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CROP - The Clinico-Radiologico-Ophthalmological Paradox in Multiple Sclerosis: Are patterns of retinal and MRI changes heterogeneous and thus not predictable?

CROP - The Clinico-Radiologico-Ophthalmological Paradox in Multiple Sclerosis: Are patterns of retinal and MRI changes heterogeneous and thus not predictable?
CROP - The Clinico-Radiologico-Ophthalmological Paradox in Multiple Sclerosis: Are patterns of retinal and MRI changes heterogeneous and thus not predictable?

BACKGROUND: To date, no direct scientific evidence has been found linking tissue changes in multiple sclerosis (MS) patients, such as demyelination, axonal destruction or gliosis, with either steady progression and/or stepwise accumulation of focal CNS lesions. Tissue changes such as reduction of the retinal nerve fiber layer (RNFL) and the total macular volume (TMV), or brain- and spinal cord atrophy indicates an irreversible stage of tissue destruction. Whether these changes are found in all MS patients, and if there is a correlation with clinical disease state, remains controversial. The objective of our study was to determine, whether there was any correlation between the RNFL or TMV of patients with MS, and: (1) the lesion load along the visual pathways, (2) the ratios and absolute concentrations of metabolites in the normal-appearing white matter (NAWM), (3) standard brain atrophy indices, (4) disease activity or (5) disease duration.

METHODS: 28 MS patients (RRMS, n = 23; secondary progressive MS (SPMS), n = 5) with moderately-high disease activity or long disease course were included in the study. We utilised: (1) magnetic resonance imaging (MRI) and (2) -spectroscopy (MRS), both operating at 3 Tesla, and (3) high-resolution spectral domain-OCT with locked reference images and eye tracking mode) to undertake the study.

RESULTS: There was no consistency in the pattern of CNS metabolites, brain atrophy indices and the RNFL/TMV between individuals, which ranged from normal to markedly-reduced levels. Furthermore, there was no strict correlation between CNS metabolites, lesions along the visual pathways, atrophy indices, RNFL, TMV, disease duration or disability.

CONCLUSIONS: Based on the findings of this study, we recommend that the concept of 'clinico-radiologico paradox' in multiple sclerosis be extended to CROP-'clinico-radiologico-ophthalmological paradox'. Furthermore, OCT data of MS patients should be interpreted with caution.

Adolescent, Adult, Atrophy/pathology, Brain/pathology, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis/pathology, Multiple Sclerosis, Chronic Progressive/pathology, Retina/pathology, Tomography, Optical Coherence, Visual Pathways/pathology, Young Adult
1932-6203
Aboulenein-Djamshidian, Fahmy
5ac3351c-ebb0-483c-b8ff-a9c7ad17a05c
Krššák, Martin
efb76b08-afe8-40c3-91fd-c3b4919165df
Serbecic, Nermin
3f835554-26ca-4133-bf1e-90124e3aeda4
Rauschka, Helmut
c8508fea-5005-4b52-a492-fda407308d3c
Beutelspacher, Sven
a63a628a-7872-4dd7-b784-97314d5bc2dd
Kukurová, Ivica Just
537dbad7-89ab-491a-9239-f727ba47a9df
Valkovič, Ladislav
c3cf5d0a-ccf2-4726-951e-5e62890634a6
Khan, Adnan
97374057-d7e7-4849-ac94-c125ba1cc360
Prayer, Daniela
a0c8d5d0-53ca-4703-b15f-0116c1ec4df9
Kristoferitsch, Wolfgang
8feae560-b21b-4718-b9ac-4f993a2f2e9e
Aboulenein-Djamshidian, Fahmy
5ac3351c-ebb0-483c-b8ff-a9c7ad17a05c
Krššák, Martin
efb76b08-afe8-40c3-91fd-c3b4919165df
Serbecic, Nermin
3f835554-26ca-4133-bf1e-90124e3aeda4
Rauschka, Helmut
c8508fea-5005-4b52-a492-fda407308d3c
Beutelspacher, Sven
a63a628a-7872-4dd7-b784-97314d5bc2dd
Kukurová, Ivica Just
537dbad7-89ab-491a-9239-f727ba47a9df
Valkovič, Ladislav
c3cf5d0a-ccf2-4726-951e-5e62890634a6
Khan, Adnan
97374057-d7e7-4849-ac94-c125ba1cc360
Prayer, Daniela
a0c8d5d0-53ca-4703-b15f-0116c1ec4df9
Kristoferitsch, Wolfgang
8feae560-b21b-4718-b9ac-4f993a2f2e9e

Aboulenein-Djamshidian, Fahmy, Krššák, Martin, Serbecic, Nermin, Rauschka, Helmut, Beutelspacher, Sven, Kukurová, Ivica Just, Valkovič, Ladislav, Khan, Adnan, Prayer, Daniela and Kristoferitsch, Wolfgang (2015) CROP - The Clinico-Radiologico-Ophthalmological Paradox in Multiple Sclerosis: Are patterns of retinal and MRI changes heterogeneous and thus not predictable? PLoS ONE, 10 (11), [e0142272]. (doi:10.1371/journal.pone.0142272).

Record type: Article

Abstract

BACKGROUND: To date, no direct scientific evidence has been found linking tissue changes in multiple sclerosis (MS) patients, such as demyelination, axonal destruction or gliosis, with either steady progression and/or stepwise accumulation of focal CNS lesions. Tissue changes such as reduction of the retinal nerve fiber layer (RNFL) and the total macular volume (TMV), or brain- and spinal cord atrophy indicates an irreversible stage of tissue destruction. Whether these changes are found in all MS patients, and if there is a correlation with clinical disease state, remains controversial. The objective of our study was to determine, whether there was any correlation between the RNFL or TMV of patients with MS, and: (1) the lesion load along the visual pathways, (2) the ratios and absolute concentrations of metabolites in the normal-appearing white matter (NAWM), (3) standard brain atrophy indices, (4) disease activity or (5) disease duration.

METHODS: 28 MS patients (RRMS, n = 23; secondary progressive MS (SPMS), n = 5) with moderately-high disease activity or long disease course were included in the study. We utilised: (1) magnetic resonance imaging (MRI) and (2) -spectroscopy (MRS), both operating at 3 Tesla, and (3) high-resolution spectral domain-OCT with locked reference images and eye tracking mode) to undertake the study.

RESULTS: There was no consistency in the pattern of CNS metabolites, brain atrophy indices and the RNFL/TMV between individuals, which ranged from normal to markedly-reduced levels. Furthermore, there was no strict correlation between CNS metabolites, lesions along the visual pathways, atrophy indices, RNFL, TMV, disease duration or disability.

CONCLUSIONS: Based on the findings of this study, we recommend that the concept of 'clinico-radiologico paradox' in multiple sclerosis be extended to CROP-'clinico-radiologico-ophthalmological paradox'. Furthermore, OCT data of MS patients should be interpreted with caution.

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journal.pone.0142272 - Version of Record
Available under License Creative Commons Attribution.
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Accepted/In Press date: 20 October 2015
e-pub ahead of print date: 13 November 2015
Published date: 2015
Keywords: Adolescent, Adult, Atrophy/pathology, Brain/pathology, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Multiple Sclerosis/pathology, Multiple Sclerosis, Chronic Progressive/pathology, Retina/pathology, Tomography, Optical Coherence, Visual Pathways/pathology, Young Adult

Identifiers

Local EPrints ID: 432524
URI: http://eprints.soton.ac.uk/id/eprint/432524
ISSN: 1932-6203
PURE UUID: 4cc97367-d1ae-439f-9d44-813f630835a6
ORCID for Adnan Khan: ORCID iD orcid.org/0000-0001-8153-8002

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Date deposited: 17 Jul 2019 16:30
Last modified: 30 Nov 2019 01:21

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Contributors

Author: Fahmy Aboulenein-Djamshidian
Author: Martin Krššák
Author: Nermin Serbecic
Author: Helmut Rauschka
Author: Sven Beutelspacher
Author: Ivica Just Kukurová
Author: Ladislav Valkovič
Author: Adnan Khan ORCID iD
Author: Daniela Prayer
Author: Wolfgang Kristoferitsch

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