Elsevier

NeuroImage: Clinical

Volume 11, 2016, Pages 743-750
NeuroImage: Clinical

Quantifying visual pathway axonal and myelin loss in multiple sclerosis and neuromyelitis optica

https://doi.org/10.1016/j.nicl.2016.05.014Get rights and content
Under a Creative Commons license
open access

Highlights

  • First study to assess relationship between segmented retinal layers and MRI in NMO

  • First study to use optic radiation myelin water imaging in demyelinating diseases

  • Inner nuclear layer thickening in MS with ON may occur independently of microcystic macular edema.

  • Myelin density reduction in the optic radiation observed in demyelinating diseases

  • Myelin loss may be due to subclinical MS disease activity in subjects without ON.

  • ON may lead to retinal and optic radiation pathology via bidirectional degeneration.

Abstract

Background

The optic nerve is frequently injured in multiple sclerosis and neuromyelitis optica, resulting in visual dysfunction, which may be reflected by measures distant from the site of injury.

Objective

To determine how retinal nerve fiber layer as a measure of axonal health, and macular volume as a measure of neuronal health are related to changes in myelin water fraction in the optic radiations of multiple sclerosis and neuromyelitis optica participants with and without optic neuritis and compared to healthy controls.

Methods

12 healthy controls, 42 multiple sclerosis (16 with optic neuritis), and 10 neuromyelitis optica participants (8 with optic neuritis) were included in this study. Optical coherence tomography assessment involved measurements of the segmented macular layers (total macular, ganglion cell layer, inner plexiform layer, and inner nuclear layer volume) and paripapillary retinal nerve fiber layer thickness. The MRI protocol included a 32-echo T2-relaxation GRASE sequence. Average myelin water fraction values were calculated within the optic radiations as a measure of myelin density.

Results

Multiple sclerosis and neuromyelitis optica eyes with optic neuritis history had lower retinal nerve fiber layer thickness, total macular, ganglion cell and inner plexiform layer volumes compared to eyes without optic neuritis history and controls. Inner nuclear layer volume increased in multiple sclerosis with optic neuritis history (mean = 0.99 mm3, SD = 0.06) compared to those without (mean = 0.97 mm3, SD = 0.06; p = 0.003). Mean myelin water fraction in the optic radiations was significantly lower in demyelinating diseases (neuromyelitis optica: mean = 0.098, SD = 0.01, multiple sclerosis with optic neuritis history: mean = 0.096, SD = 0.01, multiple sclerosis without optic neuritis history: mean = 0.098, SD = 0.02; F3,55 = 3.35, p = 0.03) compared to controls. Positive correlations between MRI and optical coherence tomography measures were also apparent (retinal nerve fiber layer thickness and ganglion cell layer thickness: r = 0.25, p = 0.05, total macular volume and inner plexiform layer volume: r = 0.27, p = 0.04).

Conclusions

The relationship between reductions in OCT measures of neuro-axonal health in the anterior visual pathway and MRI-based measures of myelin health in the posterior visual pathway suggests that these measures may be linked through bidirectional axonal degeneration.

Keywords

Multiple sclerosis
Neuromyelitis optica
Optical coherence tomography
Magnetic resonance imaging
Myelin water imaging
Optic neuritis

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