Diffusion Tensor Imaging of the Optic Nerve in Multiple Sclerosis: Association with Retinal Damage and Visual Disability

• Published in: American journal of neuroradiology : AJNR 2011-10, Vol.32 (9), p.1662-1668
• Main Authors: SMITH, S. A, WILLIAMS, Z. R, REICH, D. S, RATCHFORD, J. N, NEWSOME, S. D, FARRELL, S. K, FARRELL, J. A. D, GIFFORD, A, MILLER, N. R, VAN ZIJL, P. C. M, CALABRESI, P. A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Brain; Cohort Studies; Diffusion Tensor Imaging - methods; Diffusion Tensor Imaging - standards; Diffusion Tensor Imaging - statistics & numerical data; Female; Fundamental and applied biological sciences. Psychology; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Multiple Sclerosis - pathology; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Nervous system; Neurology; Observer Variation; Optic Nerve - metabolism; Optic Nerve - pathology; Optic Neuritis - pathology; Perception; Psychology. Psychoanalysis. Psychiatry; Psychology. Psychophysiology; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Reproducibility of Results; Retina - pathology; Sensitivity and Specificity; Vision; Vision Disorders - pathology; Visual Acuity; Water - metabolism; Young Adult
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A2574

There is a well-known relationship between MS and damage to the optic nerve, but advanced, quantitative MR imaging methods have not been applied to large cohorts. Our objective was to determine whether a short imaging protocol (< 10 minutes), implemented with standard hardware, could detect abnormal water diffusion in the optic nerves of patients with MS. We examined water diffusion in human optic nerves via DTI in the largest MS cohort reported to date (104 individuals, including 38 optic nerves previously affected by optic neuritis). We also assessed whether such abnormalities are associated with loss of visual acuity (both high and low contrast) and damage to the retinal nerve fiber layer (assessed via optical coherence tomography). The most abnormal diffusion was found in the optic nerves of patients with SPMS, especially in optic nerves previously affected by optic neuritis (19% drop in FA). DTI abnormalities correlated with both retinal nerve fiber layer thinning (correlation coefficient, 0.41) and loss of visual acuity, particularly at high contrast and in nerves previously affected by optic neuritis (correlation coefficient, 0.54). However, diffusion abnormalities were overall less pronounced than retinal nerve fiber layer thinning. DTI is sensitive to optic nerve damage in patients with MS, but a short imaging sequence added to standard clinical protocols may not be the most reliable indicator of optic nerve damage.