Blood-brain barrier permeability in relation to disease severity and timing of multiple sclerosis diagnosis in optic neuritis.

Abstract

Background: Dynamic contrast-enhanced magnetic resonance imaging is a promising biomarker allowing for in vivo quantification of blood-brain barrier permeability.

Objectives: To explore the relationship between blood-brain barrier permeability, optic neuritis disease severity, and multiple sclerosis conversion in optic neuritis.

Methods: Gjedde-Patlak models from dynamic contrast-enhanced magnetic resonance imaging were used to estimate blood-brain barrier permeability (K_i ) in 78 optic neuritis patients. The 2017 McDonald criteria were used to diagnose multiple sclerosis with a minimum follow-up time of 2 years.

Results: Normal-appearing white matter K_i correlated with the number of magnetic resonance imaging criteria for dissemination in space (Spearman's ρ = 0.3, p = 0.0074), but not with visual acuity, color vision, and inter-eye difference in retinal nerve fiber layer thickness. Normal-appearing white matter K_i did not differ between patients with and without oligoclonal bands (p = 0.067), but patients with brain contrast-enhancing lesions had higher normal-appearing white matter K_i than those without (p = 0.04). Early multiple sclerosis-converters diagnosed at optic neuritis onset (n = 36) had higher normal-appearing white matter K_i than non-converters (n = 29) (p = 0.01), but this was not the case for late multiple sclerosis-converters (n = 13) (p = 0.57). Normal-appearing white matter K_i did not significantly predict overall multiple sclerosis conversion (p = 0.068, AUC = 0.652).

Conclusions: Normal-appearing white matter K_i was associated with magnetic resonance imaging biomarkers of multiple sclerosis, but not with biomarkers of optic neuritis disease severity. Normal-appearing white matter K_i was increased at, but not before, the multiple sclerosis diagnosis.