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Yu WJ, Xiao J, Wang GX, Jiang C, Zha W, Liao RF. Predictive visual field outcomes after optic chiasm decompressive surgery by retinal vessels parameters using optical coherence tomography angiography. Int J Ophthalmol 2024; 17:365-373. [PMID: 38371253 PMCID: PMC10827611 DOI: 10.18240/ijo.2024.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/19/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To evaluate the predictive value of superficial retinal capillary plexus (SRCP) and radial peripapillary capillary (RPC) for visual field recovery after optic cross decompression and compare them with peripapillary nerve fiber layer (pRNFL) and ganglion cell complex (GCC). METHODS This prospective longitudinal observational study included patients with chiasmal compression due to sellar region mass scheduled for decompressive surgery. Generalized estimating equations were used to compare retinal vessel density and retinal layer thickness pre- and post-operatively and with healthy controls. Logistic regression models were used to assess the relationship between preoperative GCC, pRNFL, SRCP, and RPC parameters and visual field recovery after surgery. RESULTS The study included 43 eyes of 24 patients and 48 eyes of 24 healthy controls. Preoperative RPC and SRCP vessel density and pRNFL and GCC thickness were lower than healthy controls and higher than postoperative values. The best predictive GCC and pRNFL models were based on the superior GCC [area under the curve (AUC)=0.866] and the tempo-inferior pRNFL (AUC=0.824), and the best predictive SRCP and RPC models were based on the nasal SRCP (AUC=0.718) and tempo-inferior RPC (AUC=0.825). There was no statistical difference in the predictive value of the superior GCC, tempo-inferior pRNFL, and tempo-inferior RPC (all P>0.05). CONCLUSION Compression of the optic chiasm by tumors in the saddle area can reduce retinal thickness and blood perfusion. This reduction persists despite the recovery of the visual field after decompression surgery. GCC, pRNFL, and RPC can be used as sensitive predictors of visual field recovery after decompression surgery.
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Affiliation(s)
- Wen-Juan Yu
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jin Xiao
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Guang-Xin Wang
- Department of Ophthalmology, the First People's Hospital of Hefei, Hefei 230061, Anhui Province, China
| | - Chang Jiang
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Wei Zha
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Rong-Feng Liao
- Department of Ophthalmology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Zhao K, Liu M, Yang F, Shu X, Sun G, Liu R, Zhao Y, Wang F, Xu B. Reorganization of the structural connectome during vision recovery in pituitary adenoma patients post-transsphenoidal surgery. Cereb Cortex 2023; 33:10813-10819. [PMID: 37702246 DOI: 10.1093/cercor/bhad326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
Pituitary adenomas (PAs) can exert pressure on the optic apparatus, leading to visual impairment. A subset of patients may observe a swift improvement in their vision following surgery. Nevertheless, the alterations in the structural connectome during the early postoperative period remain largely unexplored. The research employed probabilistic tractography, graph theoretical analysis, and statistical methods on preoperative and postoperative structural magnetic resonance imaging and diffusion tensor images from 13 PA patients. Postoperative analysis revealed an increase in global and local efficiency, signifying improved network capacity for parallel information transfer and fault tolerance, respectively. Enhanced clustering coefficient and reduced shortest path length were also observed, suggesting a more regular network organization and shortened communication steps within the brain network. Furthermore, alterations in node graphical properties were detected, implying a restructuring of the network's control points, possibly contributing to more efficient visual processing. These findings propose that rapid vision recovery post-surgery may be associated with significant reorganization of the brain's structural connectome, enhancing the efficiency and adaptability of the network, thereby facilitating improved visual processing.
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Affiliation(s)
- Kai Zhao
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Minghang Liu
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fuxing Yang
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362002, China
| | - Xujun Shu
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province 210016, China
| | - Guochen Sun
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Ruoyu Liu
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yue Zhao
- Department of Emergency Medicine, Hainan hospital of Chinese PLA General Hospital, Sanya, Hainan 572013, China
| | - Fuyu Wang
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Bainan Xu
- Department of Neurosurgery, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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Carrozzi A, Gramegna LL, Sighinolfi G, Zoli M, Mazzatenta D, Testa C, Lodi R, Tonon C, Manners DN. Methods of diffusion MRI tractography for localization of the anterior optic pathway: A systematic review of validated methods. Neuroimage Clin 2023; 39:103494. [PMID: 37651845 PMCID: PMC10477810 DOI: 10.1016/j.nicl.2023.103494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
The anterior optic pathway (AOP) is a system of three structures (optic nerves, optic chiasma, and optic tracts) that convey visual stimuli from the retina to the lateral geniculate nuclei. A successful reconstruction of the AOP using tractography could be helpful in several clinical scenarios, from presurgical planning and neuronavigation of sellar and parasellar surgery to monitoring the stage of fiber degeneration both in acute (e.g., traumatic optic neuropathy) or chronic conditions that affect AOP structures (e.g., amblyopia, glaucoma, demyelinating disorders or genetic optic nerve atrophies). However, its peculiar anatomy and course, as well as its surroundings, pose a serious challenge to obtaining successful tractographic reconstructions. Several AOP tractography strategies have been adopted but no standard procedure has been agreed upon. We performed a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines in order to find the combinations of acquisition and reconstruction parameters that have been performed previously and have provided the highest rate of successful reconstruction of the AOP, in order to promote their routine implementation in clinical practice. For this purpose, we reviewed data regarding how the process of anatomical validation of the tractographies was performed. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias and thus the study quality We identified thirty-nine studies that met our inclusion criteria, and only five were considered at low risk of bias and achieved over 80% of successful reconstructions. We found a high degree of heterogeneity in the acquisition and analysis parameters used to perform AOP tractography and different combinations of them can achieve satisfactory levels of anterior optic tractographic reconstruction both in real-life research and clinical scenarios. One thousand s/mm2 was the most frequently used b value, while both deterministic and probabilistic tractography algorithms performed morphological reconstruction of the tract satisfactorily, although probabilistic algorithms estimated a more realistic percentage of crossing fibers (45.6%) in healthy subjects. A wide heterogeneity was also found regarding the method used to assess the anatomical fidelity of the AOP reconstructions. Three main strategies can be found: direct visual direct visual assessment of the tractography superimposed to a conventional MR image, surgical evaluation, and computational methods. Because the latter is less dependent on a priori knowledge of the anatomy by the operator, computational methods of validation of the anatomy should be considered whenever possible.
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Affiliation(s)
- Alessandro Carrozzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Laura Ludovica Gramegna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy.
| | - Giovanni Sighinolfi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Matteo Zoli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Pituitary Unit, Bologna, Italy
| | - Diego Mazzatenta
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Pituitary Unit, Bologna, Italy
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy
| | - David Neil Manners
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy; Department for Life Quality Studies (QUVI), University of Bologna, Bologna, Italy
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Ashtari M, Cook P, Lipin M, Yu Y, Ying GS, Maguire A, Bennett J, Gee J, Zhang H. Dynamic structural remodeling of the human visual system prompted by bilateral retinal gene therapy. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 4:100089. [PMID: 37397812 PMCID: PMC10313860 DOI: 10.1016/j.crneur.2023.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/03/2023] [Accepted: 05/01/2023] [Indexed: 07/04/2023] Open
Abstract
The impact of changes in visual input on neuronal circuitry is complex and much of our knowledge on human brain plasticity of the visual systems comes from animal studies. Reinstating vision in a group of patients with low vision through retinal gene therapy creates a unique opportunity to dynamically study the underlying process responsible for brain plasticity. Historically, increases in the axonal myelination of the visual pathway has been the biomarker for brain plasticity. Here, we demonstrate that to reach the long-term effects of myelination increase, the human brain may undergo demyelination as part of a plasticity process. The maximum change in dendritic arborization of the primary visual cortex and the neurite density along the geniculostriate tracks occurred at three months (3MO) post intervention, in line with timing for the peak changes in postnatal synaptogenesis within the visual cortex reported in animal studies. The maximum change at 3MO for both the gray and white matter significantly correlated with patients' clinical responses to light stimulations called full field sensitivity threshold (FST). Our results shed a new light on the underlying process of brain plasticity by challenging the concept of increase myelination being the hallmark of brain plasticity and instead reinforcing the idea of signal speed optimization as a dynamic process for brain plasticity.
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Affiliation(s)
- Manzar Ashtari
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, PA, 19104, United States
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, 19104, United States
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Philip Cook
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Mikhail Lipin
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Yinxi Yu
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Albert Maguire
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, PA, 19104, United States
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Jean Bennett
- Center for Advanced Retinal and Ocular Therapeutics (CAROT), University of Pennsylvania, Philadelphia, PA, 19104, United States
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - James Gee
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, 19104, United States
| | - Hui Zhang
- Centre for Medical Image Computing, University College London, London, United Kingdom
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Keong NC, Lock C, Soon S, Hernowo AT, Czosnyka Z, Czosnyka M, Pickard JD, Narayanan V. Diffusion Tensor Imaging Profiles Can Distinguish Diffusivity and Neural Properties of White Matter Injury in Hydrocephalus vs. Non-hydrocephalus Using a Strategy of a Periodic Table of DTI Elements. Front Neurol 2022; 13:868026. [PMID: 35873785 PMCID: PMC9296826 DOI: 10.3389/fneur.2022.868026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background:The aim of this study was to create a simplistic taxonomy to improve transparency and consistency in, and reduce complexity of, interpreting diffusion tensor imaging (DTI) profiles in white matter disruption. Using a novel strategy of a periodic table of DTI elements, we examined if DTI profiles could demonstrate neural properties of disruption sufficient to characterize white matter changes specific for hydrocephalus vs. non-hydrocephalus, and to distinguish between cohorts of neural injury by their differing potential for reversibility.MethodsDTI datasets from three clinical cohorts representing pathological milestones from reversible to irreversible brain injury were compared to those of healthy controls at baseline, over time and with interventions. The final dataset comprised patients vs. controls in the following groupings: mild traumatic brain injury (mTBI), n = 24 vs. 27, normal pressure hydrocephalus (NPH), n = 16 vs. 9 and Alzheimer's disease (AD), n = 27 vs. 47. We generated DTI profiles from fractional anisotropy (FA) and mean, axial and radial diffusivity measures (MD, L1 and L2 and 3 respectively), and constructed an algorithm to map changes consistently to a periodic table of elements, which fully described their diffusivity and neural properties.ResultsMapping tissue signatures to a periodic table of DTI elements rapidly characterized cohorts by their differing patterns of injury. At baseline, patients with mTBI displayed the most preserved tracts. In NPH, the magnitude of changes was dependent on “familial” DTI neuroanatomy, i.e., potential for neural distortion from risk of ventriculomegaly. With time, patients with Alzheimer's disease were significantly different to controls across multiple measures. By contrast, patients with mTBI showed both loss of integrity and pathophysiological processes of neural repair. In NPH, some patterns of injury, such as “stretch/compression” and “compression” were more reversible following intervention than others; these neural profile properties suggested “microstructural resilience” to injury.ConclusionUsing the novel strategy of a periodic table of DTI elements, our study has demonstrated it is possible to distinguish between different cohorts along the spectrum of brain injury by describing neural profile properties of white matter disruption. Further work to contribute datasets of disease toward this proposed taxonomic framework would enhance the translatability of DTI profiles to the clinical-research interface.
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Affiliation(s)
- Nicole C. Keong
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- *Correspondence: Nicole C. Keong
| | - Christine Lock
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Shereen Soon
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Aditya Tri Hernowo
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zofia Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Marek Czosnyka
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - John D. Pickard
- Neurosurgical Division, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Vairavan Narayanan
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kok CY, Lock C, Ang TY, Keong NC. Modeling the Properties of White Matter Tracts Using Diffusion Tensor Imaging to Characterize Patterns of Injury in Aging and Neurodegenerative Disease. Front Aging Neurosci 2022; 14:787516. [PMID: 35572145 PMCID: PMC9093601 DOI: 10.3389/fnagi.2022.787516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Diffusion tensor imaging (DTI) is a relatively novel magnetic resonance-based imaging methodology that can provide valuable insight into the microstructure of white matter tracts of the brain. In this paper, we evaluated the reliability and reproducibility of deriving a semi-automated pseudo-atlas DTI tractography method vs. standard atlas-based analysis alternatives, for use in clinical cohorts with neurodegeneration and ventriculomegaly. We showed that the semi-automated pseudo-atlas DTI tractography method was reliable and reproducible across different cohorts, generating 97.7% of all tracts. However, DTI metrics obtained from both methods were significantly different across the majority of cohorts and white matter tracts (p < 0.001). Despite this, we showed that both methods produced patterns of white matter injury that are consistent with findings reported in the literature and with DTI profiles generated from these methodologies. Scatter plots comparing DTI metrics obtained from each methodology showed that the pseudo-atlas method produced metrics that implied a more preserved neural structure compared to its counterpart. When comparing DTI metrics against a measure of ventriculomegaly (i.e., Evans’ Index), we showed that the standard atlas-based method was able to detect decreasing white matter integrity with increasing ventriculomegaly, while in contrast, metrics obtained using the pseudo-atlas method were sensitive for stretch or compression in the posterior limb of the internal capsule. Additionally, both methods were able to show an increase in white matter disruption with increasing ventriculomegaly, with the pseudo-atlas method showing less variability and more specificity to changes in white matter tracts near to the ventricles. In this study, we found that there was no true gold-standard for DTI methodologies or atlases. Whilst there was no congruence between absolute values from DTI metrics, differing DTI methodologies were still valid but must be appreciated to be variably sensitive to different changes within white matter injury occurring concurrently. By combining both atlas and pseudo-atlas based methodologies with DTI profiles, it was possible to navigate past such challenges to describe white matter injury changes in the context of confounders, such as neurodegenerative disease and ventricular enlargement, with transparency and consistency.
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Affiliation(s)
- Chun Yen Kok
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Christine Lock
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Ting Yao Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Nicole C Keong
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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Kang KM, Choi EJ, Jung W, Lee J, Choi SH, Kim YH. Diffusion Tensor Imaging and Neurite Orientation Dispersion and Density Imaging Assessment of Optic Pathway Function in Patients With Anterior Visual Pathway Compression. J Neuroophthalmol 2022; 42:e192-e202. [PMID: 34270520 DOI: 10.1097/wno.0000000000001309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In patients with sellar or parasellar tumors, it is crucial to evaluate visual field impairment in the preoperative stage and to predict visual field improvement after the surgery. The purpose of this study was to investigate the associations of diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) parameters in the optic radiations with preoperative and postoperative visual field impairment. METHODS This prospective study included 81 participants with sellar or parasellar tumors. Multishell diffusion imaging and a visual field impairment score (VFIS) were acquired before and after the surgery. The multishell diffusion-weighted imaging was acquired to measure the neurite density and neurite orientation dispersion, as well as the diffusivity. DTI parameters were fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity (RD). NODDI provided intracellular volume fraction (Vic), the orientation dispersion index, and isotropic volume fraction (Viso). The associations of DTI and NODDI parameters in the optic radiations with VFIS were investigated, adjusting for age, tumor height, and symptom duration. RESULTS Among 162 optic radiations, 117 were functionally impaired in the preoperative stage. FA and Vic had significant negative correlations, whereas MD and RD had significant positive correlations with the VFIS (all P < 0.001). In the preoperative stage, lower FA (P = 0.001; odds ratio = 0.750) and Vic (P = 0.003; OR = 0.827) and higher MD (P = 0.007; OR = 1.244) and RD (P < 0.001; OR = 1.361) were significantly associated with the presence of visual field impairment. For the degree of postoperative improvement, preoperative lower Vic (P = 0.034; OR = 0.910) and higher MD (P = 0.037; OR = 1.103) and RD (P = 0.047; OR = 1.090) were significantly associated with more postoperative improvement. CONCLUSIONS DTI and NODDI parameters in the optic radiations were correlated with VFIS and associated with preoperative visual field impairments and postoperative improvement. It may help in predicting visual field improvement after the surgery in patients with sellar or parasellar tumors.
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Affiliation(s)
- Koung Mi Kang
- Department of Radiology (KMK, SHC), Seoul National University Hospital, Jongno-gu, Republic of Korea ; Department of Electrical and Computer Engineering (E-JC), Laboratory for Imaging Science and Technology, Seoul National University, Gwanak-gu, Republic of Korea ; AIRS Medical (WJ), Seoul, Republic of Korea; Department of Electrical and Computer Engineering (JL), Laboratory for Imaging Science and Technology, INMC, IOER, Seoul National University, Gwanak-gu, Republic of Korea and Department of Neurosurgery (YHK), Seoul National University Hospital, Jongno-gu, Republic of Korea
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Qiao N, Ma Y, Chen X, Ye Z, Ye H, Zhang Z, Wang Y, Lu Z, Wang Z, Xiao Y, Zhao Y. Machine Learning Prediction of Visual Outcome after Surgical Decompression of Sellar Region Tumors. J Pers Med 2022; 12:jpm12020152. [PMID: 35207641 PMCID: PMC8879436 DOI: 10.3390/jpm12020152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction: This study aims to develop a machine learning-based model integrating clinical and ophthalmic features to predict visual outcomes after transsphenoidal resection of sellar region tumors. Methods: Adult patients with optic chiasm compression by a sellar region tumor were examined to develop a model, and an independent retrospective cohort and a prospective cohort were used to validate our model. Predictors included demographic information, and ophthalmic and laboratory test results. We defined “recovery” as more than 5% for a p-value in mean deviation compared with the general population in the follow-up. Seven machine learning classifiers were employed, and the best-performing algorithm was selected. A decision curve analysis was used to assess the clinical usefulness of our model by estimating net benefit. We developed a nomogram based on essential features ranked by the SHAP score. Results: We included 159 patients (57.2% male), and the mean age was 42.3 years old. Among them, 96 patients were craniopharyngiomas and 63 patients were pituitary adenomas. Larger tumors (3.3 cm vs. 2.8 cm in tumor height) and craniopharyngiomas (73.6%) were associated with a worse prognosis (p < 0.001). Eyes with better outcomes were those with better visual field and thicker ganglion cell layer before operation. The ensemble model yielded the highest AUC of 0.911 [95% CI, 0.885–0.938], and the corresponding accuracy was 84.3%, with 0.863 in sensitivity and 0.820 in specificity. The model yielded AUCs of 0.861 and 0.843 in the two validation cohorts. Our model provided greater net benefit than the competing extremes of intervening in all or no patients in the decision curve analysis. A model explanation using SHAP score demonstrated that visual field, ganglion cell layer, tumor height, total thyroxine, and diagnosis were the most important features in predicting visual outcome. Conclusion: SHAP score can be a valuable resource for healthcare professionals in identifying patients with a higher risk of persistent visual deficit. The large-scale and prospective application of the proposed model would strengthen its clinical utility and universal applicability in practice.
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Affiliation(s)
- Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
| | - Yichen Ma
- Fudan University Graduate School, Fudan University, Shanghai 200043, China;
| | - Xiaochen Chen
- Surgical Theatre, Huashan Hospital Hongqiao Campus, Shanghai 201107, China;
| | - Zhao Ye
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- Shanghai Key Laboratory of Medical Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai 200040, China
| | - Hongying Ye
- Department of Endocrinology, Huashan Hospital, Shanghai 200040, China; (H.Y.); (Z.Z.)
| | - Zhaoyun Zhang
- Department of Endocrinology, Huashan Hospital, Shanghai 200040, China; (H.Y.); (Z.Z.)
| | - Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- Shanghai Key Laboratory of Medical Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai 200040, China
| | - Zhaozeng Lu
- Department of Ophthalmology, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai 200040, China; (Z.L.); (Z.W.)
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai 200040, China; (Z.L.); (Z.W.)
| | - Yiqin Xiao
- Department of Ophthalmology, Huashan Hospital, 12 Wulumuqi Zhong Road, Shanghai 200040, China; (Z.L.); (Z.W.)
- Correspondence: (Y.X.); (Y.Z.)
| | - Yao Zhao
- Department of Neurosurgery, Huashan Hospital, Shanghai 200040, China; (N.Q.); (Z.Y.); (Y.W.)
- Neurosurgical Institute, Fudan University, Shanghai 200040, China
- National Center for Neurological Disorders, 985 Jinguang Road, Shanghai 201107, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai 200040, China
- Shanghai Key Laboratory of Medical Brain Function and Restoration and Neural Regeneration, Fudan University, Shanghai 200040, China
- Correspondence: (Y.X.); (Y.Z.)
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Lang ST, Ryu WHA, Starreveld YP, Costello FE. Good Visual Outcomes After Pituitary Tumor Surgery Are Associated With Increased Visual Cortex Functional Connectivity. J Neuroophthalmol 2021; 41:504-511. [PMID: 33399415 DOI: 10.1097/wno.0000000000001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients presenting with visual impairment secondary to pituitary macroadenomas often experience variable recovery after surgery. Several factors may impact visual outcomes including the extent of neuroaxonal damage in the afferent visual pathway and cortical plasticity. Optical coherence tomography (OCT) measures of retinal structure and resting-state functional MRI (rsfMRI) can be used to evaluate the impact of neuroaxonal injury and cortical adaptive processes, respectively. The purpose of this study was to determine whether rsfMRI patterns of functional connectivity (FC) distinguish patients with good vs poor visual outcomes after surgical decompression of pituitary adenomas. METHODS In this retrospective cohort study, we compared FC patterns between patients who manifested good (GO) vs poor (PO) visual outcomes after pituitary tumor surgery. Patients (n = 21) underwent postoperative rsfMRI a minimum of 1 year after tumor surgery. Seed-based connectivity of the visual cortex (primary [V1], prestriate [V2], and extrastriate [V5]) was compared between GO and PO patients and between patients and healthy controls (HCs) (n = 19). Demographics, visual function, and OCT data were compared preoperatively and postoperatively between patient groups. The threshold for GO was visual field mean deviation equal or less than -5.00 dB and/or visual acuity equal to or better than 20/40. RESULTS Increased postoperative FC of the visual system was noted for GO relative to PO patients. Specifically, good visual outcomes were associated with increased connectivity of right V5 to the bilateral frontal cortices. Compared with HCs, GO patients showed increased connectivity of V1 and left V2 to sensorimotor cortex, increased connectivity of right and left V2 to medial prefrontal cortex, and increased connectivity of right V5 the right temporal and frontal cortices. CONCLUSIONS Increased visual cortex connectivity is associated with good visual outcomes in patients with pituitary tumor, at late phase of recovery. Our findings suggest that rsfMRI does distinguish GO and PO patients after pituitary tumor surgery. This imaging modality may have a future role in characterizing the impact of cortical adaptation on visual recovery.
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Affiliation(s)
- Stefan T Lang
- Division of Neurosurgery (STL, WHAR, YPS), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Division of Ophthalmology (FEC), Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada; Division of Neurology (FEC), Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; Department of Neurological Surgery (WHAR), Rush University, Chicago, IL; and Hotchkiss Brain Institute (STL, FEC), University of Calgary, Calgary, Canada
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10
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Paul DA, Strawderman E, Rodriguez A, Hoang R, Schneider CL, Haber S, Chernoff BL, Shafiq I, Williams ZR, Vates GE, Mahon BZ. Empty Sella Syndrome as a Window Into the Neuroprotective Effects of Prolactin. Front Med (Lausanne) 2021; 8:680602. [PMID: 34307410 PMCID: PMC8295462 DOI: 10.3389/fmed.2021.680602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The goal of this study was to relate diffusion MR measures of white matter integrity of the retinofugal visual pathway with prolactin levels in a patient with downward herniation of the optic chiasm secondary to medical treatment of a prolactinoma. Methods: A 36-year-old woman with a prolactinoma presented with progressive bilateral visual field defects 9 years after initial diagnosis and medical treatment. She was diagnosed with empty-sella syndrome and instructed to stop cabergoline. Hormone testing was conducted in tandem with routine clinical evaluations over 1 year and the patient was followed with diffusion magnetic resonance imaging (dMRI), optical coherence tomography (OCT), and automated perimetry at three time points. Five healthy controls underwent a complementary battery of clinical and neuroimaging tests at a single time point. Results: Shortly after discontinuing cabergoline, diffusion metrics in the optic tracts were within the range of values observed in healthy controls. However, following a brief period where the patient resumed cabergoline (of her own volition), there was a decrease in serum prolactin with a corresponding decrease in visual ability and increase in radial diffusivity (p < 0.001). Those measures again returned to their baseline ranges after discontinuing cabergoline a second time. Conclusions: These results demonstrate the sensitivity of dMRI to detect rapid and functionally significant microstructural changes in white matter tracts secondary to alterations in serum prolactin levels. The inverse relations between prolactin and measures of white matter integrity and visual function are consistent with the hypothesis that prolactin can play a neuroprotective role in the injured nervous system.
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Affiliation(s)
- David A. Paul
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Emma Strawderman
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
| | - Alejandra Rodriguez
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Ricky Hoang
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Colleen L. Schneider
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States
- University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Sam Haber
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Benjamin L. Chernoff
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Ismat Shafiq
- Department of Endocrinology and Metabolism, University of Rochester Medical Center, Rochester, NY, United States
| | - Zoë R. Williams
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
| | - G. Edward Vates
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Bradford Z. Mahon
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, United States
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, United States
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States
- Neuroscience Institute, Carnegie Mellon University, Pittsburgh, PA, United States
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11
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Liang L, Lin H, Lin F, Yang J, Zhang H, Zeng L, Hu Y, Lan W, Zhong H, Zhang H, Luo S, Mo Y, Li W, Lei Y. Quantitative visual pathway abnormalities predict visual field defects in patients with pituitary adenomas: a diffusion spectrum imaging study. Eur Radiol 2021; 31:8187-8196. [PMID: 33893857 DOI: 10.1007/s00330-021-07878-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/18/2021] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study was to investigate clinical applicability of diffusion spectrum imaging (DSI) for quantitative detection of visual pathway abnormalities to predict the degree of visual field defects (VFD) in patients with pituitary adenomas. METHODS Sixty-five patients with pituitary adenomas and 33 healthy controls underwent conventional MRI and DSI scanning that allowed high-angular-resolution fiber tracking. Optic chiasmal compression and VFD were confirmed in all patients via radiological and neuro-ophthalmological examinations. Quantitative assessments of chiasmal lift, VFD, and DSI parameters from the optic nerve, optic tract, and optic radiation were performed. Group comparisons and correlation analyses were conducted in patients and controls. Using the 5-fold cross-validation method, the support vector machine classifiers were constructed to predict the degree of visual defects. RESULTS The mean values of quantitative anisotropy and generalized fractional anisotropy in optic nerve and optic tract showed significant differences between patients and controls (p < 0.05). These parameters were also significantly correlated with the chiasmal lift distance and degree of visual defects (p < 0.05). All patients were divided into mild (n = 42) and severe (n = 23) VFD groups, using the mean deviation value of -8 dB as the threshold. The classifiers achieved an accuracy of 0.83, sensitivity of 0.78, and specificity of 0.86 to discriminate patients with mild and severe visual defects. CONCLUSIONS Using high-angular-resolution fiber tracking, DSI may provide quantitative information to detect visual pathway abnormalities and be a potential diagnostic tool for determining the degree of visual field defects in pituitary adenomas. KEY POINTS • Abnormal QA and GFA values of optic nerve and optic tract in adenoma patients • Close relationship between DSI parameters and VFD degree in adenoma patients • The classifiers achieved an accuracy of 0.83, sensitivity of 0.78, and specificity of 0.86 to discriminate patients with mild and severe VFD.
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Affiliation(s)
- Lihong Liang
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Hai Lin
- Shenzhen University School of Medicine, Shenzhen, Guangdong, China.,Department of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China
| | - Fan Lin
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China. .,Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
| | - Jihu Yang
- Shenzhen University School of Medicine, Shenzhen, Guangdong, China.,Department of Neurosurgery, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China
| | - Hanwen Zhang
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Liang Zeng
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yaqiong Hu
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Weiwu Lan
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Hua Zhong
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Hong Zhang
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Siping Luo
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yongqian Mo
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Weihua Li
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China.,Shenzhen University School of Medicine, Shenzhen, Guangdong, China
| | - Yi Lei
- Department of Radiology, Shenzhen Second People's Hospital, the First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, Guangdong, China. .,Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
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12
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Rutland JW, Padormo F, Yim CK, Yao A, Arrighi-Allisan A, Huang KH, Lin HM, Chelnis J, Delman BN, Shrivastava RK, Balchandani P. Quantitative assessment of secondary white matter injury in the visual pathway by pituitary adenomas: a multimodal study at 7-Tesla MRI. J Neurosurg 2020; 132:333-342. [PMID: 30660127 PMCID: PMC7050645 DOI: 10.3171/2018.9.jns182022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to investigate microstructural damage caused by pituitary macroadenomas by performing probabilistic tractography of the optic tracts and radiations using 7-T diffusion-weighted MRI (DWI). These imaging findings were correlated with neuro-ophthalmological results to assess the utility of ultra-high-field MRI for objective evaluation of damage to the anterior and posterior visual pathways. METHODS Probabilistic tractography employing 7-T DWI was used to reconstruct the optic tracts and radiations in 18 patients with adenomas and in 16 healthy volunteers. Optic chiasm compression was found in 66.7% of the patients and visual defects in 61.1%. Diffusion indices were calculated along the projections and correlated with tumor volumes and results from neuro-ophthalmological examinations. Primary visual cortical thicknesses were also assessed. RESULTS Fractional anisotropy was reduced by 21.9% in the optic tracts (p < 0.001) and 17.7% in the optic radiations (p < 0.001) in patients with adenomas. Patients showed an 8.5% increase in mean diffusivity of optic radiations compared with healthy controls (p < 0.001). Primary visual cortical thickness was reduced in adenoma patients. Diffusion indices of the visual pathway showed significant correlations with neuro-ophthalmological examination findings. CONCLUSIONS Imaging-based quantification of secondary neuronal damage from adenomas strongly correlated with neuro-ophthalmological findings. Diffusion characteristics enabled by ultra-high-field DWI may allow preoperative characterization of visual pathway damage in patients with chiasmatic compression and may inform prognosis for vision recoverability.
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Affiliation(s)
- John W Rutland
- 1Translational and Molecular Imaging Institute and
- 4Neurosurgery, and
| | - Francesco Padormo
- 1Translational and Molecular Imaging Institute and
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | - Hung-Mo Lin
- 5Department of Population Health Science and Policy, Mount Sinai Hospital, New York, New York; and
| | | | - Bradley N Delman
- 6Radiology, Icahn School of Medicine at Mount Sinai, New York; and
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13
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Visual loss and recovery in chiasmal compression. Prog Retin Eye Res 2019; 73:100765. [DOI: 10.1016/j.preteyeres.2019.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
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14
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Ying J, Yuan T, Jin L, Li C, Gui S, Wang R, Zuo Z, Zhang Y. Brain Morphometric and Functional Magnetic Resonance Imaging Study on Patients with Visual Field Defects Resulting from Suprasellar Tumors: Preoperative and Postoperative Assessment. World Neurosurg 2019; 134:e353-e359. [PMID: 31634624 DOI: 10.1016/j.wneu.2019.10.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the structural and functional changes in the visual cortex in patients with suprasellar tumor with recovery of visual field defects at different times before and after surgical decompression of the optic nerves. METHODS Twenty-one patients with suprasellar tumor with visual field defects were scanned with structural images and resting-state functional magnetic resonance imaging at 1 week preoperation, 1 week postoperation, and 1 month postoperation. Paired-sample t test was performed on the gray matter volume (GMV) within the occipital cortex, and the significance level was set at false discovery rate (FDR)-adjusted P < 0.05 voxel level to define the region of interest (ROI). One-way analysis of variance was performed on GMV and amplitude of low frequency fluctuation (ALFF) within the ROI. Pearson coefficients were calculated between changes of GMV and ALFF within the ROI and clinical factors. RESULTS The GMV in the bilateral pericalcarine cortex increased significantly at 1 month postoperation compared with the preoperative period (FDR-adjusted P < 0.05), with correlation to visual field defects. ALFF values in the bilateral pericalcarine cortex at 1 month postoperation were significantly higher than preoperative values. CONCLUSIONS The postoperative visual improvement can be reflected in the increased GMV and ALFF of the bilateral pericalcarine cortex at 1 month postoperation, which suggests that an experience-dependent plasticity of the visual cortex was induced by an increase in sensory input.
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Affiliation(s)
- Jianyou Ying
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Taoyang Yuan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lu Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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15
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Solid stress in brain tumours causes neuronal loss and neurological dysfunction and can be reversed by lithium. Nat Biomed Eng 2019; 3:230-245. [PMID: 30948807 PMCID: PMC6452896 DOI: 10.1038/s41551-018-0334-7] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 11/25/2018] [Indexed: 12/12/2022]
Abstract
The compression of brain tissue by a tumour mass is believed to be a major cause of the clinical symptoms seen in patients with brain cancer. However, the biological consequences of these physical stresses on brain tissue are unknown. Here, via imaging studies in patients and by using mouse models of human brain tumours, we show that a subgroup of primary and metastatic brain tumours, classified as nodular on the basis of their growth pattern, exert solid stress on the surrounding brain tissue, causing a decrease in local vascular perfusion as well as neuronal death and impaired function. We demonstrate a causal link between solid stress and neurological dysfunction by applying and removing cerebral compression, which respectively mimic the mechanics of tumour growth and of surgical resection. We also show that, in mice, treatment with lithium reduces solid-stress-induced neuronal death and improves motor coordination. Our findings indicate that brain-tumour-generated solid stress impairs neurological function in patients, and that lithium as a therapeutic intervention could counter these effects.
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16
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Ying J, Li C, Yuan T, Jin L, Wang R, Zuo Z, Zhang Y. Increased resting-state functional connectivity in suprasellar tumor patients with postoperative visual improvement. Int J Med Sci 2019; 16:1245-1253. [PMID: 31588190 PMCID: PMC6775267 DOI: 10.7150/ijms.35660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/10/2019] [Indexed: 12/12/2022] Open
Abstract
Background and Objective: Large suprasellar tumors often compress the optic chiasm and give rise to visual impairment. Most patients have significantly improved visual function at 1 to 4 months after chiasmal decompression surgery, and only a few individuals regain normal vision at 1 week after surgery. How the recovery of visual function in these patients affects the visual cortex is not fully understood. In this study, we aimed to investigate alterations in brain functional connectivity (FC) in suprasellar tumor patients with visual improvement using resting-state functional magnetic resonance imaging (rs-fMRI). Methods: This longitudinal study was conducted on 13 suprasellar tumor patients who had ophthalmological examinations and rs-fMRI at the following time points: within 1-week preoperation (Pre-op), 1-week postoperation (Post-1w) and 1-month postoperation (Post-1m). The visual impairment score (VIS), local functional correlation (LCOR) and FC values were subjected to one-way ANOVA. Pearson correlation coefficients between changes in the LCOR and clinical factors were calculated. Results: The VIS was significantly decreased at both Post-1w and Post-1m compared to that at Pre-op. Whole-brain analysis of LCOR values showed that the left V1 (primary occipital cortex) was increased significantly at Post-1m compared to that at Pre-op (p < 0.05, FDR corrected). ROI analysis exhibited a significant negative correlation between the LCOR and VIS changes at Post-1m compared to those at Pre-op (p < 0.05, r = - 0.60). FC analysis within the visual network showed that the FC strengths were significantly increased between the left V5 and the left V4, right V3a, left V3, left V2d, and right V5 at Post-1m compared to those at Pre-op (p < 0.05, FDR corrected). Additionally, the FC strengths were significantly increased between the left V5 and the left V1, right orbital-frontal gyrus and left posterior supramarginal gyrus at the whole-brain network level at Post-1m compared to those at Pre-op (p < 0.05, FDR corrected). Conclusions: Postoperative visual improvement can be reflected by the increased FC of the visual cortex at Post-1w and Post-1m, especially at Post-1m. The LCOR value of the left V1 was associated with improved visual outcomes and may be used to objectively assess early visual recovery after chiasmal decompression at Post-1m.
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Affiliation(s)
- Jianyou Ying
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Taoyang Yuan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lu Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhentao Zuo
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,Sino-Danish College, University of Chinese Academy of Sciences, Beijing, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Institute for Brain Disorders Brain Tumor Center, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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17
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Chernoff BL, Teghipco A, Garcea FE, Sims MH, Paul DA, Tivarus ME, Smith SO, Pilcher WH, Mahon BZ. A Role for the Frontal Aslant Tract in Speech Planning: A Neurosurgical Case Study. J Cogn Neurosci 2018; 30:752-769. [PMID: 29569513 DOI: 10.1162/jocn_a_01244] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Frontal and temporal white matter pathways play key roles in language processing, but the specific computations supported by different tracts remain a matter of study. A role in speech planning has been proposed for a recently described pathway, the frontal aslant tract (FAT), which connects the posterior inferior frontal gyrus to the pre-SMA. Here, we use longitudinal functional and structural MRI and behavioral testing to evaluate the behavioral consequences of a lesion to the left FAT that was incurred during surgical resection of a frontal glioma in a 60-year-old woman, Patient AF. The pattern of performance in AF is compared, using the same measures, with that in a 37-year-old individual who underwent a left anterior temporal resection and hippocampectomy (Patient AG). AF and AG were both cognitively intact preoperatively but exhibited specific and doubly dissociable behavioral deficits postoperatively: AF had dysfluent speech but no word finding difficulty, whereas AG had word finding difficulty but otherwise fluent speech. Probabilistic tractography showed that the left FAT was lesioned postoperatively in AF (but not AG) whereas the inferior longitudinal fasciculus was lesioned in AG (but not AF). Those structural changes were supported by corresponding changes in functional connectivity to the posterior inferior frontal gyrus: decreased functional connectivity postoperatively between the posterior inferior frontal gyrus and pre-SMA in AF (but not AG) and decreased functional connectivity between the posterior inferior frontal gyrus and the middle temporal gyrus in AG (but not AF). We suggest from these findings that the left FAT serves as a key communicative link between sentence planning and lexical access processes.
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18
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Abstract
PURPOSE OF REVIEW This article discusses the advantages and pitfalls of testing neuroprotective treatment strategies in patients suffering from optic neuritis. RECENT FINDINGS Spectral domain optical coherence tomography now permits for automated segmentation of individual retinal layers. The peripapillary retinal nerve fibre layer (pRNFL) has been used in 13 of the 15 trials reviewed. Twelve trials also made use of electrophysiology. Overestimation of good visual recovery in the past has recently been recognized. Assessment of low contrast visual acuity and colour vision are now mainstream. SUMMARY The availability of highly accurate and robust trial outcome measures has facilitated research on this topic. A single long-term structural outcome measurement of the pRNFL is sufficient. For shorter term, assessments of the ganglion cell/inner plexiform layer and axonal birefringence are promising. Longitudinal blood levels of neurofilament proteins permit to recognize axonal loss at presentation and monitor changes longitudinally. Inner nuclear layer volume changes relate to inflammatory disease activity.Pitfalls are related to the timing of events. Hyperacute recruitment is needed for future trials. The onset of demyelination is not known, which complicates timing of electrophysiological recordings. Optic disc oedema precludes the use of the pRNFL from the affected eye as a baseline variable. The concomitant use of corticosteroids complicates interpretation of trial data.
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Le Meur G, Lebranchu P, Billaud F, Adjali O, Schmitt S, Bézieau S, Péréon Y, Valabregue R, Ivan C, Darmon C, Moullier P, Rolling F, Weber M. Safety and Long-Term Efficacy of AAV4 Gene Therapy in Patients with RPE65 Leber Congenital Amaurosis. Mol Ther 2017; 26:256-268. [PMID: 29033008 DOI: 10.1016/j.ymthe.2017.09.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/05/2017] [Accepted: 09/09/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was the evaluation of the safety and efficacy of unilateral subretinal injection of the adeno-associated vector (AAV) serotypes 2 and 4 (AAV2/4) RPE65-RPE65 vector in patients with Leber congenital amaurosis (LCA) associated with RPE65 gene deficiency. We evaluated ocular and general tolerance and visual function up to 1 year after vector administration in the most severely affected eye in nine patients with retinal degeneration associated with mutations in the RPE65 gene. Patients received either low (1.22 × 1010 to 2 × 1010 vector genomes [vg]) or high (between 3.27 × 1010 and 4.8 × 1010 vg) vector doses. An ancillary study, in which six of the original nine patients participated, extended the follow-up period to 2-3.5 years. All patients showed good ophthalmological and general tolerance to the rAAV2/4-RPE65-RPE65 vector. We observed a trend toward improved visual acuity in patients with nystagmus, stabilization and improvement of the visual field, and cortical activation along visual pathways during fMRI analysis. OCT analysis after vector administration revealed no retinal thinning, except in cases of macular detachment. Our findings show that the rAAV2/4.RPE65.RPE65 vector was well tolerated in nine patients with RPE65-associated LCA. Efficacy parameters varied between patients during follow-up.
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Affiliation(s)
- Guylène Le Meur
- Ophthalmology Department, University Hospital Centre (CHU) de Nantes, Nantes, France; INSERM UMR 1089, University of Nantes, CHU de Nantes, Nantes France.
| | - Pierre Lebranchu
- Ophthalmology Department, University Hospital Centre (CHU) de Nantes, Nantes, France; UMR 6597 CNRS, Image and Video Communication Team, Institute for Research into Communications and Cybernetics of Nantes, Polytech Nantes, Nantes, France
| | - Fanny Billaud
- Ophthalmology Department, University Hospital Centre (CHU) de Nantes, Nantes, France
| | - Oumeya Adjali
- INSERM UMR 1089, University of Nantes, CHU de Nantes, Nantes France
| | | | | | - Yann Péréon
- Reference Centre for Neuromuscular Disorders, FILNEMUS, CHU de Nantes, Nantes, France
| | - Romain Valabregue
- Institut du Cerveau et de la Moelle épinière ICM, Centre for NeuroImaging Research (CENIR), Paris, France
| | - Catherine Ivan
- Ophthalmology Department, University Hospital Centre (CHU) de Nantes, Nantes, France
| | | | | | - Fabienne Rolling
- INSERM UMR 1089, University of Nantes, CHU de Nantes, Nantes France
| | - Michel Weber
- Ophthalmology Department, University Hospital Centre (CHU) de Nantes, Nantes, France; INSERM UMR 1089, University of Nantes, CHU de Nantes, Nantes France
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Lilja Y, Gustafsson O, Ljungberg M, Starck G, Lindblom B, Skoglund T, Bergquist H, Jakobsson KE, Nilsson D. Visual pathway impairment by pituitary adenomas: quantitative diagnostics by diffusion tensor imaging. J Neurosurg 2016; 127:569-579. [PMID: 27885957 DOI: 10.3171/2016.8.jns161290] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Despite ample experience in surgical treatment of pituitary adenomas, little is known about objective indices that may reveal risk of visual impairment caused by tumor growth that leads to compression of the anterior visual pathways. This study aimed to explore diffusion tensor imaging (DTI) as a means for objective assessment of injury to the anterior visual pathways caused by pituitary adenomas. METHODS Twenty-three patients with pituitary adenomas, scheduled for transsphenoidal tumor resection, and 20 healthy control subjects were included in the study. A minimum suprasellar tumor extension of Grade 2-4, according to the SIPAP (suprasellar, infrasellar, parasellar, anterior, and posterior) scale, was required for inclusion. Neuroophthalmological examinations, conventional MRI, and DTI were completed in all subjects and were repeated 6 months after surgery. Quantitative assessment of chiasmal lift, visual field defect (VFD), and DTI parameters from the optic tracts was performed. Linear correlations, group comparisons, and prediction models were done in controls and patients. RESULTS Both the degree of VFD and chiasmal lift were significantly correlated with the radial diffusivity (r = 0.55, p < 0.05 and r = 0.48, p < 0.05, respectively) and the fractional anisotropy (r = -0.58, p < 0.05 and r = -0.47, p < 0.05, respectively) but not with the axial diffusivity. The axial diffusivity differed significantly between controls and patients with VFD, both before and after surgery (p < 0.05); however, no difference was found between patients with and without VFD. Based on the axial diffusivity and fractional anisotropy, a prediction model classified all patients with VFD correctly (sensitivity 1.0), 9 of 12 patients without VFD correctly (sensitivity 0.75), and 17 of 20 controls as controls (specificity 0.85). CONCLUSIONS DTI could detect pathology and degree of injury in the anterior visual pathways that were compressed by pituitary adenomas. The correlation between radial diffusivity and visual impairment may reflect a gradual demyelination in the visual pathways caused by an increased tumor effect. The low level of axial diffusivity found in the patient group may represent early atrophy in the visual pathways, detectable on DTI but not by conventional methods. DTI may provide objective data, detect early signs of injury, and be an additional diagnostic tool for determining indication for surgery in cases of pituitary adenomas.
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Affiliation(s)
- Ylva Lilja
- Department of Clinical Neuroscience and Rehabilitation and.,Ear, Nose and Throat Clinic
| | - Oscar Gustafsson
- Department of Radiation Physics and.,Department of Medical Physics and Biomedical Engineering, and
| | - Maria Ljungberg
- Department of Radiation Physics and.,Department of Medical Physics and Biomedical Engineering, and
| | - Göran Starck
- Department of Radiation Physics and.,Department of Medical Physics and Biomedical Engineering, and
| | - Bertil Lindblom
- Department of Ophthalmology, Institute of Neuroscience and Physiology
| | - Thomas Skoglund
- Department of Clinical Neuroscience and Rehabilitation and.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Bergquist
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; and.,Ear, Nose and Throat Clinic
| | - Karl-Erik Jakobsson
- Department of Clinical Neuroscience and Rehabilitation and.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Nilsson
- Department of Clinical Neuroscience and Rehabilitation and.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
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Tunç B, Ingalhalikar M, Parker D, Lecoeur J, Singh N, Wolf RL, Macyszyn L, Brem S, Verma R. Individualized Map of White Matter Pathways: Connectivity-Based Paradigm for Neurosurgical Planning. Neurosurgery 2016; 79:568-77. [PMID: 26678299 PMCID: PMC4911597 DOI: 10.1227/neu.0000000000001183] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Advances in white matter tractography enhance neurosurgical planning and glioma resection, but white matter tractography is limited by biological variables such as edema, mass effect, and tract infiltration or selection biases related to regions of interest or fractional anisotropy values. OBJECTIVE To provide an automated tract identification paradigm that corrects for artifacts created by tumor edema and infiltration and provides a consistent, accurate method of fiber bundle identification. METHODS An automated tract identification paradigm was developed and evaluated for glioma surgery. A fiber bundle atlas was generated from 6 healthy participants. Fibers of a test set (including 3 healthy participants and 10 patients with brain tumors) were clustered adaptively with this atlas. Reliability of the identified tracts in both groups was assessed by comparison with 2 experts with the Cohen κ used to quantify concurrence. We evaluated 6 major fiber bundles: cingulum bundle, fornix, uncinate fasciculus, arcuate fasciculus, inferior fronto-occipital fasciculus, and inferior longitudinal fasciculus, the last 3 tracts mediating language function. RESULTS The automated paradigm demonstrated a reliable and practical method to identify white mater tracts, despite mass effect, edema, and tract infiltration. When the tumor demonstrated significant mass effect or shift, the automated approach was useful for providing an initialization to guide the expert with identification of the specific tract of interest. CONCLUSION We report a reliable paradigm for the automated identification of white matter pathways in patients with gliomas. This approach should enhance the neurosurgical objective of maximal safe resections. ABBREVIATIONS AF, arcuate fasciculusDTI, diffusion tensor imagingIFOF, inferior fronto-occipital fasciculusILF, inferior longitudinal fasciculusROI, region of interestWM, white matter.
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Affiliation(s)
- Birkan Tunç
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Madhura Ingalhalikar
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Drew Parker
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jérémy Lecoeur
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| | - Nickpreet Singh
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald L. Wolf
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Luke Macyszyn
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ragini Verma
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, USA
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22
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Lilja Y, Gustafsson O, Ljungberg M, Nilsson D, Starck G. Impact of region-of-interest method on quantitative analysis of DTI data in the optic tracts. BMC Med Imaging 2016; 16:42. [PMID: 27400959 PMCID: PMC4940685 DOI: 10.1186/s12880-016-0145-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background To extract DTI parameters from a specific structure, a region of interest (ROI) must be defined. ROI selection in small structures is challenging; the final measurement results could be affected due to the significant impact of small geometrical errors. In this study the optic tracts were analyzed with the aim to assess differences in DTI parameters due to ROI method and to identify the most reliable method. Methods Images of 20 healthy subjects were acquired. Fractional anisotropy (FA) was extracted from the optic tracts by four different ROI methods. Manual tracing was performed in 1) the b0 image and 2) a T1-weighted image registered to the FA image. Semi-automatic segmentation was performed based on 3) tractography and 4) the FA-skeleton algorithm in the tract-based spatial statistics (TBSS) framework. Results were analyzed with regard to ROI method as well as to inter-scan, intra-rater and inter-rater reliability. Results The resulting FA values divided the ROI methods into two groups that differed significantly: 1) the FA-skeleton and the b0 methods showed higher FA values compared to 2) the tractography and the T1-weighted methods. The intra- and inter-rater variabilities were similar for all methods, except for the tractography method where the inter-rater variability was higher. The FA-skeleton method had a better reproducibility than the other methods. Conclusion Choice of ROI method was found to be highly influential on FA values when the optic tracts were analyzed. The FA-skeleton method performed the best, yielding low variability and high repeatability.
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Affiliation(s)
- Ylva Lilja
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Ear, Nose and Throat Clinic, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Göteborg, Sweden.
| | - Oscar Gustafsson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Ljungberg
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Nilsson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Göran Starck
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Ashtari M, Zhang H, Cook PA, Cyckowski LL, Shindler KS, Marshall KA, Aravand P, Vossough A, Gee JC, Maguire AM, Baker CI, Bennett J. Plasticity of the human visual system after retinal gene therapy in patients with Leber's congenital amaurosis. Sci Transl Med 2016; 7:296ra110. [PMID: 26180100 DOI: 10.1126/scitranslmed.aaa8791] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Much of our knowledge of the mechanisms underlying plasticity in the visual cortex in response to visual impairment, vision restoration, and environmental interactions comes from animal studies. We evaluated human brain plasticity in a group of patients with Leber's congenital amaurosis (LCA), who regained vision through gene therapy. Using non-invasive multimodal neuroimaging methods, we demonstrated that reversing blindness with gene therapy promoted long-term structural plasticity in the visual pathways emanating from the treated retina of LCA patients. The data revealed improvements and normalization along the visual fibers corresponding to the site of retinal injection of the gene therapy vector carrying the therapeutic gene in the treated eye compared to the visual pathway for the untreated eye of LCA patients. After gene therapy, the primary visual pathways (for example, geniculostriate fibers) in the treated retina were similar to those of sighted control subjects, whereas the primary visual pathways of the untreated retina continued to deteriorate. Our results suggest that visual experience, enhanced by gene therapy, may be responsible for the reorganization and maturation of synaptic connectivity in the visual pathways of the treated eye in LCA patients. The interactions between the eye and the brain enabled improved and sustained long-term visual function in patients with LCA after gene therapy.
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Affiliation(s)
- Manzar Ashtari
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania Perelman School of Medicine, 309 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104, USA. F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19014, USA.
| | - Hui Zhang
- Department of Computer Science and Centre for Medical Image Computing, University College London, Gower Street, London WC1E 6BT, UK
| | - Philip A Cook
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, 3600 Market Street, Philadelphia, PA 19104, USA
| | - Laura L Cyckowski
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19014, USA
| | - Kenneth S Shindler
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania Perelman School of Medicine, 309 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104, USA. F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19014, USA
| | - Kathleen A Marshall
- Center for Cellular and Molecular Therapeutics at The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Boulevard, Philadelphia, PA 19014, USA
| | - Puya Aravand
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania Perelman School of Medicine, 309 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104, USA. F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19014, USA
| | - Arastoo Vossough
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19014, USA
| | - James C Gee
- Penn Image Computing and Science Laboratory, Department of Radiology, University of Pennsylvania, 3600 Market Street, Philadelphia, PA 19104, USA
| | - Albert M Maguire
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania Perelman School of Medicine, 309 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104, USA. F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19014, USA. Center for Cellular and Molecular Therapeutics at The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Boulevard, Philadelphia, PA 19014, USA
| | - Chris I Baker
- Laboratory of Brain and Cognition, National Institutes of Health, 10 Center Drive, MSC 1240, Bethesda, MD 20892, USA
| | - Jean Bennett
- Center for Advanced Retinal and Ocular Therapeutics, University of Pennsylvania Perelman School of Medicine, 309 Stellar-Chance Labs, 422 Curie Boulevard, Philadelphia, PA 19104, USA. F.M. Kirby Center for Molecular Ophthalmology, Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19014, USA. Center for Cellular and Molecular Therapeutics at The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Boulevard, Philadelphia, PA 19014, USA
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