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05-09-2023 | Optic Neuritis | Head and Neck

High diagnostic accuracy of T2FLAIR at 3 T in the detection of optic nerve head edema in acute optic neuritis

Authors: Natalia Shor, Cedric Lamirel, Sana Rebbah, Catherine Vignal, Vivien Vasseur, Julien Savatovsky, Marine Boudot de la Motte, Olivier Gout, Augustin Lecler, Rabih Hage, Romain Deschamps

Published in: European Radiology | Issue 3/2024

Abstract

Objectives

Optic nerve head edema (ONHE) detected by fundoscopy is observed in one-third of patients presenting optic neuritis (ON). While ONHE is an important semiological feature, the correlation between ONHE and optic nerve head MRI abnormalities (ONHMA), sometimes called “optic nerve head swelling,” remains unknown.

Our study aimed to assess the diagnostic accuracy of T2 fluid-attenuated inversion recovery (FLAIR) MRI sequence in detecting ONHE in patients with acute ON.

Methods

In the present single-center study, data were extracted from two prospective cohort studies that consecutively included adults with a first episode of acute ON treated between 2015 and 2020. Two experienced readers blinded to study data independently analyzed imaging. A senior neuroradiologist resolved any discrepancies. The primary judgment criterion of ONHMA was assessed as optic nerve head high signal intensity on gadolinium-enhanced T2FLAIR MRI sequence. Its diagnostic accuracy was evaluated with both the gold standard of ONHE on fundus photography (FP) and peripapillary retinal nerve fiber layer thickening on optic coherence tomography (OCT).

Results

A total of 102 patients were included, providing 110 affected and 94 unaffected optic nerves. Agreement was high between the different modalities: 92% between MRI and FP (k = 0.77, 95% CI: 0.67–0.88) and 93% between MRI and OCT (k = 0.77, 95% CI: 0.67–0.87). MRI sensitivity was 0.84 (95% CI: 0.70–0.93) and specificity was 0.94 (95% CI: 0.89–0.97) when compared with the FP.

Conclusion

Optic nerve head high T2FLAIR signal intensity corresponds indeed to the optic nerve head edema diagnosed by the ophthalmologists. MRI is a sensitive tool for detecting ONHE in patients presenting acute ON.

Clinical relevance statement

In patients with optic neuritis the high T2FLAIR (fluid-attenuated inversion recovery) signal intensity of the optic nerve head corresponds indeed to optic nerve head edema, which is a useful feature in optic neuritis etiological evaluation and treatment.

Key Points

Optic nerve head edema is a prominent clinical feature of acute optic neuritis and is usually diagnosed during dilated or non-dilated eye fundus examination.
Agreement was high between magnetic resonance imaging, fundus photography, and optical coherence tomography.
Optic nerve head high T2 fluid attenuation inversion recovery signal intensity is a promising detection tool for optic nerve head edema in patients presenting acute optic neuritis.

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Title: High diagnostic accuracy of T2FLAIR at 3 T in the detection of optic nerve head edema in acute optic neuritis
Authors: Natalia Shor
Cedric Lamirel
Sana Rebbah
Catherine Vignal
Vivien Vasseur
Julien Savatovsky
Marine Boudot de la Motte
Olivier Gout
Augustin Lecler
Rabih Hage
Romain Deschamps
Publication date: 05-09-2023
Publisher: Springer Berlin Heidelberg
Keywords: Optic Neuritis
Edema
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: European Radiology / Issue 3/2024
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-10139-8

At a glance: The STEP trials

Springer Medicine

High diagnostic accuracy of T2FLAIR at 3 T in the detection of optic nerve head edema in acute optic neuritis

Abstract

Objectives

Methods

Results

Conclusion

Clinical relevance statement

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Clinical relevance statement

Key Points

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