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Optic nerve diffusion tensor imaging after acute optic neuritis predicts axonal and visual outcomes.

Anneke van der Walt1, Scott C Kolbe2, Yejun E Wang2

  • 1Department of Anatomy and Neuroscience, University of Melbourne, Melbourne, Victoria, Australia ; Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia ; Department of Neuro-ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia ; Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.

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Early optic nerve diffusion tensor imaging (DTI) measures, specifically axial diffusivity (AD), can predict visual outcomes in acute optic neuritis (ON). Reduced AD at one month indicates axonal loss, while persistent reduction at three months predicts poorer visual function.

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Radiology

Background:

  • Multiple Sclerosis (MS) requires early outcome markers for neuroprotective therapy testing.
  • Acute optic neuritis (ON) is a common MS manifestation impacting vision.

Purpose of the Study:

  • To evaluate if early diffusion tensor imaging (DTI) parameters in the optic nerve predict axonal and clinical outcomes in acute ON.
  • To assess the predictive value of axial diffusivity (AD) and radial diffusivity (RD) at 6 and 12 months post-ON.

Main Methods:

  • Thirty-seven patients with acute ON underwent optic nerve DTI, clinical, and paraclinical assessments.
  • Measurements were taken at baseline, 1, 3, 6, and 12 months.
  • DTI parameters (AD, RD) were correlated with retinal nerve fibre layer (RNFL) thinning, visual evoked potential (VEP) amplitude, visual acuity, and visual field loss.

Main Results:

  • Reduced optic nerve AD was observed at baseline, 1, and 3 months post-ON.
  • One-month AD reduction correlated with RNFL thinning and VEP amplitude loss at 6 and 12 months.
  • Three-month AD reduction predicted poorer visual acuity at 6 and 12 months; normalized AD by 3 months was associated with better outcomes.

Conclusions:

  • Optic nerve AD reduction during acute ON is a significant early marker of axonal injury.
  • Persistent AD reduction at 3 months post-ON predicts long-term visual dysfunction.
  • Therapies normalizing optic nerve AD by 3 months may improve axon survival and visual outcomes in ON.