From the Univ. Lille (M.D., J.-P.P., X.L., O.O.), Department of Neuroradiology, INSERM, CHU Lille, U1172-Lille Neurosciences Institute; Univ. Lille (J.-P.W., V.M.S.), Department of Visual Explorations and Neuro-Ophthalmology, Hôpital Roger Salengro, CHU Lille; Univ. Lille (E.D., Julien Labreuche), CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Department of Biostatistics; and Univ. Lille (Julien Lannoy, J.B., M.Z., H.Z.), Department of Neurology, INSERM, CHU Lille, U1172-Lille Neurosciences Institute, France.
Neurol Neuroimmunol Neuroinflamm. 2022 Jan 28;9(2). doi: 10.1212/NXI.0000000000001135. Print 2022 Mar.
Acute optic neuritis (ON) is a classical presenting symptom of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and anti-MOG-associated disorders. The resulting visual impairment is variable and can be severe. Clinicians are in need of predictive biomarkers to optimize the management of acute ON. In this longitudinal study (IRMANO, NCT03651662), we evaluated the ability of optic nerve lesion length measured on MRI at the acute phase of ON to predict retinal neuro-axonal loss and visual impairment at a chronic stage.
We conducted a longitudinal study (IRMANO, NCT03651662) of patients who presented a clinical episode of ON (≤8 weeks). All patients underwent a retinal optical coherence tomography (OCT) and a brain/optic nerve MRI, including 3D double-inversion recovery (DIR) sequence at the acute phase of ON and 12 months later. Primary outcomes were optic nerve DIR hypersignal lesion length, macular ganglion cell-inner plexiform layer (GCIPL) volume measured on OCT, and low-contrast monocular visual acuity (LCMVA).
The study group included 51 patients (33 women, mean age of 32.4 years ± 7.9). We recruited patients with a clinically isolated syndrome (n = 20), a relapsing-remitting MS (n = 23), an isolated ON (n = 6), and a first clinical episode of NMOSD (n = 2). Optic nerve DIR hypersignal was observed in all but 1 symptomatic optic nerves. At inclusion, the mean optic nerve lesion length (in mm) was 12.35 ± 5.98. The mean GCIPL volume (in mm) significantly decreased between inclusion (1.90 ± 0.18) and M (1.67 ± 0.21; < 0.0001). Optic nerve lesion length at inclusion was significantly associated with GCIPL thinning (estimate ± SD; -0.012 ± 0.004; = 0.0016) and LCMVA at M (0.016 ± 0.003; < 0.001). Optic nerve lesion length significantly increased at M (15.76 ± 8.70; = 0.0007). The increase in optic nerve lesion length was significantly associated with the GCIPL thinning between inclusion and M (-0.012 ± 0.003; = 0.0011).
At the acute phase of ON, optic nerve lesion length is an imaging biomarker predictive of retinal neuro-axonal loss and chronic visual impairment, which can help to stratify future therapeutic strategies in acute ON.
This study provides Class I evidence that optic nerve lesion length measured on MRI during the acute phase of a first episode of ON is associated with long-term retinal neuro-axonal loss and visual impairment.
急性视神经炎（ON）是多发性硬化症（MS）、视神经脊髓炎谱系障碍（NMOSD）和抗 MOG 相关疾病的典型首发症状。由此导致的视力损害程度不一，可较为严重。临床医生需要预测性生物标志物来优化急性 ON 的管理。在这项纵向研究（IRMANO，NCT03651662）中，我们评估了急性 ON 期 MRI 上视神经病变长度对慢性期视网膜神经轴突丢失和视力损害的预测能力。
我们进行了一项纵向研究（IRMANO，NCT03651662），纳入了出现 ON 临床发作（≤8 周）的患者。所有患者均接受了视网膜光学相干断层扫描（OCT）和脑/视神经 MRI 检查，包括急性 ON 期和 12 个月后的 3D 双反转恢复（DIR）序列。主要结局是视神经 DIR 高信号病变长度、OCT 测量的黄斑神经节细胞-内丛状层（GCIPL）体积和低对比度单眼视力（LCMVA）。
研究组包括 51 例患者（33 例女性，平均年龄 32.4 岁±7.9）。我们招募了临床表现孤立综合征（n=20）、复发缓解型 MS（n=23）、孤立性 ON（n=6）和首次 NMOSD 临床发作（n=2）的患者。除了 1 条有症状的视神经外，所有视神经均可见 DIR 高信号。纳入时，视神经病变长度（mm）平均为 12.35±5.98。纳入时的平均 GCIPL 体积（mm）在 M 时明显变薄（1.90±0.18 和 1.67±0.21；<0.0001）。纳入时的视神经病变长度与 GCIPL 变薄（估计值±SD；-0.012±0.004；=0.0016）和 M 时的 LCMVA（0.016±0.003；<0.001）显著相关。M 时视神经病变长度明显增加（15.76±8.70；=0.0007）。M 时视神经病变长度的增加与纳入时和 M 时的 GCIPL 变薄显著相关（-0.012±0.003；=0.0011）。
在急性 ON 期，视神经病变长度是预测视网膜神经轴突丢失和慢性视力损害的影像学生物标志物，有助于分层急性 ON 的未来治疗策略。
这项研究提供了 I 级证据，表明在首次 ON 发作的急性期中测量的 MRI 上的视神经病变长度与长期的视网膜神经轴突丢失和视力损害相关。
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