Brain Structure and Degeneration Staging in Friedreich Ataxia: Magnetic Resonance Imaging Volumetrics from the ENIGMA-Ataxia Working Group.
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Harding Ian H, Chopra Sidhant, Arrigoni Filippo, Boesch Sylvia, Brunetti Arturo, Cocozza Sirio, Corben Louise A, Deistung Andreas, Delatycki Martin, Diciotti Stefano, Dogan Imis, Evangelisti Stefania, França Marcondes C, Göricke Sophia L, Georgiou-Karistianis Nellie, Gramegna Laura L, Henry Pierre-Gilles, Hernandez-Castillo Carlos R, Hutter Diane, Jahanshad Neda, Joers James M, Lenglet Christophe, Lodi Raffaele, Manners David N, Martinez Alberto R M, Martinuzzi Andrea, Marzi Chiara, Mascalchi Mario, Nachbauer Wolfgang, Pane Chiara, Peruzzo Denis, Pisharady Pramod K, Pontillo Giuseppe, Reetz Kathrin, Rezende Thiago J R, Romanzetti Sandro, Saccà Francesco, Scherfler Christoph, Schulz Jörg B, Stefani Ambra, Testa Claudia, Thomopoulos Sophia I, Timmann Dagmar, Tirelli Stefania, Tonon Caterina, Vavla Marinela, Egan Gary F, Thompson Paul M
Аннотация
METHODS: A coordinated international analysis of regional brain volume using magnetic resonance imaging data charted the whole-brain profile, interindividual variability, and temporal staging of structural brain differences in 248 individuals with FRDA and 262 healthy controls.
RESULTS: The brainstem, dentate nucleus region, and superior and inferior cerebellar peduncles showed the greatest reductions in volume relative to controls (Cohen d = 1.5-2.6). Cerebellar gray matter alterations were most pronounced in lobules I-VI (d = 0.8), whereas cerebral differences occurred most prominently in precentral gyri (d = 0.6) and corticospinal tracts (d = 1.4). Earlier onset age predicted less volume in the motor cerebellum (rmax = 0.35) and peduncles (rmax = 0.36). Disease duration and severity correlated with volume deficits in the dentate nucleus region, brainstem, and superior/inferior cerebellar peduncles (rmax = -0.49); subgrouping showed these to be robust and early features of FRDA, and strong candidates for further biomarker validation. Cerebral white matter abnormalities, particularly in corticospinal pathways, emerge as intermediate disease features. Cerebellar and cerebral gray matter loss, principally targeting motor and sensory systems, preferentially manifests later in the disease course.
INTERPRETATION: FRDA is defined by an evolving spatial profile of neuroanatomical changes beyond primary pathology in the cerebellum and spinal cord, in line with its progressive clinical course. The design, interpretation, and generalization of research studies and clinical trials must consider neuroanatomical staging and associated interindividual variability in brain measures. ANN NEUROL 2021;90:570-583.