ParticipantsMaximiliano Darakdjian, MD, Buenos Aires City, Argentina (Presenter) Nothing to Disclose
Hernan Chaves, MD, Vicente Lopez, Argentina (Abstract Co-Author) Consultant, ENTELAI
Jairo Hernandez, MD, MS, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
Claudia P. Cejas, MD, Buenos Aires, Argentina (Abstract Co-Author) Nothing to Disclose
maxdarakdjian@gmail.com
PURPOSEMRI patterns of optic nerve involvement have been described and correlated with underlying optic neuritis (ON) etiologies. Optic nerve enhancement is an accurate biomarker of acute ON. Our purpose is to analyze if there is any difference between patterns of optic nerve enhancement and acute ON etiologies.
METHOD AND MATERIALSWe retrospectively analyzed enhancement patterns on fat-suppressed T1-weighted images of 50 optic nerves (43 patients) with clinical and radiological acute ON, who presented at our institution over a 4-year period. We evaluated location and extension of enhancing optic nerve segments and the presence of perineural enhancement (PE). Images were analyzed in consensus by a third-year radiology resident and a neuroradiologist. The relation between optic nerve enhancement patterns and underlying etiology was evaluated. Fisher's exact test and chi2 were calculated.
RESULTSPatients mean age was 30.7 years-old (range 6-79) and 28 were females (65.1%). Twenty-three (53.4%) were diagnosed with Multiple Sclerosis (MS), 8 (18.6%) Neuromyelitis Optica (NMO) and 12 (27.9%) anti-MOG. Seven patients had bilateral involvement [14.29% MS, 14.3% NMO, 71.3% anti-MOG (p=0.029)]. Nine nerves had PE (33.3% MS, 33.3% NMO and 33.3% anti-MOG). Thirty-five had intraorbital involvement [34.2% MS, 22.8% NMO, 42.8% anti-MOG (p=0.012)]. Canalicular involvement was seen in 28 patients (46.4% MS, 10.6% NMO, 42.9% anti-MOG), intracranial in 20 (45% MS, 15% NMO, 40% anti-MOG) and chiasmatic in 3 patients (33% MS, 33% NMO, 33% anti-MOG). Twenty-six patients had only 1 involved segment (61.54% MS, 19.23% NMO, 19.23% anti-MOG), 13 patients had 2 segments (38.5% MS, 15.4% NMO, 46.2% anti-MOG), 10 patients had 3 segments (30% MS, 20% NMO, 50% anti-MOG) and only one patient had 4 segments affected (anti-MOG). The median time from symptom onset to MRI was 8.7 days (range 0-33).
CONCLUSIONIn acute ON, bilaterality and intraorbital involvement of optic nerves were more frequent in anti-MOG patients compared to MS and NMO groups. There was no statistically significant difference in the presence of PE or number of involved segments between groups.
CLINICAL RELEVANCE/APPLICATIONDespite acute ON treatment is similar in all demyelinating entities, prognosis and further management differs considerably. Patterns of nerve enhancement could differentiate between etiologies.