Preliminary Diagnosis: Amytrophic Lateral Sclerosis
I. What imaging technique is first-line for this diagnosis?
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MRI of the brain with dIffusion tension imaging (DTI), noncontrast
II. Describe the advantages and disadvantages of this technique for diagnosis of amytrophic lateral sclerosis (ALS).
Advantages
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Highly specific and sensitive for detailing abnormalities in the corticospinal tracts seen in ALS patients.
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Able to detail and differentiate gray and white matter exquisitely and is able to detail the extent of white matter abnormality.
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DTI is highly useful in detailing findings specific to ALS.
Disadvantages
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MRI is subject to motion artifact, which degrades image quality due to the length of the exam.
III. What are the contraindications for the first-line imaging technique?
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MRI is contraindicated in patients with non-MR-compatible hardware.
IV. What alternative imaging techniques are available?
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Positive emission tomography (PET) Imaging
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Technetium-99m HMPAO SPECT imaging
V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of amyotrophic lateral sclerosis.
PET Imaging
Advantages
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Can aid in diagnosis and determining extent of the disease
Disadvantages
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Nuclear medicine exams are less sensitive and specific when compared to MR imaging
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Exposure to ionizing radiation (minimal)
Technetium-99m HMPAO SPECT Imaging
Advantages
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Can aid in diagnosis and determining extent of the disease
Disadvantages
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Nuclear medicine exams are less sensitive and specific than MRI.
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Exposure to ionizing radiation (minimal)
VI. What are the contraindications for the alternative imaging techniques?
PET Imaging
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May be contraindicated in pregnant and breast feeding patients.
Technetium-99m HMPAO SPECT Imaging
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May be contraindicated in pregnant and breastfeeding patients.
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