How Common Is Signal-Intensity Increase in Optic Nerve Segments on 3D Double Inversion Recovery Sequences in Visually Asymptomatic Patients with Multiple Sclerosis?

Sartoretti, Thomas; Sartoretti, Elisabeth; Rauch, S.; Binkert, Christoph A.; Wyss, Michael; Czell, David; Sartoretti–Schefer, Sabine

doi:10.3174/ajnr.a5262

Cited by 19 publications

(18 citation statements)

References 48 publications

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“…In patients being assessed for multiple sclerosis, such image processing may help uncover underlying optic nerve abnormalities that are otherwise not captured on routine clinical assessment or routine MR imaging. 30,31 By using patients who underwent imaging due to concern for optic neuritis but were found to have no clinical evidence of optic neuritis and by incorporating a large number of masked reviewers with a range of training experience, our study tries to overcome some of the limitations of prior studies, which include restriction of controls to the contralateral eye in symptomatic patients and only 1 or 2 subspecialist reviewers. [13][14][15]18,21,22,27,32 Some limitations of our study are worth mentioning.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Utility of a Postprocessing Algorithm for MRI Evaluation of Optic Neuritis

Stunkel

Sharma

Parsons

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: MR imaging is useful for the detection and/or confirmation of optic neuritis. The objective of this study was to determine whether a postprocessing algorithm selectively increases the contrast-to-noise ratio of abnormal optic nerves in optic neuritis, facilitating this diagnosis on MR imaging. MATERIALS AND METHODS: In this retrospective case-control study, coronal FLAIR images and coronal contrast-enhanced T1WI from 44 patients (31 eyes with clinically confirmed optic neuritis and 28 control eyes) underwent processing using a proprietary postprocessing algorithm designed to detect and visually highlight regions of contiguous increases in signal intensity by increasing the signal intensities of regions that exceed a predetermined threshold. For quantitative evaluation of the effect on image processing, the contrast-to-noise ratio of equivalent ROIs and the contrast-to-noise ratio between optic nerves and normal-appearing white matter were measured on baseline and processed images. The effect of image-processing on diagnostic performance was evaluated by masked reviews of baseline and processed images by 6 readers with varying experience levels. RESULTS: In abnormal nerves, processing resulted in an increase in the median contrast-to-noise ratio from 17.8 to 85.0 (P Ͻ .001) on FLAIR and from 19.4 to 93.7 (P Ͻ .001) on contrast-enhanced images. The contrast-to-noise ratio for control optic nerves was not affected by processing (P ϭ 0.13). Image processing had a beneficial effect on radiologists' diagnostic performance, with an improvement in sensitivities for 5/6 readers and relatively unchanged specificities. Interobserver agreement improved following processing. CONCLUSIONS: Processing resulted in a selective increase in the contrast-to-noise ratio for diseased nerves and corresponding improvement in the detection of optic neuritis on MR imaging by radiologists.

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Section: Discussionmentioning

confidence: 99%

Evaluating the Utility of a Postprocessing Algorithm for MRI Evaluation of Optic Neuritis

Stunkel

Sharma

Parsons

et al. 2019

AJNR Am J Neuroradiol

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“…For the first time, we report on pathologic long-segment 3D DIR hypersignal in optic nerves affected by GON in glaucoma patients associated with significantly decreased RNFL thickness values and significantly increased IOP and not associated with demyelinating or ischemic optic neuropathy. It is known from a previous study that normal and healthy optic nerves always present with a hypointense signal compared to the signal intensity of ipsilateral lateral rectus muscle [23] and hypersignal on DIR is always pathologic [23].…”

Section: Discussionmentioning

confidence: 99%

“…Thus the clinically relevant findings of this study are that long-segment DIR hypersignal in GON should not be mistaken for the typical short-segment subclinical optic nerve demyelination usually occurring in the retrobulbar nerve segment in patients with multiple sclerosis [23].…”

Section: Discussionmentioning

confidence: 99%

“…Pathologic DIR hypersignal of optic nerve segments (i.e. retrobulbar, canalicular, prechiasmatic, chiasmatic segments) was rated in comparison with the signal intensity of the ipsilateral lateral rectus muscle [23]. Long-segment DIR hypersignal was defined as hypersignal in at least 2 nerve segments.…”

Section: Methodsmentioning

confidence: 99%

“…and MRI of the optic system is not considered necessary for diagnosis. In patients with atypical and asymmetric visual field defects, however, where the diagnosis of glaucoma is not easily achieved, an additional MR examination of brain and orbits is added to exclude ischemic and demyelinating pathology [20–23].…”

Section: Introductionmentioning

confidence: 99%

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Long segment 3D double inversion recovery (DIR) hypersignal on MRI in glaucomatous optic neuropathy

et al. 2019

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BackgroundIn 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.MethodsAll 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.Results3D 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.ConclusionsIn 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.

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Detecting optic nerve lesions in clinically isolated syndrome and multiple sclerosis: double-inversion recovery magnetic resonance imaging in comparison with visually evoked potentials

et al. 2018

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How Common Is Signal-Intensity Increase in Optic Nerve Segments on 3D Double Inversion Recovery Sequences in Visually Asymptomatic Patients with Multiple Sclerosis?

Cited by 19 publications

References 48 publications

Evaluating the Utility of a Postprocessing Algorithm for MRI Evaluation of Optic Neuritis

Evaluating the Utility of a Postprocessing Algorithm for MRI Evaluation of Optic Neuritis

Long segment 3D double inversion recovery (DIR) hypersignal on MRI in glaucomatous optic neuropathy

Detecting optic nerve lesions in clinically isolated syndrome and multiple sclerosis: double-inversion recovery magnetic resonance imaging in comparison with visually evoked potentials

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