Can Advanced Brain Imaging Diagnose ALS Earlier?

Current methods for diagnosing ALS involve ruling out other diseases that share similar symptoms. As a result, it can take a year or more from the onset of symptoms to confirm a diagnosis of ALS. That’s far too long — especially for a disease that on average claims lives within two to five years after diagnosis.

Traditional magnetic resonance imaging (MRI) is an excellent, non-invasive tool for helping doctors diagnose diseases like brain cancer or multiple sclerosis, and researchers continue to explore ways it can prove successful in identifying or understanding ALS.

Abdullah Ishaque, a graduate student in the combined MD/PhD program at the University of Alberta, is working on a world-first project in the lab of Dr. Sanjay Kalra to develop advanced MRI techniques to identify changes in the brain at the earliest stages of ALS. He recently received a $75,000 trainee award from the ALS Canada Research Program, in partnership with Brain Canada, to collect more data and to analyze the massive quantities of information the study is generating. This builds on the ALS Canada–Brain Canada Arthur J. Hudson Translational Team Grant — the largest grant awarded in ALS Canada’s history – which was awarded to Dr. Kalra and his team of 13 investigators to fund the first multicentre imaging study for advanced MRI techniques to detect ALS in the world.

“If we are successful with these new methods, a non-invasive MRI scan could someday help us to diagnose ALS early and predict disease progression based on changes in the brain,” said Ishaque. “Identifying people at the earliest stages of ALS would also allow them to enroll in clinical trials earlier when there would likely be a higher chance for new therapies to work.”

Developing new brain imaging technologies

For several years, Dr. Kalra and Ishaque have been developing two exciting new MRI techniques called texture analysis and quantitativeT2 mapping. “Similar to editing a photograph by adjusting brightness or contrast to make details visible, texture analysis lets us see very fine changes in a brain image that are not visible with a regular MRI scan,” said Ishaque. Quantitative T2 mapping lets researchers examine the biology of the tissue to see areas of the brain that change as the disease progresses.

Dr. Kalra and Ishaque’s goal is to develop these new MRI tools so that they can be used as a biological marker, a “biomarker,” that may someday pinpoint the start of ALS and provide information at different time points about how the disease is progressing.

Advancing ALS Research

The study is enrolling over 700 people, split between those with and without ALS, who receive a baseline MRI and clinical evaluation and then two follow-up visits at four-month intervals. It takes advantage of the expertise of a multidisciplinary collaboration of experts across Canada called the Canadian ALS Neuroimaging Consortium (CALSNIC) founded in 2013 by Dr. Kalra. The clinical trial sites are Calgary, Edmonton, Vancouver, London, Toronto, Montreal, Quebec City, and Miami. (Some sites are finished recruiting. Active sites are listed here under “Locations.”)

Ishaque is excited to be continuing his work on this world-first project. “It takes weeks to process the data, but there is a whole team behind me,” says Ishaque. “We are collaborating with computer scientists, biomedical engineers, neuropathologists and of course, clinicians in ALS clinics across Canada.”

This research project is one of 6 trainee awards funded in 2018 by the ALS Canada Research Program, which is the only dedicated source of funding for ALS research in Canada. ALS Canada trainee awards support Canada’s emerging ALS researchers, whether they are doctoral students, postdoctoral researchers, or clinical research fellows. Trainee awards encourage young researchers to choose ALS as their area of focus, helping to ensure that Canada has a strong base of talented ALS researchers today and into the future.

The funding of the project followed a rigorous scientific assessment by panels of ALS experts. The panelists evaluated a larger pool of applications to identify the projects that demonstrate scientific excellence and have the potential to most quickly advance the field of ALS research in order to develop effective treatments.

ALS Canada is a registered charity that receives no government funding. Everything we do – from funding research to providing community-based support for people living with ALS – is possible only because of donor generosity and partnerships with provincial ALS Societies who contribute to the ALS Canada Research Program.