title: The role of demyelination in neuromyelitis optica damage: diffusion-tensor MR imaging study.
abstract: OBJECTIVE
  To test the hypothesis that white matter damage in neuromyelitis optica (NMO) is more extensive than previously described and likely includes involvement of normal-appearing white matter and to explore by using diffusion-tensor (DT) imaging whether white matter lesions are not only related to wallerian degeneration but are also caused by demyelination.
  
  
  METHODS
  Seventeen patients with NMO (mean age, 45 years; 14 women) were compared with 17 sex- and age-matched control subjects. The institutional review board approved the study, and all subjects gave written informed consent. In addition to conventional magnetic resonance imaging sequences, DT imaging was performed along 30 noncollinear directions by using a 1.5-T imager. For tract-based spatial statistics (TBSS) analysis, the white matter skeleton was created, and a permutation-based inference with 5000 permutations with a threshold of P less than .05 to enable the identification of abnormalities in fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) was used. Partial correlation was applied to identify whether the number of clinical relapses and disease duration were correlated with all TBSS parameters.
  
  
  RESULTS
  TBSS showed multiple areas with significant FA decrease in patients with NMO, mainly located in the corona radiata, uncinate fasciculus, corpus callosum, optic radiation, internal and external capsules, and cerebral peduncles. The mean FA, RD, and AD in the abnormal voxels located on the corpus callosum were, respectively, 0.69 ± 0.03 (standard deviation), 0.39 × 10(23) mm(2)/sec ± 0.04, and 1.53 × 10(23) mm(2)/sec ± 0.04 in patients with NMO compared with 0.75 ± 0.02, 0.33 × 10(23) mm(2)/sec ± 0.03, and 1.57 × 10(23) mm(2)/sec ± 0.04 in control subjects (P < .0001, P < .0001, and P = .007, respectively). There was a highly significant inverse correlation between FA and RD (r = 20.976, P < .0001).
  
  
  CONCLUSIONS
  The use of TBSS allowed the identification of extensive white matter damage in patients with NMO. Multiple white matter tracts were involved, including the pyramidal tract, optic radiation, and corpus callosum, likely related to both demyelination and wallerian degeneration.
authors.affiliation: Department of Radiology, Federal University of Rio de Janeiro, Av Brigadeiro Trompowsky 255, Ilha do Fundão, Rio de Janeiro, RJ, Brazil 21941-913. Frueda81@hotmail.com
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Rueda Lopes
authors.forename: Thomas
authors.initials: T
authors.lastname: Doring
authors.forename: Christianne
authors.initials: C
authors.lastname: Martins
authors.forename: Fernanda C
authors.initials: FC
authors.lastname: Cabral
authors.forename: Fabíola R
authors.initials: FR
authors.lastname: Malfetano
authors.forename: Valéria C S R
authors.initials: VC
authors.lastname: Pereira
authors.forename: Soniza
authors.initials: S
authors.lastname: Alves-Leon
authors.forename: Emerson L
authors.initials: EL
authors.lastname: Gasparetto
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009471:Neuromyelitis Optica / Q000473:pathology*; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA