Contributions
Abstract: P507
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 19 Neurodegeneration
Background: Optical coherence tomography (OCT) is a reliable, reproducible non-invasive retinal imaging technique. There is growing evidence supporting OCT as a complementary tool to MRI for tracking neurodegeneration. In this regard, the ganglion cell layer+ inner plexiform layer (GCIP) thickness shows greatest utility due to its sensitivity and reproducibility. A number of OCT determined MS phenotypes have been described including macular thinning predominant [MTP; combination of average macular thickness < 5th percentile and retinal nerve fiber layer thickness between the 5-95th percentiles], and macular microcystoid pathology (MCP; cystoid changes mainly in the inner nuclear layer). Biological differences in these phenotypes over time remain unclear.
Objective: To determine longitudinal changes in MRI and OCT of MTP, MCP and non-MTP/MCP (nMTCP) MS patients.
Methods: 51 nMTCP, 26 MTP and 24 MCP MS patients were tracked for a mean duration of 5.4 years. Annually contrast enhanced 3T brain MRI and 6-monthly OCT scans were performed. Validated image segmentation pipelines developed at Johns Hopkins University were used to analyze both the MRI and OCT data. Mixed-effects linear regression (Stata) was used for statistical analysis.
Results: Significant thinning was observed in all retinal layers across MS phenotypes. GCIP annual rates of change were -0.30%, -0.64% and -0.78% in nMTCP, MTP and MCP respectively (p< 0.008 for all). The difference in rates of GCIP and outer nuclear layer atrophy were significantly different between the MCP and nMTCP cohorts (p=0.006 and p=0.012 respectively). The difference in rate of GCIP atrophy between the MTP and nMTCP cohorts trended towards significance (p=0.07). Across phenotypes, significant whole brain (p< 0.001) and brain substructure (p< 0.05, for all) atrophy was observed. In particular, thalamic atrophy was pronounced and faster in the MTP vs nMTCP cohorts (MTP: -0.83%/year vs nMTCP: -0.44%/year, p=0.04 adjusted for age, sex and disease duration).
Conclusion: OCT and MRI measures are valuable instruments for assessing tissue loss in MS. This study shows pronounced thalamic atrophy, underpinning the importance of gray matter pathology in MS. OCT defined MTP MS patient exhibit more prominent retinal and brain atrophy, indicating that this phenotype may follow a more aggressive course than nMTCP. Accordingly, phenotype identification and characterization of MTP patients with OCT may help inform clinical care
Disclosure: Laura Balcer has received consulting fees from Biogen.
Teresa Frohman has received speaker and consulting fees from Acorda, Genzyme, and Novartis
Elliot Frohman has received speaker and consulting fees from Genzyme, Acorda, Novartis, and TEVA.
Peter Calabresi has received personal honorariums for consulting from Biogen and Vertex. He is PI on research grants to Johns Hopkins from Novartis, Teva, MedImmune, Annexon, and Biogen.
Shiv Saidha has received consulting fees from Medical Logix for the development of CME programs in neurology, consulting fees from Axon Advisors LLC, speaking honoraria from the National Association of Managed Care Physicians, Family Medicine Foundation of West Virginia, and Advanced Studies in Medicine and served on scientific advisory boards for Biogen-Idec, Genzyme, Genentech Corporation & Novartis. He receives research support from Genentech Corporation and the National MS Society, and received support from the Race to Erase MS foundation. He is a member of the working committee of the International Multiple Sclerosis Visual System (IMSVISUAL) Consortium.
NGC, ES, BD, KF, JG, JN, AR, EO, CC, PD and JP have nothing to disclose
Abstract: P507
Type: Poster
Abstract Category: Pathology and pathogenesis of MS - 19 Neurodegeneration
Background: Optical coherence tomography (OCT) is a reliable, reproducible non-invasive retinal imaging technique. There is growing evidence supporting OCT as a complementary tool to MRI for tracking neurodegeneration. In this regard, the ganglion cell layer+ inner plexiform layer (GCIP) thickness shows greatest utility due to its sensitivity and reproducibility. A number of OCT determined MS phenotypes have been described including macular thinning predominant [MTP; combination of average macular thickness < 5th percentile and retinal nerve fiber layer thickness between the 5-95th percentiles], and macular microcystoid pathology (MCP; cystoid changes mainly in the inner nuclear layer). Biological differences in these phenotypes over time remain unclear.
Objective: To determine longitudinal changes in MRI and OCT of MTP, MCP and non-MTP/MCP (nMTCP) MS patients.
Methods: 51 nMTCP, 26 MTP and 24 MCP MS patients were tracked for a mean duration of 5.4 years. Annually contrast enhanced 3T brain MRI and 6-monthly OCT scans were performed. Validated image segmentation pipelines developed at Johns Hopkins University were used to analyze both the MRI and OCT data. Mixed-effects linear regression (Stata) was used for statistical analysis.
Results: Significant thinning was observed in all retinal layers across MS phenotypes. GCIP annual rates of change were -0.30%, -0.64% and -0.78% in nMTCP, MTP and MCP respectively (p< 0.008 for all). The difference in rates of GCIP and outer nuclear layer atrophy were significantly different between the MCP and nMTCP cohorts (p=0.006 and p=0.012 respectively). The difference in rate of GCIP atrophy between the MTP and nMTCP cohorts trended towards significance (p=0.07). Across phenotypes, significant whole brain (p< 0.001) and brain substructure (p< 0.05, for all) atrophy was observed. In particular, thalamic atrophy was pronounced and faster in the MTP vs nMTCP cohorts (MTP: -0.83%/year vs nMTCP: -0.44%/year, p=0.04 adjusted for age, sex and disease duration).
Conclusion: OCT and MRI measures are valuable instruments for assessing tissue loss in MS. This study shows pronounced thalamic atrophy, underpinning the importance of gray matter pathology in MS. OCT defined MTP MS patient exhibit more prominent retinal and brain atrophy, indicating that this phenotype may follow a more aggressive course than nMTCP. Accordingly, phenotype identification and characterization of MTP patients with OCT may help inform clinical care
Disclosure: Laura Balcer has received consulting fees from Biogen.
Teresa Frohman has received speaker and consulting fees from Acorda, Genzyme, and Novartis
Elliot Frohman has received speaker and consulting fees from Genzyme, Acorda, Novartis, and TEVA.
Peter Calabresi has received personal honorariums for consulting from Biogen and Vertex. He is PI on research grants to Johns Hopkins from Novartis, Teva, MedImmune, Annexon, and Biogen.
Shiv Saidha has received consulting fees from Medical Logix for the development of CME programs in neurology, consulting fees from Axon Advisors LLC, speaking honoraria from the National Association of Managed Care Physicians, Family Medicine Foundation of West Virginia, and Advanced Studies in Medicine and served on scientific advisory boards for Biogen-Idec, Genzyme, Genentech Corporation & Novartis. He receives research support from Genentech Corporation and the National MS Society, and received support from the Race to Erase MS foundation. He is a member of the working committee of the International Multiple Sclerosis Visual System (IMSVISUAL) Consortium.
NGC, ES, BD, KF, JG, JN, AR, EO, CC, PD and JP have nothing to disclose