1
|
Mosleh R, Labella Álvarez F, Bouthour W, Saindane AM, Dattilo M, Bruce BB, Newman NJ, Biousse V. Glaucoma as a cause of optic nerve abnormalities on magnetic resonance imaging. Eye (Lond) 2024; 38:1626-1632. [PMID: 38355669 PMCID: PMC11156972 DOI: 10.1038/s41433-024-02964-y] [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: 09/26/2023] [Revised: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND/OBJECTIVES To report a series of patients with glaucoma and optic nerve abnormalities on magnetic resonance imaging (MRI) in at least one-eye, and to determine whether these findings correlate with the severity of glaucoma. PATIENTS AND METHODS Retrospective study of all patients who underwent a brain/orbits MRI without and with contrast at our institution between 07/1/2019-6/30/2022. Patients with optic nerve T2-hyperintensity and/or MRI optic nerve atrophy in at least one-eye and a diagnosis of isolated glaucoma in at least one-eye were included. Demographic information, glaucoma clinical characteristics, glaucoma severity parameters, and MRI indication were collected. RESULTS Fifty-six patients (112 eyes) (age 65 years-old [range 26-88]; 70% male) had isolated bilateral glaucoma with at least one-eye MRI optic nerve abnormality. The indication for MRI was atypical/asymmetric glaucoma in 91% of patients. Of the 112 eyes, 23 had optic nerve T2-hyperintensity alone; 33 had both optic nerve T2-hyperintensity and MRI optic nerve atrophy; 34 had MRI optic nerve atrophy alone; and 22 did not have abnormal optic nerve MRI-findings. None had optic nerve enhancement. A statistically significant association between optic nerve T2-hyperintensity or MRI optic nerve atrophy and glaucoma severity parameters was found. CONCLUSIONS Glaucoma is a clinical diagnosis and MRI brain is usually not required, except in atypical or asymmetric cases. Optic nerve T2-hyperintensity and MRI optic nerve atrophy are nonspecific MRI-findings that can be found in severe glaucomatous optic nerves and should not systematically prompt investigations for another cause of optic neuropathy.
Collapse
Affiliation(s)
- Rasha Mosleh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- The Goldschleger Eye Institute, The Sheba Medical Center, Tel Hashomer, Israel
| | | | - Walid Bouthour
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael Dattilo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Beau B Bruce
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Valerie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA.
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
2
|
Sartoretti T, Stürmer J, Sartoretti E, Najafi A, Schwenk Á, Wyss M, Binkert C, Sartoretti-Schefer S. Long segment 3D double inversion recovery (DIR) hypersignal on MRI in glaucomatous optic neuropathy. BMC Ophthalmol 2019; 19:258. [PMID: 31842814 PMCID: PMC6916010 DOI: 10.1186/s12886-019-1273-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/11/2019] [Indexed: 01/26/2023] Open
Abstract
Background In this retrospective study the relationship between intraocular pressure (IOP), retinal nerve fiber layer (RNFL) thickness and pathologic hypersignal in optic nerve segments on 3D double inversion recovery (DIR) MR sequence in 21 patients with proven glaucoma of different origin was evaluated. Methods All patients were examined on a 3 T MR Philips® scanner. Pathologic optic nerve DIR hypersignal was determined in four different nerve segments. IOP was measured in mmHg by applanation tonometry. RNFL thickness was measured in μm with optical coherence tomography (OCT Heidelberg Engineering Spectralis® apparatus). Wilcoxon rank sum tests, student’s t-tests and (multivariate) linear regression models were appied. Results 3D DIR hypersignal was present in 17 (41.5%) optic nerves. 3D DIR hypersignal was not related to ischemic or demyelinating optic nerve pathology but was associated with increased IOP (19.8 [24–18]; versus 15.45; [18.85–13.75] mmHg; p = 0.008) and decreased RNFL thickness (61.06 ± 12.1 versus 82.5 ± 21.6 μm; p < 0.001) in comparison to optic nerves of glaucoma patients without DIR hypersignal. Specifically, presence of DIR hypersignal in optic nerves in at least one optic nerve segment lowered RNFL thickness on average by 17.54 μm (p = 0.005) in comparison to optic nerves without DIR hypersignal. Conclusions In patients with glaucomatous optic neuropathy (GON) and pathologic optic nerve DIR hypersignal, significantly increased IOP and significantly decreased RNFL thickness values are present. DIR hypersignal seems to be a marker for disease severity in GON related to decreased RNFL thickness and may thus represent long-segment severe axonal degeneration in optic nerves in patients with GON. Venous congestion and edema within the optic nerve related to high IOP may contribute to the DIR hypersignal as well.
Collapse
Affiliation(s)
- Thomas Sartoretti
- Laboratory of Translational Nutrition Biology, Department of Health Sciences and Technology, 8603, ETH Zürich, Schwerzenbach, Switzerland.
| | - Jörg Stürmer
- Department of Ophthalmology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Elisabeth Sartoretti
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Arash Najafi
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Árpád Schwenk
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland
| | - Michael Wyss
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.,Philips Health Systems, Zürich, Switzerland
| | - Christoph Binkert
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Sabine Sartoretti-Schefer
- Department of Radiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| |
Collapse
|