Kuchling Joseph, Brandt Alexander U, Paul Friedemann, Scheel Michael
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, NeuroCure Clinical Research Center, Charitéplatz 1, D-10117 Berlin, Germany.
Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117 Berlin, Germany.
EPMA J. 2017 Jul 25;8(3):279-294. doi: 10.1007/s13167-017-0102-x. eCollection 2017 Sep.
The afferent visual pathway represents the most frequently affected white matter pathway in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Diffusion tensor imaging (DTI) can reveal microstructural or non-overt brain tissue damage and quantify pathological processes. DTI facilitates the reconstruction of major white matter fiber tracts allowing for the assessment of structure-function and damage-dysfunction relationships In this review, we outline DTI studies investigating the afferent visual pathway in idiopathic optic neuritis (ON), NMOSD, and MS. Since MS damage patterns are believed to depend on multiple factors, i.e., ON (anterior visual pathway damage), inflammatory lesions (posterior visual pathway damage), and global diffuse inflammatory and neurodegenerative processes, comprehensive knowledge on different contributing factors using DTI in vivo may advance our understanding of MS disease pathology. Combination of DTI measures and visual outcome parameters yields the potential to improve routine clinical diagnostic procedures and may further the accuracy of individual prognosis with regard to visual function and personalized disease outcome. However, due to the inherent limitations of DTI acquisition and post-processing techniques and the so far heterogeneous and equivocal data of previous studies, evaluation of the true potential of DTI as a possible biomarker for afferent visual pathway dysfunction is still substantially limited. Further research efforts with larger longitudinal studies and standardized DTI acquisition and post-processing validation criteria are needed to overcome current DTI limitations. DTI evaluation at different levels of the visual pathway has the potential to provide markers for individual damage evaluation in the future. As an imaging biomarker, DTI may support individual outcome prediction during personalized treatment algorithms in MS and other neuroinflammatory diseases, hereby leveraging the concept of predictive, preventive, and personalized medicine in the field of clinical neuroimmunology.
在多发性硬化症（MS）和视神经脊髓炎谱系障碍（NMOSD）中，传入视觉通路是最常受影响的白质通路。扩散张量成像（DTI）可以揭示微观结构或非显性脑组织损伤，并量化病理过程。DTI有助于重建主要的白质纤维束，从而能够评估结构-功能以及损伤-功能障碍之间的关系。在本综述中，我们概述了利用DTI研究特发性视神经炎（ON）、NMOSD和MS中传入视觉通路的研究。由于MS的损伤模式被认为取决于多种因素，即ON（前部视觉通路损伤）、炎性病变（后部视觉通路损伤）以及全身性弥漫性炎症和神经退行性过程，因此在体内使用DTI全面了解不同的影响因素可能会增进我们对MS疾病病理学的理解。将DTI测量值与视觉结果参数相结合，有可能改善常规临床诊断程序，并提高个体在视觉功能和个性化疾病转归方面预后的准确性。然而，由于DTI采集和后处理技术存在固有局限性，且既往研究的数据至今仍存在异质性和不确定性，DTI作为传入视觉通路功能障碍潜在生物标志物的真正潜力评估仍受到很大限制。需要通过更大规模的纵向研究以及标准化的DTI采集和后处理验证标准来进一步开展研究，以克服当前DTI的局限性。在视觉通路不同水平进行DTI评估有可能在未来为个体损伤评估提供标志物。作为一种成像生物标志物，DTI可能有助于在MS和其他神经炎症性疾病的个性化治疗方案中进行个体预后预测，从而在临床神经免疫学领域充分利用预测、预防和个性化医学的理念。
