Objective To evaluate the feature and diagnostic accuracy of proton magnetic resonance spectroscopy (1 H-MRS) in detecting upper motor neuron (UMN) involvement in amyotrophic lateral sclerosis (ALS).Methods The study included 31 ALS patients and 32 healthy controls and measured the concentration of N-acetylaspartate (NAA),choline (Cho) and creatine (Cr) by 1H-MRS in subcortical white matter of precentral gyrus,posterior limb of internal capsule (PLIC) and cerebral peduncle (CP).Ratios of NAA/Cr,NAA/ (Cho+Cr) and Cho/Cr were calculated from these measurements.The diagnostic value of NAA ratios for ALS lesions was analyzed by receiver operating characteristic (ROC) curves.Results Compared with the controls,ALS group had significantly decreased NAA/Cr and NAA/ (Cho+Cr) ratios at the three levels along the corticospinal tract (CST) (P＜0.05).In ROC analysis,areas under the curves (AUC) ranged from 0.67 to 0.91.The average NAA/ (Cho+Cr) ratio of PLIC and CP showed the best performance with an AUC of 0.91,a sensitivity of 0.828 and a specificity of 0.906,followed by the average NAA/ (Cho+Cr) ratio of all the three levels,with the corresponding data as 0.90,0.769 and 0.875.Conclusions 1H-MRS can reveal metabolite abnormalities in the intracranial CTS of ALS patients and serve as a neuroimaging biomarker for UMN involvement.Regarding its moderate diagnostic accuracy,multilevel measurements and synthetically using parameters will help to improve its efficacy.%目的 探讨质子磁共振波谱(proton magnetic resonance spectroscopy,1 H-MRS)检测肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的上运动神经元损害(upper motor neuron,UMN)的特点和诊断准确性.方法 收集ALS患者31例和健康对照32名,采用1 H-MRS检测脑中央前回皮质下、内囊后肢和大脑脚感兴趣区代谢产物N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)的水平,计算NAA/Cr、NAA/(Cho+Cr)、Cho/Cr比值,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析1H-MRS对ALS患者UMN损害的诊断价值.结果 ALS患者各锥体束走行部位和部位组合的NAA/Cr和NAA/(Cho+Cr)较对照组显著降低(P＜0.05). NAA比值预测ALS的UMN损害的ROC曲线下面积(area under the curve,AUC)为0.67～0.91,其中内囊后肢、大脑脚两部位的平均NAA/(Cho+ Cr)和三部位的平均NAA/(Cho+ Cr)的AUC、灵敏度、特异度分别为0.91、0.828、0.906和0.90、0.769、0.875.结论 1 H-MRS可检出ALS患者锥体束走行的生化代谢异常,是评估ALS的UMN损害的客观影像学指标,其诊断准确性中等,多水平检测和综合指标的选择有助于提高其诊断效力.
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