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Brain parenchymal damage in neuromyelitis optica spectrum disorder – A multimodal MRI study

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Abstract

Objective

To investigate different brain regions for grey (GM) and white matter (WM) damage in a well-defined cohort of neuromyelitis optica spectrum disorder (NMOSD) patients and compare advanced MRI techniques (VBM, Subcortical and cortical analyses (Freesurfer), and DTI) for their ability to detect damage in NMOSD.

Methods

We analyzed 21 NMOSD patients and 21 age and gender matched control subjects. VBM (GW/WM) and DTI whole brain (TBSS) analyses were performed at different statistical thresholds to reflect different statistical approaches in previous studies. In an automated atlas-based approach, Freesurfer and DTI results were compared between NMOSD and controls.

Results

DTI TBSS and DTI atlas based analysis demonstrated microstructural impairment only within the optic radiation or in regions associated with the optic radiation (posterior thalamic radiation p < 0.001, 6.9 % reduction of fractional anisotropy). VBM demonstrated widespread brain GM and WM reduction, but only at exploratory statistical thresholds, with no differences remaining after correction for multiple comparisons. Freesurfer analysis demonstrated no group differences.

Conclusion

NMOSD specific parenchymal brain damage is predominantly located in the optic radiation, likely due to a secondary degeneration caused by ON. In comparison, DTI appears to be the most reliable and sensitive technique for brain damage detection in NMOSD.

Key Points

• The hypothesis of a widespread brain damage in NMOSD is challenged.

• The optic radiation (OR) is the most severely affected region.

• OR-affection is likely due to secondary degeneration following optic neuritis.

• DTI is currently the most sensitive technique for NMOSD-related brain-damage detection.

• DTI is currently the most reliable technique for NMOSD-related brain-damage detection.

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Acknowledgments

The scientific guarantor of this publication is Prof. Dr. med. Friedemann Paul. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding from the Bundesministerium für Bildung und Forschung (BMBF Competence Network Multiple Sclerosis to FP, FlP, JW and KR) and by Deutsche Forschungsgemeinschaft (Exc 257 to FP), as well as from BIH-Charité Clinical Scientist Program funded by the Charité- Universitätsmedizin Berlin and the Berlin Institute of Health (to FlP). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained.

Written informed consent was obtained from all subjects (patients) in this study. Methodology:

Prospective, cross sectional study, one institution.

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Authors and Affiliations

  1. NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité- Universitätsmedizin Berlin, Berlin, Germany

    F. Pache, H. Zimmermann, A. Lacheta, S. Papazoglou, J. Kuchling, J. Wuerfel, F. Paul, A. U. Brandt & M. Scheel

  2. Department of Neurology, Charité- Universitätsmedizin Berlin, Berlin, Germany

    F. Pache, C. Finke, K. Ruprecht & F. Paul

  3. Berlin School of Mind and Brain, Humboldt-Universitaet zu Berlin, Berlin, Germany

    C. Finke

  4. Department of Radiology, Charité- Universitätsmedizin Berlin, Berlin, Germany

    B. Hamm & M. Scheel

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  1. F. Pache
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  2. H. Zimmermann
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Correspondence to F. Pache.

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Pache, F., Zimmermann, H., Finke, C. et al. Brain parenchymal damage in neuromyelitis optica spectrum disorder – A multimodal MRI study. Eur Radiol 26, 4413–4422 (2016). https://doi.org/10.1007/s00330-016-4282-x

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  • DOI: https://doi.org/10.1007/s00330-016-4282-x

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