Spinal cord hypermetabolism extends to skeletal muscle in amyotrophic lateral sclerosis: a computational approach to [18F]-fluorodeoxyglucose PET/CT images

Matteo Bauckneht, Rita Lai, Alberto Miceli, Daniela Schenone, Vanessa Cossu, Maria Isabella Donegani, Stefano Raffa, Anna Borra, Stefano Marra, Cristina Campi, Annamaria Orengo, Anna Maria Massone, Alberto Tagliafico, Claudia Caponnetto, Corrado Cabona, Angelina Cistaro, Adriano Chiò, Silvia Morbelli, Flavio Nobili, Gianmario SambucetiMichele Piana, Cecilia Marini

Research output: Contribution to journalArticlepeer-review


Purpose: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease leading to neuromuscular palsy and death. We propose a computational approach to [18F]-fluorodeoxyglucose (FDG) PET/CT images to analyze the structure and metabolic pattern of skeletal muscle in ALS and its relationship with disease aggressiveness. Materials and methods: A computational 3D method was used to extract whole psoas muscle’s volumes and average attenuation coefficient (AAC) from CT images obtained by FDG PET/CT performed in 62 ALS patients and healthy controls. Psoas average standardized uptake value (normalized on the liver, N-SUV) and its distribution heterogeneity (defined as N-SUV variation coefficient, VC-SUV) were also extracted. Spinal cord and brain motor cortex FDG uptake were also estimated. Results: As previously described, FDG uptake was significantly higher in the spinal cord and lower in the brain motor cortex, in ALS compared to controls. While psoas AAC was similar in patients and controls, in ALS a significant reduction in psoas volume (3.6 ± 1.02 vs 4.12 ± 1.33 mL/kg; p < 0.01) and increase in psoas N-SUV (0.45 ± 0.19 vs 0.29 ± 0.09; p < 0.001) were observed. Higher heterogeneity of psoas FDG uptake was also documented in ALS (VC-SUV 8 ± 4%, vs 5 ± 2%, respectively, p < 0.001) and significantly predicted overall survival at Kaplan–Meier analysis. VC-SUV prognostic power was confirmed by univariate analysis, while the multivariate Cox regression model identified the spinal cord metabolic activation as the only independent prognostic biomarker. Conclusion: The present data suggest the existence of a common mechanism contributing to disease progression through the metabolic impairment of both second motor neuron and its effector.

Original languageEnglish
Article number23
JournalEJNMMI Research
Issue number1
Publication statusPublished - Jan 1 2020


  • Amyotrophic lateral sclerosis
  • FDG
  • Prognosis
  • Skeletal muscle

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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