, C. Germann, F. Wanivenhaus, D. Nanz, R. Sutter; Zurich/CHPurpose: This study aimed to evaluate the diagnostic value of 3D dual-echo steady-state (DESS) MR imaging of the cervical spine at 7 T compared to 3 T in patients with cervical radiculopathy.Methods or Background: Between March 2020 and January 2023, patients diagnosed with cervical radiculopathy were prospectively recruited prior to surgical decompression and underwent 3D DESS imaging on 3 T and 7 T MRI. Two radiologists independently assessed cervical nerve root compression and the dimensions of the dorsal root ganglion (DRG). Likert scales were used to assess signal intensity, visibility of nerve anatomy, diagnostic confidence and image artefacts. The degree of neuroforaminal stenosis was assessed on standard clinical 3 T scans. Statistical analysis included diagnostic accuracy and inter-reader reliability. The Wilcoxon signed-rank test was used to assess differences between groups.Results or Findings: 48 patients (mean age 57±12 years, 22women) were included in the study with the highest prevalence of severe neuroforaminal stenosis observed at C6 (n=68) followed by C7 (n=43). Direct evaluation of nerve root compression showed significantly higher diagnostic confidence and visibility of cervical nerve rootlets, roots and DRG on 7 T DESS than on 3 T DESS (diagnostic confidence P=
  1. 01, visibility: P<0.01). Assessment of nerve root compression using 7 T DESS allowed more sensitive grading than standard clinical MRI (P<0.01) and improved the performance in predicting sensory or motor dysfunction (AUC combined: 0.87).
    2. Conclusion: 7T DESS imaging provides direct assessment of cervical nerve root compression in patients with radiculopathy, predicting sensory or motor dysfunction better than standard clinical MRI. The diagnostic confidence and image quality of 7T DESS were found to be superior to that of 3 T DESS.Limitations: 7T MRI is not widely available and only patients with radiculopathy due to degenerative changes were included.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the Cantonal Ethics Committee Zurich.
7 min
Accuracy of automated AI-driven susceptiblity map-weighted MRI analyses for neurodegenerative Parkinsonism
Elon Wallert, Amsterdam / Netherlands
    Author Block: E. Wallert1, E. Van De Giessen1, M. Beudel1, D. H. Shin2, T. Van Mierlo3, J. Blankevoort4, H. Berendse1, R. De Bie1, J. Booij1; 1Amsterdam/NL, 2Seoul/KR, 3Haarlem/NL, 4Almere/NLPurpose: This study aimed to determine the accuracy of AI-driven automated diagnostic susceptibility map-weighted imaging (SMWI) software in patients who presented with a clinically uncertain Parkinsonian syndrome (CUPS).Methods or Background: Parkinson’s disease (PD) is characterized by degeneration of the substantia nigra (SN), particularly in the nigrosome-1 area, and is associated with locally increased iron deposition. The accuracy of a clinical diagnosis is estimated at 80%. SMWI is a novel MRI sequence that combines magnitude images with quantitative susceptibility mapping to enhance the contrast of nigrosome-1 and loss of its signal in neurodegenerative Parkinsonian patients due to iron deposition, which may aid diagnostics.A diagnostic accuracy study was performed in patients who had a dopamine transporter (DAT) SPECT because of CUPS between January 2019 and July
  1. The index test was the result of AI-driven diagnostic software (Heuron IPD, formerly mPDia) analysis of the SMWI sequence between May 2022 and September 2023. The reference standard was the result of the DAT SPECT.
    2. Results or Findings: 132 patients were enrolled in this study. Twelve were excluded from the analysis; four because of uncertain DAT-SPECT results and eight because of severe artefacts on MRI. DAT-SPECT was abnormal in 53 and normal in 67 patients. In this preliminary analysis, the accuracy of the diagnostic software compared with the DAT-SPECT results was 88% with a sensitivity of 87% and specificity of 89%.Conclusion: The diagnostic accuracy of the diagnostic software is promising in a clinically relevant population of patients who presented with CUPS.Limitations: A limitation of this study is the delay between the index test and the reference test of
  2. 6 years. DAT-SPECT is considered to be a golden standard in the diagnostics of patients with CUPS. However, the follow-up time is limited to 2.3 years.
    3. Funding for this study: Funding for this study was received from Heuron Co.Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the Amsterdam UMC METC.
7 min
Functional brain connectivity in patients with de novo Parkinson's disease based on rs-fMRI
Noemi Pucci, Rome / Italy
    Author Block: N. Pucci, S. Minosse, E. Picchi, V. Ferrazzoli, F. Garaci, T. Schirinzi, F. Di Giuliano; Rome/ITPurpose: This study aimed to evaluate a putative reorganisation of brain networks between de novo Parkinson's disease patients and healthy controls by measures based on graph theory.Methods or Background: 31 de novo PD patients and 30 healthy controls underwent MRI examination to obtain rsf-MRI and 3D-T1-MPRAGE data. The rs-fMRI data were pre-processed in FLS. The time series was parcelled into 116 regions using the Automated Anatomical Labelling Atlas (AAL) per subject. Pearson correlation between all-time series was used to generate subject-based adjacency matrices. Local nodal measures (degree and centrality), functional integration measures (global efficiency), functional segregation measures (local efficiency, clustering coefficient, transitivity and modularity), and resilience measures (assortment coefficient) were calculated using Brain Connectivity. The local measures were analysed by means of disruption index k. We calculated the hub regions in the two groups using the BC of each node. All local and global variables were compared using the Mann-Whitney U Test.Results or Findings: We found no statistically significant differences in measures of global variables between de novo PD and healthy controls. We did find statistically significant differences due to disaggregation index k in all local metrics. For all statistically significant comparisons, the disruption index k was lower in the de novo PD group than in the healthy controls.Conclusion: The alterations found by local network measurements highlight a reorganisation of brain networks in de novo PD patients, supporting the hypothesis that the analysis of functional connectivity may facilitate a better understanding of the complexity of PD pathophysiology from the earliest stages of the disease.Limitations: Our study was performed in a relatively small sample size and didn't include neurocognitive tests, so we cannot examine putative associations between neurocognitive status and MRI parameters.Funding for this study: Funding for this study was supported by #NEXTGENERATIONEU (NGEU) and funded by the Ministry of University and Research (MUR), National Recovery and Resilience Plan (NRRP), project MNESYS (PE0000006) - A Multiscale integrated approach to the study of the nervous system in health and disease (DN. 1553
  1. 10.2022).
    2. Has your study been approved by an ethics committee? YesEthics committee - additional information: The study protocol was approved by the local Institutional Review Board and adhered to the tenets of the Declaration of Helsinki. All subjects provided written informed consent.
7 min
Diagnostic value of quantitative susceptibility mapping in assessing iron deposition in the basal ganglia of patients with Parkinson's disease
Vahid Shahmaei, Tehran / Iran
    Author Block: V. Shahmaei, F. Sodaei, F. Faeghi, F. Ashrafi; Tehran/IRPurpose: This study aimed to assess iron deposition in the basal ganglia using QSM, determine the diagnostic value of this method, and explore the association between disease stage and QSM values in individual nuclei. Iron deposition in the brain is commonly associated with Parkinson's disease. Quantitative Susceptibility Mapping (QSM) has proven to be a more sensitive imaging technique compared to T2-weighted imaging, T2*, and R
  1. However, there have been limited studies utilising QSM to evaluate iron deposition in the basal ganglia of Parkinson's disease patients.
    2. Methods or Background: A total of 25 patients were assessed using the Hoehn and Yahr test, which classified them into three different stages. 15 healthy subjects were included as a control group. Routine MRI sequences and QSM were performed using a Siemens
  2. Tesla scanner. Signal processing and image analysis were conducted using STI Suite software. Susceptibility measures of all basal ganglia nuclei were extracted individually.
    3. Results or Findings: Significant differences in susceptibility measures were observed in the Substantia Nigra, Red Nucleus, Thalamic Nucleus, and Globus Pallidus nuclei between the patients and control groups (P-value <
  3. 001). There was a significant relationship between disease stage and QSM in the Substantia Nigra, Red Nucleus, and Globus Pallidus nuclei (P-value < 0.05, R= 0.51-0.78). QSM values demonstrated a significant association with disease stage across all nuclei (P-value < 0.001). Furthermore, QSM exhibited higher accuracy in the Substantia Nigra, Globus Pallidus, Red Nucleus, and Thalamic Nucleus, respectively (Acc= 88%-98%).
    4. Conclusion: Utilising QSM to assess iron deposition in the Red Nucleus, Substantia Nigra, and Globus Pallidus nuclei can aid in the diagnosis and staging of patients with Parkinson's disease. Future studies focusing on the disease stage could provide further information.Limitations: No limitations were identified.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: The informed consent was obtained from participants included in the study following the supervision of the ethics committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
7 min
Human visual nigrosome analysis improves AI-based diagnoses in neurodegenerative disease
Ebru Sayilir, Saint Martin D'Heres / France
Author Block: E. Sayilir1, E. Piot1, C. Bonardel1, F. Renard2, S. Grand1, A. Attye2, A. Krainik1; 1Grenoble/FR, 2La Tronche/FR
Purpose: This study aimed to evaluate the diagnostic performance of BrainGML a manifold-learning AI software (Geodaisics.com) in neurodegenerative diseases combined with the visual analysis of nigrosome imaging. Neurodegenerative diseases are associated with regional cerebral atrophy patterns, such as temporohippocampal and parietal atrophy in Alzheimer's disease (AD), and frontotemporal atrophy in frontotemporal dementia (FTD). Parkinson's (PD) and dementia with Lewy bodies (DLB) have subtle structural abnormalities such as insular atrophy and nigrosome loss. Artificial intelligence software shows potential for accurate diagnosis of atrophy patterns, while nigrosome analysis is still unavailable.
Methods or Background: A retrospective study was conducted on patients with AD, FTD, PD, and DLB. BrainGML analysed
cerebral atrophy using 3DT1 images, assigning the highest probability for Normal, AD, FTD, or PD. Nigrosome visual analysis was performed on susceptibility-weighted images by 4 radiologists who determined whether nigrosomes were normal or abnormal. The primary outcome was the accuracy of the radiological diagnosis, defined as 'Right', 'Wrong', or 'Undefined' (when nigrosome imaging was normal in PD and DLB, or when nigrosome imaging was abnormal in AD or FTD).
Results or Findings: The cohort included 79 patients (29 AD, 11 FTD, 26 PD, 13 DLB). Nigrosomes were normal in
AD (100%) and FTD (100%), and were abnormal in PD (92%) and DLB (62%). BrainGML provided 59% Right diagnoses on trained diagnoses (all but DLB), and 49% on all patients including DLB. Combining nigrosome analysis with BrainGML decreased the ratio of 'Wrong' diagnoses from 51% to 15%, which was replaced by the increase of 'Undefined' diagnoses from 0 to 36%.
Conclusion: In conclusion, adding nigrosome visual analysis to BrainGML highest diagnosis probability turned most 'wrong' diagnoses into 'undefined' diagnoses.
Limitations: The main limitations are small population samples, unknown DLB diagnosis by BrainGML, and no pathological diagnoses.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the French South-East Ethics committee.
7 min
Is pure akinesia with gait freezing associated with more ventriculomegaly in brain MRI than other subtypes of progressive supranuclear palsy?
Marcos Jiménez Vázquez, Pamplona / Spain
    Author Block: M. Jiménez Vázquez, P. Del Nido Recio, M. R. López de la Torre Carretero, C. Mbongo, M. Calvo Imirizaldu, R. Garcia de Eulate, P. Dominguez Echavarri, C. Espinoza-Vinces, M. R. I. Luquin; Pamplona/ESPurpose: This study aimed to evaluate if patients with PAGF have more ventriculomegaly in MR imaging in comparison with other subtypes of PSP. Freezing of gait can be seen in progressive supranuclear palsy (PSP), specifically in the pure akinesia with gait freezing (PAGF) subtype, mimicking Normal Pressure Hydrocephalus (NPH).Methods or Background: We retrospectively analysed a cohort of 48 patients who underwent brain MRI between 2018 and 2023 due to freezing of gait as the main clinical feature. 40 patients were posteriorly diagnosed with PSP, four with NPH and four with Alzheimer’s disease. After excluding the last patients, we divided the PSP patients into a group posteriorly diagnosed with PAGF (27) and another diagnosed with other PSP subtypes (13). Evans Index (EI) and Callosal Angle (CA) were measured in the two groups and cut-off values of EI >
  1. 3 and CA <100º were selected for defining ventriculomegaly. Midbrain-to-pons ratio and frontal and midbrain atrophy were also evaluated. Fisher’s Exact Test and T-test were applied to studying proportions and means.
    2. Results or Findings: The mean EI was significantly higher in the PSP-PAGF group compared to the other subtypes group (
  2. 32 vs 0.29, p=0.041), while the mean CA was significantly lower (103.69º vs 118.35º, p=0.008). Moreover, CA cut-off <100º showed a significant difference between both groups (p=0.015) with a specificity of 92.31%. EI cut-off >0.3 showed a non-significant sensibility of 74.07% (p=0.155). No significant differences were found in the midbrain-to-pons ratio and frontal and midbrain atrophy between the two groups.
    3. Conclusion: Our results illustrate that patients with freezing of gait and ventricular enlargement in imaging will probably have a diagnosis of PSP-PAGF, after excluding NPH. PSP-PAGF is associated with more significant ventriculomegaly than other subtypes of PSP.Limitations: No limitations were identified.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? Not applicableEthics committee - additional information: The study is retrospective.
7 min
Early re-emerging tremor after MRgFUS thalamotomy: case-control analysis of procedural and imaging features
Pierfrancesco Badini, L'Aquila / Italy
Author Block: P. Badini, C. Santobuono, F. Colarieti, A. Di Gioia, I. Antonio, F. Bruno, A. Splendiani, E. Di Cesare, A. Catalucci; L'Aquila/IT
Purpose: This study aimed to identify possible prognostic factors determining early tremor relapse after MRgFUS thalamotomy in patients with essential tremor (ET) and Parkinson's disease (PD).
Methods or Background: 9 patients (6 ET, 3PD) who underwent Vim MRgFUS thalamotomy in a single institution and developed early re-emergent tremor were analysed. Demographic and clinical characteristics of patients were compared to a pairwise matched control group of patients with stable tremor relief at the same follow-up period. In both groups, procedural parameters of target and sonications and MR imaging findings (including lesion shape and volume in multiparametric sequences and dentatorubrothalamic tract DTI analysis) were compared.
Results or Findings: We did not find statistically significant differences in gender and age between the two groups. Concerning MRI analysis, we found larger thalamotomy lesions in the control group with stable outcomes, compared to patients with tremor relapse. In the tractography evaluation, we found a more frequent eccentric position of the DRTt in patients with tremor relapse.
Conclusion: The most relevant determining factors for tremor relapse after MRgFUS thalamotomy appear to be the size of the thalamotomy lesion and inaccurate thalamic targeting.
Limitations: Limited study sample and retrospective analysis.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki.
7 min
Resting-state brain connectivity in patients with essential tremor undergoing vim ablation with MRgFUS: preliminary results
Filippo Colarieti, L'Aquila / Italy
    Author Block: F. Colarieti, C. Santobuono, P. Badini, A. Di Gioia, I. Antonio, A. Catalucci, F. Bruno, E. Di Cesare, A. Splendiani; L'Aquila/ITPurpose: This study aimed to verify any changes in brain connectivity in patients with essential tremors undergoing MRgFUs thalamotomy. Essential tremor is the result of abnormal communication between certain areas of the brain, including the thalamus, cerebellum, and brainstem. Vim MRgFUS thalamotomy is a new minimally invasive procedure used for the treatment of disabling tremors.Methods or Background: 15 patients with essential tremor (TE) (mean age=
  1. 1, SD= 13.1), without cognitive impairments (mean IQ= 109.0, SD= 9.9), were included in the study. These patients' resting-state brain connectivity was recorded before treatment and after six months with 3T MRI. The MRgFUS thalamotomy treatment was effective in all patients, with a mean FTM (Fahn-Tolosa-Marin tremor scale) reduction of the treated upper limb from 5.1 to 0.8. An analysis of ROI-to-ROI connectivity was then carried out with Coon Toolbox studying the mains brain networks to assess the difference in pre- and post-treatment brain connectivity.
    2. Results or Findings: The results indicated significantly greater post-treatment connectivity between the anterior cerebellum and the left parietal lobe (default mode network) and between the left occipital cortex (visual network) and the cerebellum.Conclusion: Although preliminary, our results indicate greater connectivity of the cerebellum following MRgFUS treatment, in accordance with better fine motor control reported by patients undergoing surgery.Limitations: This was a low study sample.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? Not applicableEthics committee - additional information: All subjects gave informed consent for inclusion before participating in the study. The study was conducted in accordance with the Declaration of Helsinki.
7 min
Changes to the peripheral nervous system in chronic spinal cord injury: a study on 3T MR neurography
Johann Malte Enno Jende, Heidelberg / Germany
    Author Block: J. M. E. Jende, L. Heutehaus, F. Preisner, C. Mooshage, R. Rupp, M. Bendzus, N. Weidner, F. Kurz, S. Franz; Heidelberg/DEPurpose: This study aimed to combine MRN and clinical assessments in individuals with chronic SCI and non-disabled controls. It is known that structural and functional changes to the peripheral nervous system (PNS) can occur in disorders of the central nervous system (CNS) such as multiple sclerosis. To date, it is unknown to what extent changes at the PNS level occur after spinal cord injury (SCI) and whether such changes are relevant for functional recovery or the development of neuropathic painful symptoms below the level of injury. 3 Tesla Magnetic Resonance Neurography (MRN) allows the detection and quantification of structural and functional damage to peripheral nerves.Methods or Background: 20 participants with chronic SCI and 20 controls matched for sex, age, and body-mass index underwent t2-weighted and diffusion-weighted MRN of the sciatic nerve. The sciatic nerve’s mean cross-sectional area (CSA), fascicular lesion load, and fractional anisotropy (FA) were calculated. Results were correlated with clinical and electrophysiologic assessments.Results or Findings: Sciatic nerve CSA and lesion load were larger (
  1. 29 mm 2±5.82 vs 14.08 mm 2±4.62; p<0.001, and 8.70% ±7.47 vs 3.60% ±2.45; p<0.001) in individuals with SCI compared to controls, whereas FA was lower (0.55±0.11 vs 0.63±0.08; p=0.022). MRN parameters correlated with electrophysiological results but did not correlate with the extent of myelopathy or clinical severity of SCI.
    2. Conclusion: Individuals with chronic SCI are subject to a decline of structural peripheral nerve integrity that may occur independently from the clinical severity of SCI. This may have an impact on functional recovery following SCI. The underlying cause of this phenomenon remains yet to be determined since no association with the extent of myelopathy or the severity of SCI-related disability could be found.Limitations: This study is limited by its cross-sectional design and the small number of participants.Funding for this study: Funding for this study was received by the International Foundation for Research in Paraplegia, The Else Kröner-Fresenius Stiftung and the German Research Foundation.Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the ethics committee of Heidelberg University Hospital.
7 min
AI-based three-dimensional analysis of lumbar vertebrae micromovements in spondylolisthesis patients with weight-bearing MRI
Luca Alessandro Cappellini, Pieve Emanuele / Italy
    Author Block: R. Levi1, L. A. Cappellini1, M. Battaglia1, F. Garoli1, M. De robertis1, G. Savini1, M. Fornari2, M. Grimaldi2, L. S. S. Politi2; 1Pieve Emanuele/IT, 2Rozzano/ITPurpose: This study aimed to automatically evaluate the micro-instability of lumbar vertebrae through 3D deep-learning analysis of MRI in supine and standing positions in healthy subjects and patients with spondylolisthesis.Methods or Background: The current assessment of spondylolisthesis relies on the Meyerding grading system from morphodynamical lateral X-rays and supine MRI. These approaches measure instability only on the sagittal plane providing a partial representation of the disease. We retrospectively included 28 subjects (10 patients with spondylolisthesis and 18 controls) who underwent weight-bearing MRI (wbMRI) with 3D-HYCE acquisitions in supine and upright positions. Deep-learning algorithms were employed to segment vertebrae and dural sac and to quantify advanced micro-instability parameters: centre of mass (COM), variation of the angle passing through the COM, and roto-translation matrix (RTM). These parameters were correlated to pain numerical rating scale (PNRS).Results or Findings: Automatic quantification of vertebral posterior wall listhesis resulted in the upgrading of Meyerding classification from grade I to II in 3 patients (30%). Patients with spondylolisthesis demonstrated significantly reduced lordotic curvature in the upright position compared to controls showing reduced anterior movement of COM (p=
  1. 0105) and narrower anterior variation of the angle (p<0.001). The analysis of RTM reported higher rotation in controls for anteroposterior direction at L2-L3 level (p=0.038) and cranio-caudal direction at L3-L4 level (p=0.006).
    2. In patients, pre-operative PNRS evaluation of back pain was of
  2. 50 (std. 0.93) with a mean post-operative PNRS of 4.00 (std. 2.51). Translation in the anteroposterior movement was positively associated with pre-operative PNRS (R=0.701, p=0.042). Post-operative PNRS was positively associated with the latero-lateral movement (R=0.699, p=0.045).
    3. Conclusion: This preliminary study highlights the clinical potentials of wbMRI and deep-learning 3D analysis for spondylolisthesis micro-movements assessment, offering a comprehensive insight into vertebral instability, peri-procedural pain, and indication to neurosurgical treatment.Limitations: This study had a limited population.Funding for this study: No funding was received for this study.Has your study been approved by an ethics committee? YesEthics committee - additional information: No information provided by the submitter.
7 min
Neurite orientation dispersion and density imaging quantifies microstructural impairment in the thalamus and its connectivity in amyotrophic lateral sclerosis
Yun-bin Cao, Fuzhou / China
    Author Block: Y-b. Cao, H-J. Chen; Fuzhou/CNPurpose: This study aimed to evaluate microstructural impairment in the thalamus and thalamocortical connectivity using neurite orientation dispersion and density imaging (NODDI) in amyotrophic lateral sclerosis (ALS).Methods or Background: This study included 47 healthy controls and 43 ALS patients, whose structural and diffusion-weighted data were collected. We used state-of-the-art parallel transport tractography to identify thalamocortical pathways in individual spaces. The thalamus was then parcellated into six subregions based on its connectivity pattern with the priori defined cortical (i.e., prefrontal/motor/somatosensory/temporal/posterior-parietal/occipital) regions. For each of the thalamic and cortical subregions and thalamocortical tracts, we compared the following NODDI metrics between groups: orientation dispersion index (ODI), neurite density index (NDI), and isotropic volume fraction (ISO). We also used these metrics to conduct receiver operating characteristic curve (ROC) analyses and Spearman correlation.Results or Findings: In ALS patients, we found decreased ODI and increased ISO in the thalamic subregion connecting the left motor cortex and other extramotor (e.g., somatosensory and occipital) cortex (Bonferroni-corrected P <
  1. 05). NDI decreased in bilateral thalamo-motor and thalamo-somatosensory tracts and in the right thalamo-posterior-parietal and thalamo-occipital tracts (Bonferroni-corrected P <0.05). NDI reduction in the bilateral thalamo-motor tract (P= 0.017 and 0.009) and left thalamo-somatosensory tract (P= 0.029) was correlated with disease severity. In thalamocortical tracts, NDI yielded a higher effect size during between-group comparisons and a greater area under ROC (P <0.05) compared with conventional diffusion tensor imaging metrics.
    2. Conclusion: Microstructural impairment in the thalamus and thalamocortical connectivity is the hallmark of ALS. NODDI improved the detection of disrupted thalamocortical connectivity in ALS.Limitations: Firstly, the study had a relatively small sample size. Secondly, the study design was cross-sectional. Thirdly, the pattern of connectivity between other subcortical areas and the cortex should also be evaluated in future ALS studies.Funding for this study: This study was supported by grants from the Graduate Student Academic Exchange Fund of Fujian Medical University.Has your study been approved by an ethics committee? YesEthics committee - additional information: This study was approved by the Research Ethics Committee of Fujian Medical University Union Hospital

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