The following is a summary of “Optic nerve sheath enhancement on orbital MRI in giant cell arteritis,” published in the December 2024 issue of Ophthalmology by Ephrem et al.
Differentiating arteritic anterior ischaemic optic neuropathy (A-AION) because of giant cell arteritis (GCA) from non-arteritic anterior ischaemic optic neuropathy (NA-AION) might pose a diagnostic challenge.
Researchers conducted a retrospective study to assess the use of standard orbital MRI in differentiating ocular manifestations of GCA from NA-AION.
They included 25 patients (11 with GCA, 14 with NA-AION who underwent contrast-enhanced orbital MRIs within 3 months of symptom onset, 2 radiologists, blinded to clinical data, independently assessed the MRIs for optic nerve sheath (ONS) enhancement and other orbital structures.
The results showed the ONS enhancement was more common in patients with GCA than in those with NA-AION (64% vs 14%, P =0.02), ONS enhancement was observed in both typical A-AION cases and in patients with GCA along other ocular ischaemic features (e.g., retinal artery occlusion). In patients with GCA, ONS enhancement was bilateral in 6 out of 7 cases despite unilateral visual symptoms.
Investigators concluded the orbital MRI demonstrated greater ONS enhancement in patients with ocular GCA compared to NA-AION, suggesting its potential utility in diagnosing GCA and detecting early subclinical disease in both affected and unaffected eyes.
Source: bjo.bmj.com/content/early/2024/12/18/bjo-2024-326608
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