Optic nerve double inversion recovery hypersignal in patients with clinically isolated syndrome is associated with asymptomatic gadolinium-enhanced lesion

Mult Scler. 2019 Dec;25(14):1888-1895. doi: 10.1177/1352458518815797. Epub 2018 Dec 3.


Background: Optic nerve involvement is not considered in dissemination in space (DIS) or time (DIT) of multiple sclerosis (MS) lesions.

Objectives: To evaluate frequency of optic nerve involvement using three-dimensional (3D)-double inversion recovery (DIR) sequence in clinically isolated syndrome (CIS) and to measure its relationship with DIS and DIT (2010 and 2017 McDonald criteria).

Methods: From November 2013 to August 2016, 57 CIS patients underwent 3T-magnetic resonance imaging (3T-MRI) including 3D-DIR sequence and optical coherence tomography (OCT) at 3 months after CIS. We assessed signal abnormalities of the optic nerves on DIR sequence and collected data for DIS and DIT criteria according to 2010 and 2017 McDonald criteria.

Results: Among the 57 recruited patients, the presence of ⩾1 DIR hypersignal in optic nerve was observed in 36 (63%; 48 optic nerves) including asymptomatic hypersignal in 22 (38.5%; 25 optic nerves). Optic nerve involvement was significantly associated with DIT (p = 0.006) and MS according to 2010 criteria (p = 0.01) but was not significantly associated with presence of DIS criteria according to 2010 and 2017 McDonald criteria. We identified a significant (p < 0.001) temporal peripapillary retinal nerve fiber layer thinning on eyes with optic nerve involvement versus healthy controls.

Conclusions: Optic nerve involvement is very frequent at the earliest clinical stage of MS. It is associated with the presence of asymptomatic gadolinium-enhancement and retinal axonal loss and may reflect the inflammatory disease activity level.

Keywords: CIS; DIR; MRI; multiple sclerosis; optic neuritis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Demyelinating Diseases / diagnostic imaging*
  • Female
  • Gadolinium
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Optic Nerve / diagnostic imaging*
  • Optic Neuritis / diagnostic imaging*
  • Tomography, Optical Coherence
  • Young Adult


  • Gadolinium