Hyperintense areas in the intraorbital optic nerve evaluated by T2-weighted magnetic resonance imaging: a glymphatic pathway?

Tsutsumi, Satoshi; Onο, Hideo; Ishii, Hisato

doi:10.1007/s00276-020-02649-7

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…These findings are consistent with previous studies in which no healthy controls or patients who underwent an MRI for an indication unrelated to visual complaints or MS were found to have ON T2-hyperintensity, 3 but contradict another study that showed ON T2-hyperintensity in patients without known history of optic neuropathy, believed to reflect the glymphatic system. 12 Prudently, patients with incidentally found true ON T2-hyperintensity should receive a thorough ophthalmological examination.…”

Section: Discussionmentioning

confidence: 99%

“…However, ON T2-hyperintensity has been reported in the setting of optic neuropathies and retinal disorders of any cause, [6][7][8][9][10][11] as well as in patients without a known pathology. 12 Despite existing studies illustrating the nonspecificity of MRI ON T2-hyperintensity, many providers equate this MRI finding specifically with demyelinating optic neuritis, either acute or chronic. Indeed, it is not uncommon for patients to be erroneously diagnosed with optic neuritis because of isolated, nonenhancing ON T2-hyperintensity on MRI and to consequently undergo unnecessary ancillary testing, such as repeat imaging and lumbar puncture, and even, in some cases, long-term targeted anti-inflammatory treatments.…”

mentioning

confidence: 99%

“…However, ON T2-hyperintensity has been reported in the setting of optic neuropathies and retinal disorders of any cause, 6–11 as well as in patients without a known pathology. 12…”

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confidence: 99%

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Optic Nerve MRI T2-Hyperintensity: A Nonspecific Marker of Optic Nerve Damage

Labella Álvarez,

Mosleh,

Bouthour

et al. 2023

Journal of Neuro-Ophthalmology

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Background: MRI abnormalities are common in optic neuropathies, especially on dedicated orbital imaging. In acute optic neuritis, optic nerve T2-hyperintensity associated with optic nerve contrast enhancement is the typical imaging finding. In chronic optic neuropathies, optic nerve T2-hyperintensity and atrophy are regularly seen. Isolated optic nerve T2-hyperintensity is often erroneously presumed to reflect optic neuritis, frequently prompting unnecessary investigations and neuro-ophthalmology consultations. Our goal was to determine the significance of optic nerve/chiasm T2-hyperintensity and/or atrophy on MRI. Methods: Retrospective study of consecutive patients who underwent brain/orbital MRI with/without contrast at our institution between July 1, 2019, and June 6, 2022. Patients with optic nerve/chiasm T2-hyperintensity and/or atrophy were included. Medical records were reviewed to determine the etiology of the T2-hyperintensity and/or atrophy. Results: Four hundred seventy-seven patients (698 eyes) were included [mean age 52 years (SD ±18 years); 57% women]. Of the 364 of 698 eyes with optic nerve/chiasm T2-hyperintensity without atrophy, the causes were compressive (104), inflammatory (103), multifactorial (49), glaucoma (21), normal (19), and other (68); of the 219 of 698 eyes with optic nerve/chiasm T2-hyperintensity and atrophy, the causes were compressive (57), multifactorial (40), inflammatory (38), glaucoma (33), normal (7), and other (44); of the 115 of 698 eyes with optic nerve/chiasm atrophy without T2-hyperintensity, the causes were glaucoma (34), multifactorial (21), inflammatory (13), compressive (11), normal (10), and other (26). Thirty-six eyes with optic nerve/chiasm T2-hyperintensity or atrophy did not have evidence of optic neuropathy or retinopathy on ophthalmologic examination, and 17 eyes had clinical evidence of severe retinopathy without primary optic neuropathy. Conclusions: Optic nerve T2-hyperintensity or atrophy can be found with any cause of optic neuropathy and with severe chronic retinopathy. These MRI findings should not automatically prompt optic neuritis diagnosis, workup, and treatment, and caution is advised regarding their use in the diagnostic criteria for multiple sclerosis. Cases of incidentally found MRI optic nerve T2-hyperintensity and/or atrophy without a known underlying optic neuropathy or severe retinopathy are rare. Such patients should receive an ophthalmologic examination before further investigations.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Optic Nerve MRI T2-Hyperintensity: A Nonspecific Marker of Optic Nerve Damage

Labella Álvarez,

Mosleh,

Bouthour

et al. 2023

Journal of Neuro-Ophthalmology

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“…Studies have suggested that hyperintense areas in the optic nerves (ONs) and tracts that can be detected using T2-weighted imaging, constructive interference steady-state (CISS) sequences, and contrast-enhanced fluid-attenuated inversion recovery imaging may be important for maintaining normal visual function. [ 6 , 8 , 11 ]…”

Section: Introductionmentioning

confidence: 99%

Large rhabdoid meningioma presenting prominent hyperintensity in the optic nerve: An indicator of visual disturbance on constructive interference steady-state sequence?

Inami

Tsutsumi

Hashizume

et al. 2023

Surgical Neurology International

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Background: Rhabdoid meningiomas (RMs) are a rare type of malignant meningioma. Here, we report a case of intracranial RM presenting with visual disturbance and prominent hyperintensity in the optic nerve (ON). Case Description: A 20-year-old female presented with a 1-year history of headache. At presentation, her visual acuity (VA) was 20/50 on the right side and 20/40 on the left, with an intraocular pressure of 17 mmHg on both sides. Cerebral magnetic resonance imaging revealed a broad-based tumor in the right frontal convexity. It measured 82 mm × 65 mm × 70 mm in diameter, accompanied by cystic components, and was inhomogeneously enhanced. The intraorbital ONs demonstrated prominent intramedullary hyperintensity on the constructive interference steady-state sequence. Gross total tumor resection was performed and the pathology was consistent with RM. Immediately after surgery, her VA and IOP were 20/17 and 10 mmHg, respectively, with a remarkable resolution of the intramedullary hyperintensity. Conclusion: Prominent hyperintensity in the ON identified in patients with chronic intracranial hypertension may be an indicator of visual disturbance. It can rapidly resolve after resolution of intracranial hypertension with functional recovery.

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“…Evidence suggests that the optic nerve may function as a glymphatic pathway [2] , [3] , [4] , [5] , [6] . Recently, studies using magnetic resonance imaging (MRI) have delineated the possible glymphatic pathways in the intracranial and intraorbital segments of the human optic nerve [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Hyperintense areas in the intraorbital optic nerve evaluated by T2-weighted magnetic resonance imaging: a glymphatic pathway?

Cited by 7 publications

References 27 publications

Optic Nerve MRI T2-Hyperintensity: A Nonspecific Marker of Optic Nerve Damage

Optic Nerve MRI T2-Hyperintensity: A Nonspecific Marker of Optic Nerve Damage

Large rhabdoid meningioma presenting prominent hyperintensity in the optic nerve: An indicator of visual disturbance on constructive interference steady-state sequence?

Prominent hyperintense areas in swollen optic pathway: An indicator of congestive glymphatic pathway?

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