# Shape Alterations of Subcortical Nuclei Correlate With Amyotrophic Lateral Sclerosis Progression

## TL;DR

This study found that changes in brain structures correlate with how quickly ALS progresses, suggesting these changes could help diagnose and manage the disease.

## Contribution

The study identifies subcortical shape alterations as potential biomarkers for ALS progression, particularly in fast-progressing patients.

## Key findings

- Fast-progressing ALS patients showed significant shape changes in basal ganglia and brainstem compared to healthy controls.
- Left thalamus shape changes correlated with ALS functional scores and disease duration.
- Subcortical shape alterations may serve as neuroimaging biomarkers for ALS progression.

## Abstract

Neuroimaging has been increasingly used to assess brain structural alterations in patients with amyotrophic lateral sclerosis (ALS). We aimed to investigate alterations in brain sub‐cortical structures and to identify potential neuroimaging biomarkers for disease progression for patients with ALS.

A total of 61 patients with ALS were prospectively enrolled and were divided into three subgroups according to disease progression, i.e., fast, intermediate, and slow progression. Sixty‐one matched healthy controls (HCs) were also recruited. All participants acquired a brain structural magnetic resonance imaging scan for subcortical volumetric and shape analyses. Neuropsychological testing and functional assessment were performed.

Patients with fast progression showed significant shape alterations in basal ganglia and brainstem as compared to the HCs group. In ALS patients with fast progression, shape contractions with atrophic changes were noted in bilateral nucleus accumbens, left caudate, left thalamus, and brainstem; while shape expansion with hypertrophy was noted in the left caudate, left thalamus, and left pallidum (all p < 0.05). There were significant positive correlations of the shape changes of the left thalamus with the Amyotrophic Lateral Sclerosis Functional Rating Scale‐Revised (ALS‐FRS‐R) total and limb scores and with disease duration (all p < 0.05). There were positive correlations of left pallidum with anxiety or with disease duration, and of left nucleus accumbens with ALS‐FRS‐R total or bulbar score, and of brainstem with mini‐mental state examination score (all p < 0.05).

Extensive shape alterations of subcortical nuclei were noted in patients with fast progression of ALS, implicating subcortical shape being a potential neuroimaging biomarker for ALS progression.

Extensive shape alterations of subcortical nuclei noted in amyotrophic lateral sclerosis (ALS) patients with fast progression implicated subcortical shape being a potential neuroimaging biomarker for ALS progression, facilitating early diagnosis and prompt management of patients with ALS.