Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis

PLOS ONE, Dec 2019

Introduction Optical coherence tomography (OCT) with retinal segmentation analysis is a valuable tool in assessing axonal loss and neuro-degeneration in multiple sclerosis (MS) by in-vivo imaging, delineation and quantification of retinal layers. There is evidence of deep retinal involvement in MS beyond the inner retinal layers. The ultra-structural retinal changes in MS in different MS phenotypes can reflect differences in the pathophysiologic mechanisms. There is limited data on the pattern of deeper retinal layer involvement in progressive MS (PMS) versus relapsing remitting MS (RRMS). We have compared the OCT segmentation analysis in patients with relapsing-remitting MS and progressive MS. Methods Cross-sectional study of 113 MS patients (226 eyes) (29 PMS, 84 RRMS) and 38 healthy controls (72 eyes). Spectral domain OCT (SDOCT) using the macular cube acquisition protocol (Cirrus HDOCT 5000; Carl Zeiss Meditec) and segmentation of the retinal layers for quantifying the thicknesses of the retinal layers. Segmentation of the retinal layers was carried out utilizing Orion software (Voxeleron, USA) for quantifying the thicknesses of individual retinal layers. Results The retinal nerve finer layer (RNFL) (p = 0.023), the ganglion-cell/inner plexiform layer (GCIPL) (p = 0.006) and the outer plexiform layer (OPL) (p = 0.033) were significantly thinner in PMS compared to RRMS. There was significant negative correlation between the outer nuclear layer (ONL) and EDSS (r = -0.554, p = 0.02) in PMS patients. In RRMS patients with prior optic neuritis, the GCIPL correlated negatively (r = -0.317; p = 0.046), while the photoreceptor layer (PR) correlated positively with EDSS (r = 0.478; p = 0.003). Conclusions Patients with PMS exhibit more atrophy of both the inner and outer retinal layers than RRMS. The ONL in PMS and the GCIPL and PR in RRMS can serve as potential surrogate of disease burden and progression (EDSS). The specific retinal layer predilection and its correlation with disability may reflect different pathophysiologic mechanisms and various stages of progression in MS.

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Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis

February Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis Raed Behbehani 0 1 Abdullah Abu Al-Hassan 0 1 Ali Al-Salahat 0 1 Devarajan Sriraman 1 J. D. Oakley 1 2 Raed Alroughani 1 0 Al-Bahar Ophthalmology Center, Ibn Sina Hospital , Kuwait City , Kuwait , 2 Neurology Clinic, Dasman Institute , Dasman , Kuwait , 3 National Dasman Diabetes Biobank, Dasman Institute , Dasman , Kuwait 1 Editor: Radouil Tzekov, Roskamp Institute , UNITED STATES 2 Voxeleron LLC , Pleasanton, CA , United States of America, 5 Division of Neurology, Amiri Hospital , Sharq , Kuwait Optical coherence tomography (OCT) with retinal segmentation analysis is a valuable tool in assessing axonal loss and neuro-degeneration in multiple sclerosis (MS) by in-vivo imaging, delineation and quantification of retinal layers. There is evidence of deep retinal involvement in MS beyond the inner retinal layers. The ultra-structural retinal changes in MS in different MS phenotypes can reflect differences in the pathophysiologic mechanisms. There is limited data on the pattern of deeper retinal layer involvement in progressive MS (PMS) versus relapsing remitting MS (RRMS). We have compared the OCT segmentation analysis in patients with relapsing-remitting MS and progressive MS. - Data Availability Statement: Data are available from the RA 2011-020 Institutional Data Access / Ethics Committee for researchers who meet the criteria for access to confidential data. Dasman Institute, with which the authors are affiliated, has restrictions which prevent the authors from making the data publicly available. These are issues pertaining mainly to patient confidentiality. However, the data can be shared with other institutes as part of collaborative research project. Data are from the RA 2011-020 study whose authors may be contacted at office of research Results Cross-sectional study of 113 MS patients (226 eyes) (29 PMS, 84 RRMS) and 38 healthy controls (72 eyes). Spectral domain OCT (SDOCT) using the macular cube acquisition protocol (Cirrus HDOCT 5000; Carl Zeiss Meditec) and segmentation of the retinal layers for quantifying the thicknesses of the retinal layers. Segmentation of the retinal layers was carried out utilizing Orion software (Voxeleron, USA) for quantifying the thicknesses of individual retinal layers. The retinal nerve finer layer (RNFL) (p = 0.023), the ganglion-cell/inner plexiform layer (GCIPL) (p = 0.006) and the outer plexiform layer (OPL) (p = 0.033) were significantly thinner in PMS compared to RRMS. There was significant negative correlation between the outer nuclear layer (ONL) and EDSS (r = -0.554, p = 0.02) in PMS patients. In RRMS patients with prior optic neuritis, the GCIPL correlated negatively (r = -0.317; p = 0.046), while the photoreceptor layer (PR) correlated positively with EDSS (r = 0.478; p = 0.003). affairs in Dasman Inst Office of Research Affairs. Contact information for the research ethics committee: Ms Rashmi Shiju Research Compliance Officer Office of Research Affairs P.O. Box 1180, Dasman 15462,Kuwait Phone: +965 2224 2999 Ext. 230 Funding: The authors received no specific funding for this work. Competing interests: Jonathan Oakley is an employee of Voxeleron LLC who created the OCT analysis software used in the study. The software found on the host device, the Cirrus, is not able to perform the segmentations required of this study. The data exported from the Cirrus devices was in Dicom format that required conversion to raw data for processing in Orion. Dr. Oakley performed all of the necessary conversion. Conclusions Patients with PMS exhibit more atrophy of both the inner and outer retinal layers than RRMS. The ONL in PMS and the GCIPL and PR in RRMS can serve as potential surrogate of disease burden and progression (EDSS). The specific retinal layer predilection and its correlation with disability may reflect different pathophysiologic mechanisms and various stages of progression in MS. Introduction Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system characterized by axonal loss and neurodegeneration. Most patients with MS exhibit a relapsing remitting course initially and later on transition into a secondary progressive stage. Less commonly patients exhibit a primary progressive course from the disease onset. [ 1 ] Optical Coherence tomography (OCT) has emerged as an excellent non-invasive tool to quantitatively assess axonal loss and neurodegeneration by imaging the retina. Numerous studies were performed using spectral domain OCT (SDOCT) on relapsing remitting MS (RRMS) patients, but only few attempted to compare pattern of neuroaxonal loss and neurodegneration with progressive MS (PMS) patients, both primary (PPMS) and secondary progressive (SPMS). [2±7] Studies using time-domain OCT have attempted to explore the difference between MS subtypes based on the pattern and extent of retinal nerv (...truncated)


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Raed Behbehani, Abdullah Abu Al-Hassan, Ali Al-Salahat, Devarajan Sriraman, J. D. Oakley, Raed Alroughani. Optical coherence tomography segmentation analysis in relapsing remitting versus progressive multiple sclerosis, PLOS ONE, 2017, Volume 12, Issue 2, DOI: 10.1371/journal.pone.0172120