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...

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Hauptverfasser: Aboulenein, Fahmy (VerfasserIn) , Beutelspacher, Sven C. (VerfasserIn)
Dokumenttyp: Article (Journal)
Sprache:Englisch
Veröffentlicht: November 13, 2015
In: PLOS ONE
Year: 2015, Jahrgang: 10, Heft: 11, Pages: e0142272
ISSN:1932-6203
DOI:10.1371/journal.pone.0142272
Online-Zugang:Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1371/journal.pone.0142272
Verlag, kostenfrei, Volltext: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142272
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Verfasserangaben:Fahmy Aboulenein-Djamshidian, Martin Krššák, Nermin Serbecic, Helmut Rauschka, Sven Beutelspacher, Ivica Just Kukurová, Ladislav Valkovič, Adnan Khan, Daniela Prayer, Wolfgang Kristoferitsch

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520 |a 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. 
650 4 |a Atrophy 
650 4 |a Eye diseases 
650 4 |a Eyes 
650 4 |a Lesions 
650 4 |a Magnetic resonance imaging 
650 4 |a Multiple sclerosis 
650 4 |a Tobacco mosaic virus 
650 4 |a Visual pathways 
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