Non-invasive Assessments of Biomechanical and Biochemical Properties in Animal and Human Eyes using Multi-modal MRI
Leon C. Ho1,2, Ian A. Sigal1,3, Ning-juan Jan1,3, Chan Hong Moon4, Xiaoling Yang1, Yolandi van der Merwe1,3, Tao Jin4, Ed X. Wu2, Seong-Gi Kim4,5, Gadi Wollstein1,3, Joel S. Schuman1,3, and Kevin C. Chan1,3

1UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States, 2Department of Electrical and Electronic Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 3Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States, 4Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States, 5Center for Neuroscience Imaging Research, Institute for Basic Science, Suwon, Korea, Republic of

Synopsis

The microstructural organization and compositions of the corneoscleral shell are central to ocular biomechanics, and are important in diseases such as glaucoma and myopia. In this study, we showed that T2-weighted MRI, diffusion tensor MRI and magnetization transfer MRI can be used to detect and differentiate microstructural and macromolecular changes in freshly prepared ovine eyes under different abnormal conditions including intraocular pressure loading, cross-linking and glycosaminoglycans depletion. We also demonstrated the feasibility of assessing the human sclera with in vivo MRI. Multi-modal MRI may be useful for evaluating the biomechanical and pathophysiological mechanisms in the corneoscleral shell non-invasively and quantitatively.

Purpose

The sclera and cornea are dense and fibrous connective tissues that form the outer coat of the eye, which act to support and protect the eye from the surrounding environments. These load-bearing connective tissues can dynamically interact with changing physiological conditions1, 2. Under elevated intraocular pressure (IOP), the corneoscleral shell transfers tensile, compression and shear stresses on the optic nerve head, and may contribute to the deformation of optic nerve axons and neurodegeneration in the visual system in glaucoma3-5. To date, limited non-invasive imaging techniques are available for determining the microstructural organization and compositions of the corneoscleral shell globally and quantitatively in different environments, which are critical for understanding the dynamics and the biomechanical and biochemical properties of the eye6. In this study, we hypothesized that T2-weighted MRI (T2WI), diffusion tensor MRI (DTI) and magnetization transfer MRI (MTI) can detect and differentiate microstructural and macromolecular changes of the sclera and cornea in three experiments: #1: stepwise changes in biomechanical IOP loading (mimicking ocular hypertension7); #2: cross-linking (mimicking aging conditions8 and corneoscleral stiffening treatment9, 10); and #3: glycosaminoglycans cleavage (mimicking glaucoma and myopic conditions11). In a fourth experiment, we demonstrated in vivo the feasibility of magic-angle enhancement in the human sclera for examining the fibrous microstructures in the eye using T2*-weighted MRI (T2*WI).

Methods

Experiment #1: T2 mapping was performed to 12 fresh, unfixed ovine eyes undergoing anterior chamber perfusion in the 9.4-Tesla MRI scanner using a plastic cannula connected to a saline bag and a pressure transducer (Figure 1). Six eyes were loaded at 0-40mmHg by raising the saline bag at different heights, followed by unpressurization back to 0mmHg. Six other eyes were cannulated but kept at 0mmHg as an unloaded control. Experiments #2 and #3: 16 ovine eyes were dissected at the central globes to give 4 sclera and 4 cornea tissue sections per eye. The tissue sections were treated with various concentrations of glyceraldehyde for cross-linking (#2) and chondroitinase-ABC for glycosaminoglycans depletion (#3) at 37oC for 12 hours followed by T2WI, DTI and MTI assessments. All ovine eye experiments were performed using a 9.4-Tesla Varian/Agilent MRI scanner with the following imaging parameters. i) T2 mapping: TR/TE=1000/9.48ms, EST=9.48ms, number of echoes=5, in-plane resolution=130×130µm2, slice thickness=1mm; ii) DTI: 2 non-diffusion-weighted images and 12 diffusion gradient directions at b=1000s/mm2, δ/Δ=5/17ms, TR/TE=2300/27.8ms; iii) MTI: 9.5µT saturation pulses at 6000Hz off-resonance and 150ms pulse length, TR/TE=1500/8.43ms. Both DTI and MTI shared the same slice geometry, with in-plane resolution=140×140µm2 and slice thickness=1mm. Experiment #4: A healthy adult subject fixated his eyes at 3 orientations (up, center, bottom) in the 3-Tesla Siemens Trio MRI scanner, and sagittal T2* mapping was performed to the right eye (IOP=11mmHg) using a 2D FLASH sequence, with TR/TE=50/3.52ms, EST=3.17ms, number of echoes=5, in-plane resolution=375×375µm2, slice thickness=2mm and scanning duration=3min.

Results

In the ovine experiments, T2 in sclera and cornea increased non-linearly with biomechanical IOP loading at 0-40mmHg and remained higher than unloaded tissues after being unpressurized (Figure 2). Increasing dosages of glyceraldehyde (Figure 3) and chondroitinase-ABC treatments (Figure 4) decreased diffusivities and increased magnetization transfer in cornea. Glyceraldehyde also increased magnetization transfer in sclera (Figure 3). In the human experiment, T2* of the posterior sclera increased with increasing angle to the main magnetic field from 0o to 55o (the magic angle) as the subject fixated at different orientations (Figure 5).

Discussion and Conclusion

The T2 increase in IOP-loaded fresh ocular tissues might be explained by the diminishing spin dephasing between increasingly distant neighboring protons during collagen fiber straightening6, 12. More importantly, the non-linearity of T2 changes echoed with recent studies showing non-linear uncrimping of collagen fibrils in the corneoscleral shell with IOP loading13, 14. T2 of IOP-loaded tissues remained high after being unpressurized suggestive of MRI detection of hysteresis or hydraulic effects15, 16. The increasing magnetization transfer and reducing diffusivity in the glyceraldehyde-treated ocular tissues suggested that MTI and DTI could characterize the state of collagen cross-linking such as increasing cross-linking packing density17 and reducing permeability18 in the eye under different physiological conditions. DTI and MTI may also detect glycosaminoglycan removal which is often a cause of altered creep and stiffness in glaucoma and myopic eyes19. As our multi-modal imaging techniques share similar physical principles in both high-field MRI and clinical MRI, our initial magic angle-enhanced MRI demonstration to detect the fibrous tissues in the human eye opened up the possibility for future non-invasive multi-modal MRI assessments of the corneoscleral biomechanics in the living human eyes, which may help identify new modifiable risk factors and guide vision preservation in a variety of ophthalmic diseases.

Acknowledgements

This work was supported by the National Institutes of Health Contracts P30-EY008098, R01-EY023966 and UL1-TR000005 (Bethesda, Maryland); BrightFocus Foundation G2013077 (Clarksburg, Maryland); Alcon Research Institute Young Investigator Grant (Fort Worth, Texas); Eye and Ear Foundation (Pittsburgh, Pennsylvania); and Research to Prevent Blindness (New York, New York).

References

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Figures

Figure 1. (a)Schematic diagram of anterior chamber perfusion to a fresh, unfixed ovine eye in the 9.4 Tesla MRI scanner (Bo: main magnetic field). (b)Experimental paradigm of the stepwise IOP loading MRI experiment and control experiment without IOP loading.

Figure 2. (a)Representative T2WI of the same eye loaded at various IOP. (b, c)Mean±SD of T2 relaxation time in cornea and sclera upon stepwise IOP loading and in unloaded control. (Bonferroni's multiple comparison tests between IOP loaded and unloaded control tissues: *p<0.05, **p<0.01; between first and subsequent MRI sessions: ###p<0.001)

Figure 3. (a)Representative T2WI, mean diffusivity (MD), and magnetization transfer ratio (MTR) maps, and (b-g)quantitative comparisons of cross-linked cornea and sclera after treating with various concentrations of glyceraldehyde solution or sham solution (0M). (Bonferroni's multiple comparisons tests between glyceraldehyde-treated tissues and sham control tissues: *p<0.05, **p<0.01, ***p<0.001).

Figure 4. (a)Representative T2WI, mean diffusivity (MD) and magnetization transfer ratio (MTR) maps, and (b-g)quantitative comparisons of glycosaminoglycans cleavage in cornea and sclera after treating with various concentrations of chondroitinase-ABC solution or sham solution (0M). (Bonferroni's multiple comparisons tests between chondroitinase-ABC treated tissues and sham control tissues: *p<0.05, **p<0.01, ***p<0.001).

Figure 5. (a-c)Sagittal T2*WI of a healthy adult human eye (IOP=11mmHg) fixating at 3 different orientations. Green arrows indicate the sclera section oriented at 0o, 30o and 55o to the main magnetic field (Bo). (d)T2*W signal decay profiles of the sclera at the 3 orientations and their corresponding T2* values.



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
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