Despite these challenges, some previous studies have reported sensitivities in the detection of optic neuritis by neuroradiologists ranging from 75.7% on noncontrast MR imaging 21 to 94% on contrast-enhanced MR imaging. 20 However, the lack of proximity of the optic nerve to the white matter and different intensities of surrounding structures make this comparison difficult. 13 – 19 The optic nerve signal is best compared with normal white matter in the brain. 7 In addition, with increasing recognition of subclinical optic neuropathy in patients with multiple sclerosis, 12 the use of MR imaging to detect optic neuritis–related nerve abnormalities might become even more important.Ĭhallenges of MR imaging of the optic nerve include its small size, heterogeneity of the surrounding orbital tissue, and artifacts related to eye movements or the presence of surrounding orbital fat. 11 MR imaging can help solidify the clinical diagnosis, especially in atypical cases. 1, 2, 5 – 10 While the diagnosis can often be made clinically, misdiagnosis is common, reported in almost 60% of referrals in 1 study. 1, 3 – 5 It presents with changes in visual acuity, eye pain, a relative afferent pupillary defect, and sometimes optic disc swelling. Optic neuritis is an acute-to-subacute, demyelinating optic neuropathy, typically occurring in young women 1, 2 in association with multiple sclerosis.
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