Structural brain abnormalities are related to retinal nerve fiber layer thinning and disease duration in neuromyelitis optica spectrum disorders.
Although aquaporin-4 (AQP4) is widely expressed in the human brain cortex, lesions are rare in neuromyelitis optica (NMO) spectrum disorders (NMOSD). Recently, however, several studies have demonstrated occult structural brain atrophy in NMO.



This study aims to investigate magnetic resonance imaging (MRI) patterns of gray matter (GM) and white matter (WM) abnormalities in patients with NMOSD and to assess the visual pathway integrity during disease duration correlation of the retinal nerve fiber layer (RNFL) and pericalcarine cortex thickness.



Twenty-one patients with NMOSD and 34 matched healthy controls underwent both high-field MRI (3T) high-resolution T1-weighted and diffusion-tensor MRI. Voxel-based morphometry, cortical analyses (Freesurfer) and diffusion-tensor imaging (DTI) analyses (TBSS-FSL) were used to investigate brain abnormalities. In addition, RNFL measurement by optic-coherence tomography (OCT) was performed.



We demonstrate that NMOSD is associated with GM and WM atrophy, encompassing more frequently the motor, sensory and visual pathways, and that the extent of GM atrophy correlates with disease duration. Furthermore, we demonstrate for the first time a correlation between RNFL and pericalcarine cortical thickness, with cortical atrophy evolving over the course of disease.



Our findings indicate a role for retrograde and anterograde neurodegeneration in GM atrophy in NMOSD. However, the presence atrophy encompassing almost all lobes suggests that additional pathomechanisms might also be involved.
Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil fglehn@terra.com.br leonilda@unicamp.br yasuda.clarissa@gmail.com.
Felipe
F
von Glehn
Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany.
Sven
S
Jarius
Department of Ophthalmology, University of Campinas, Brazil.
Rodrigo Pessoa
RP
Cavalcanti Lira
Department of Ophthalmology, University of Campinas, Brazil.
Maria Carolina
MC
Alves Ferreira
Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil.
Fadua H Ribeiro
FH
von Glehn
Department of Ophthalmology, University of Campinas, Brazil.
Stella Maris
SM
Costa E Castro
Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil Institute of Physics "Gleb Wataghin", University of Campinas, Brazil.
Guilherme Coco
GC
Beltramini
Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil.
Felipe Pg
FP
Bergo
Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil.
Alessandro S
AS
Farias
Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil.
Carlos Otávio
CO
Brandão
Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Germany.
Brigitte
B
Wildemann
Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil.
Benito P
BP
Damasceno
Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil.
Fernando
F
Cendes
Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Brazil.
Leonilda M B
LM
Santos
Laboratory of Neuroimaging, Department of Neurology, University of Campinas, Brazil.
Clarissa Lin
CL
Yasuda
D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000000981:diagnostic imaging*; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D041623:Tomography, Optical Coherence; D066127:White Matter / Q000000981:diagnostic imaging*; D055815:Young Adult
Neuromyelitis optica; VBM analysis; longitudinally extensive transverse myelitis; optical coherence tomography analysis; retinal nerve fiber layer atrophy