title: Fractional anisotropy of the optic radiations is associated with visual acuity loss in optic pathway gliomas of neurofibromatosis type 1.
abstract: BACKGROUND
  No more than half of patients with neurofibromatosis type 1 (NF1)-associated optic pathway gliomas (OPGs) develop vision loss. Prospectively identifying those who will require therapy remains challenging, because no reliable factors have yet been identified that predict future vision loss. To determine whether brain tissue microstructure is associated with visual acuity loss, we examined diffusion tensor imaging (DTI) and ophthalmologic evaluations in children with NF1-associated OPG.
  
  
  METHODS
  We retrospectively reviewed ophthalmology records and concurrent DTI measurements of the optic nerves, tracts, and radiations from 50 children with NF1-associated OPGs. Multivariate linear regression measured the association between fiber trajectory quantity and white matter integrity on visual acuity measured by the logarithm of the minimal angle of resolution (logMAR).
  
  
  RESULTS
  In multivariate analysis, fractional anisotropy (FA) of the optic radiations was associated with visual acuity loss (adjusted coefficient = -6.081 logMAR/FA; P = .006) after adjusting for age, extent of tumor, DTI acquisition type, prior chemotherapy, and fundus examination findings. The association remained after eliminating tumors involving the optic radiations. In an evaluation of 15 subjects with paired ophthalmologic examination and DTI a year apart, initial FA of the optic radiation was associated with a trend toward change in visual acuity a year later (coefficient = -2.652 logMAR/FA; P = .069).
  
  
  CONCLUSIONS
  A decrease in FA of the optic radiations is associated with abnormal visual acuity in NF1-associated OPGs and may be predictive of visual acuity loss during the following year.
authors: Division of Pediatric Hematology and Oncology, Rainbow Babies and Children’s Hospital and Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA. peter.deblank@uhhospitals.org
authors: Peter Matthew Kennedy
authors: PM
authors: de Blank
authors: Jeffrey Ira
authors: JI
authors: Berman
authors: Grant T
authors: GT
authors: Liu
authors: Timothy Paul Leslie
authors: TP
authors: Roberts
authors: Michael Jay
authors: MJ
authors: Fisher
mesh_terms: D016880:Anisotropy; D002648:Child; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009456:Neurofibromatosis 1 / Q000150:complications / Q000175:diagnosis*; D020339:Optic Nerve Glioma / Q000150:complications / Q000175:diagnosis*; D011379:Prognosis; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis* / Q000209:etiology; D014792:Visual Acuity; D014795:Visual Pathways
keywords: diffusion tensor imaging; neuro-ophthalmology; neurofibromatosis type 1; optic pathway glioma; visual acuity
references: J Magn Reson Imaging. 2005 Aug;22(2):302-6
references: 16028247
references: J Pediatr. 1989 May;114(5):788-92
references: 2497236
references: J Neuropathol Exp Neurol. 2009 May;68(5):542-51
references: 19525901
references: Am J Med Genet A. 2003 Oct 1;122A(2):95-9
references: 12955759
references: J Neurosurg Pediatr. 2012 Oct;10(4):273-80
references: 22900485
references: Comput Methods Programs Biomed. 2006 Feb;81(2):106-16
references: 16413083
references: J Neurol Neurosurg Psychiatry. 1982 Feb;45(2):143-6
references: 7069426
references: Neuro Oncol. 2012 Jun;14(6):790-7
references: 22474213
references: Neurology. 2010 May 25;74(21):1694-701
references: 20498437
references: J Neuroimaging. 2007 Apr;17 Suppl 1:42S-45S
references: 17425734
references: Neurology. 1997 Apr;48(4):1121-7
references: 9109916
references: Arch Dermatol. 2005 Jan;141(1):71-4
references: 15655144
references: J Pediatr Hematol Oncol. 2001 Dec;23(9):572-7
references: 11902299
references: Pediatr Blood Cancer. 2010 Dec 1;55(6):1083-8
references: 20979170
references: Am J Ophthalmol. 2001 Apr;131(4):442-5
references: 11292406
references: J Magn Reson Imaging. 2010 Jul;32(1):76-81
references: 20578013
references: Am J Ophthalmol. 2011 Mar;151(3):542-9.e2
references: 21232732
references: Pediatr Blood Cancer. 2011 Sep;57(3):481-5
references: 21241008
references: J Pediatr. 1994 Jul;125(1):63-6
references: 8021787
references: Eye (Lond). 2010 Oct;24(10):1603-5
references: 20689568
references: Neurology. 2005 Oct 11;65(7):1037-44
references: 16217056
references: AJNR Am J Neuroradiol. 2011 Jun-Jul;32(6):1016-20
references: 21393412
references: Pediatr Neurol. 2001 Jan;24(1):44-8
references: 11182280
references: Ophthalmology. 2010 Apr;117(4):818-24
references: 20079537
references: Pediatr Radiol. 2012 Feb;42(2):168-74
references: 21858653
references: Ann Neurol. 2007 Mar;61(3):189-98
references: 17387725
references: Eur J Nucl Med Mol Imaging. 2010 Jul;37(7):1309-17
references: 20179923