Table 1_Glymphatic dysfunction in amyotrophic lateral sclerosis: a multimodal MRI investigation of brain-CSF functional and structural dynamics.docx

BackgroundAmyotrophic lateral sclerosis (ALS) is characterized by progressive motor neuron degeneration and glial activation. The coupling of global blood oxygen level-dependent (gBOLD) signals with cerebrospinal fluid (CSF) inflow dynamics is a novel non-invasive biomarker, which is applied to assess the relationship between lymphatic function and ALS.
ObjectiveThe gBOLD-CSF coupling was used to assess the glymphatic system dysfunction related to ALS, and the relationship between this disease and the glymphatic system was further explored by combining the diffusion tensor imaging index of the perivascular space (DTI-ALPS) and the volume fraction of the choroid plexus (choroid plexus volume [CPV]/intracranial total volume [TIV]).
MethodsWe conducted a systematic analysis and comparative study of the imaging indicators and clinical data of 41 patients with ALS and 43 healthy controls (HC).
ResultsALS patients showed significantly reduced gBOLD-CSF coupling (p < 0.001), reduced ALPS index (p < 0.001), and increased CPV fraction (p < 0.001). The area under the ROC curve (AUC) were 0.790 (gBOLD-CSF), 0.760 (ALPS index), and 0.748 (CPV fraction). A diagnostic model for ALS was developed based on gBOLD-CSF coupling, ALPS index, and CPV fraction with an AUC of 0.897 (0.830–0.964). The calibration curve demonstrates that the model exhibits strong consistency. The results of the Decision Curve Analysis (DCA) further indicate that the nomogram possesses substantial clinical utility.
ConclusionThis study identified that gBOLD-CSF coupling has diagnostic value for ALS and developed a diagnostic model by combining the ALPS index and CPV fraction, which has good diagnostic efficacy and clinical application value.

背景：肌萎缩侧索硬化症（Amyotrophic lateral sclerosis, ALS）以进行性运动神经元变性及神经胶质激活为主要特征。全脑血氧水平依赖（global blood oxygen level-dependent, gBOLD）信号与脑脊液（cerebrospinal fluid, CSF）流入动力学的耦合是一种新型无创生物标志物，可用于评估淋巴功能与ALS之间的关联。
目的：采用gBOLD-CSF耦合指标评估与ALS相关的胶质淋巴系统功能障碍，并结合血管周围间隙扩散张量成像指数（diffusion tensor imaging index of the perivascular space, DTI-ALPS）以及脉络丛体积分数（脉络丛体积[CPV]/颅内总体积[TIV]），进一步探索该病与胶质淋巴系统的关联。
方法：本研究对41例ALS患者与43例健康对照（healthy controls, HC）的影像学指标及临床数据开展了系统分析与对比研究。
结果：ALS患者的gBOLD-CSF耦合程度显著降低（p < 0.001），ALPS指数下降（p < 0.001），而脉络丛体积分数升高（p < 0.001）。受试者工作特征曲线（receiver operating characteristic curve, ROC）下面积（area under the ROC curve, AUC）分别为0.790（gBOLD-CSF耦合）、0.760（ALPS指数）与0.748（脉络丛体积分数）。本研究基于gBOLD-CSF耦合、ALPS指数及脉络丛体积分数构建ALS诊断模型，其AUC为0.897（95%置信区间：0.830–0.964）。校准曲线显示该模型具有良好的一致性。决策曲线分析（Decision Curve Analysis, DCA）结果进一步表明，列线图（nomogram）具备显著的临床应用价值。
结论：本研究证实gBOLD-CSF耦合对ALS具有诊断价值，并联合ALPS指数与脉络丛体积分数构建了诊断模型，该模型具备良好的诊断效能与临床应用价值。