{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:09:14Z","timestamp":1790788154801,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,19]],"date-time":"2018-12-19T00:00:00Z","timestamp":1545177600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Federal Ministry of Education and Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"BMBF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>MRI fluid\u2010attenuated inversion recovery (FLAIR) studies reported hyperintensity in the corticospinal tract and corpus callosum of patients with amyotrophic lateral sclerosis (ALS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the lesion segmentation toolbox (LST) for the objective quantification of FLAIR lesions in ALS patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Type<\/jats:title><jats:p>Retrospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Twenty\u2010eight ALS patients (eight females, mean age: 50 range: 24\u201373, mean ALSFRS\u2010R sum score: 36) were compared with 31 age\u2010matched healthy controls (12 females, mean age: 45, range: 25\u201367). ALS patients were treated with riluzole and additional G\u2010CSF (granulocyte\u2010colony stimulating factor) on a named patient basis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Field Strength\/Sequence<\/jats:title><jats:p>1.5 T, FLAIR, T<jats:sub>1<\/jats:sub>\u2010weighted MRI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Assessment<\/jats:title><jats:p>The lesion prediction algorithm (LPA) of the LST enabled the extraction of individual binary lesion maps, total lesion volume (TLV), and number (TLN). Location and overlap of FLAIR lesions across patients were investigated by registration to FLAIR average space and an atlas. ALS\u2010specific functional rating scale revised (ALSFRS\u2010R), disease progression, and survival since diagnosis served as clinical correlates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Statistical Tests<\/jats:title><jats:p>Univariate analysis of variance (ANOVA), repeated\u2010measures ANOVA, <jats:italic>t<\/jats:italic>\u2010test, Bravais\u2010Pearson correlation, Chi\u2010square test of independence, Kaplan\u2013Meier analysis, Cox\u2010regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both ALS patients and healthy controls exhibited FLAIR alterations. TLN significantly depended on age (<jats:italic>F<\/jats:italic>(1,54) = 24.659, <jats:italic>P<\/jats:italic> &lt; 0.001) and sex (<jats:italic>F<\/jats:italic>(1,54) = 5.720, <jats:italic>P<\/jats:italic> = 0.020). ALS patients showed higher TLN than healthy controls depending on sex (<jats:italic>F<\/jats:italic>(1, 54) = 5.076, <jats:italic>P<\/jats:italic> = 0.028). FLAIR lesions were small and most pronounced in male ALS patients. FLAIR alterations were predominantly detected in the superior and posterior corona radiata, anterior capsula interna, and posterior thalamic radiation. Patients with pyramidal tract (PT) lesions exhibited significantly inferior survival than patients without PT lesions (<jats:italic>P<\/jats:italic> = 0.013). Covariate age exhibited strong prognostic value for survival (<jats:italic>P<\/jats:italic> = 0.015).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Conclusion<\/jats:title><jats:p>LST enables the objective quantification of FLAIR alterations and is a potential prognostic biomarker for ALS.<\/jats:p><jats:p><jats:bold>Level of Evidence<\/jats:bold>: 3<\/jats:p><jats:p><jats:bold>Technical Efficacy<\/jats:bold>: Stage 2<\/jats:p><jats:p>J. Magn. Reson. 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