title: Visualisation of the medial longitudinal fasciculus using fibre tractography in multiple sclerosis patients with internuclear ophthalmoplegia.
abstract: BACKGROUND
  This study investigates the use of fibre tractography to facilitate visualisation of the medial longitudinal fasciculus (MLF) and the impact of internuclear ophthalmoplegia (INO) causing lesions on these reconstructions of the tract. Improved visualisation of such tracts may improve knowledge, understanding and confidence related to neurological conditions.
  
  
  OBJECTIVE
  To explore the use of fibre tractography for the visualisation of the MLF in patients with INO.
  
  
  METHODS
  Twelve MS subjects with clinical evidence of INO and 12 matched controls underwent magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI), of the brain. Fibre tractography reconstructions were then evaluated and validated by an experienced neuroanatomist.
  
  
  RESULTS
  The evaluating neuroanatomist confirmed that the MLF had been reproduced in all of the reconstructed cases (fibre tractography was unsuccessful in five cases). The sensitivity of fibre tractography to MLF pathology was 58.3 % while the specificity was much higher at 85.7 % with a positive predictive value of 87.5 % and a negative predictive value of 54.6 %, with excellent intra-reader reliability.
  
  
  CONCLUSIONS
  This study demonstrates that fibre tractography of the MLF can potentially be performed with a view to facilitating improved visualisation of the tract and associated pathology in cases of INO. This may help explain the association between lesion type and location with clinical symptomatology and may assist in monitoring disease progression. These reconstructions may provide a valuable addition to the teaching and understanding of clinical signs related to subtle pathology.
authors.affiliation: School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland. jonathan.mcnulty@ucd.ie.
authors.forename: J P
authors.initials: JP
authors.lastname: McNulty
authors.affiliation: Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Lonergan
authors.affiliation: School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Bannigan
authors.affiliation: School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland.|Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: R
authors.initials: R
authors.lastname: O'Laoide
authors.affiliation: School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland.
authors.forename: L A
authors.initials: LA
authors.lastname: Rainford
authors.affiliation: School of Medicine, University College Dublin, Health Sciences Centre, Belfield, Dublin 4, Ireland.|Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Tubridy
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D015835:Ocular Motility Disorders / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results
keywords: Fibre tractography; Internuclear ophthalmoplegia; Magnetic resonance imaging; Medial longitudinal fasciculus; Multiple sclerosis