Optic nerve T2-hyperintensity: a nonspecific marker of optic nerve damage (P2-9.004)

Abstract

<h3>Objective:</h3> To determine the significance of optic nerve (ON) T2-hyperintensity and optic atrophy on MRI. <h3>Background:</h3> The best imaging modality to investigate optic neuropathy etiologies is an orbital MRI. In acute optic neuritis, ON T2-hyperintensity and contrast enhancement (CE) are seen in 77% and 90% of patients, respectively. However, in chronic optic neuropathies, ON T2-hyperintensity and atrophy are typically seen. Interestingly, isolated ON T2-hyperintensity is often presumed to be due to optic neuritis, prompting unnecessary investigations and frequent referrals to neuro-ophthalmology. <h3>Design/Methods:</h3> Retrospective study of consecutive patients who underwent brain/orbit MRI with/without contrast at our institution between 07/01/2019–06/30/2022. Patients with ON T2-hyperintensity or atrophy were included. Medical records were reviewed to determine the etiology, if any, of the T2-hyperintensity and/or atrophy. <h3>Results:</h3> 491 patients were included (mean age 52±17 years; 57% men). 381/724 ONs had <b>T2-hyperintensity </b><b><i>without</i></b><b> atrophy</b>; diagnoses: inflammatory (100), compressive (94), glaucoma (19), multifactorial (47), other (69), unspecified (15), normal (37). 219/724 ONs had <b>T2-hyperintensity </b><b><i>and</i></b><b> atrophy</b>; diagnoses: inflammatory (36), compressive (50), glaucoma (30), multifactorial (39), other (36), unspecified (12), normal (16). 124/724 ONs had <b>atrophy </b><b><i>without</i></b><b> T2-hyperintensity</b>; diagnoses: inflammatory (13), compressive (12), glaucoma (32), multifactorial (21), other (24), unspecified (7), normal (15). 68/724 eyes with T2-hyperintensity or atrophy had a normal ophthalmologic examination. <h3>Conclusions:</h3> ON T2-hyperintensity on MRI is a non-specific finding; it can be seen in various acute and chronic optic neuropathies. ON T2-hyperintensity <b>with</b> ON atrophy <b>without</b> associated CE can occur secondary to chronic optic neuropathies, such as compressive and glaucomatous optic neuropathies, and is not highly associated with inflammatory optic neuropathies. Therefore, these radiological findings should not automatically prompt an urgent neuro-ophthalmology evaluation or further work-up for optic neuritis, such as a lumbar puncture. However, in the absence of a known cause of the optic neuropathy, an optic neuropathy work-up should be performed. <b>Disclosure:</b> Dr. Labella Alvarez has received research support from Fundación Alfonso Martín Escudero. Dr. Mosleh has nothing to disclose. Dr. Bouthour has nothing to disclose. Amit Saindane has nothing to disclose. Dr. Dattilo has nothing to disclose. Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophoenix. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avidity. Dr. Newman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Neurodiem. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Chiesi/Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $0-$499 for serving as a Consultant for Neurophoenix. The institution of Dr. Biousse has received research support from NIH. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.