Neuroimaging in ophthalmology

Abstract

In the past three decades, there have been countless advances in imaging modalities that have revolutionized evaluation, management, and treatment of neuro-ophthalmic disorders. Non-invasive approaches for early detection and monitoring of treatments have decreased morbidity and mortality. Understanding of basic methods of imaging techniques and choice of imaging modalities in cases encountered in neuro-ophthalmology clinic is critical for proper evaluation of patients. Two main imaging modalities that are often used are computed tomography (CT) and magnetic resonance imaging (MRI). However, variations of these modalities and appropriate location of imaging must be considered in each clinical scenario. In this article, we review and summarize the best neuroimaging studies for specific neuro-ophthalmic indications and the diagnostic radiographic findings for important clinical entities.

Keywords: Computed tomography; Imaging; Magnetic resonance imaging; Neuroophthalmology.

Figure 1

Axial (A) and coronal (B) views of T1 sequence post contrast fat suppression magnetic resonance imaging demonstrating post contrast enhancement of the left optic nerve (arrows).

Figure 2

MRI of the sella in coronal image of post contrast T1 sequence shows pituitary macroadenoma compressing chiasm from below (arrow).

Figure 3

(A) Hyperintensity in DWI due to acute infarct in the left MCA distribution caused right homonymous hemianopsia (arrow). (B) Hypointensity in ADC due to acute infarct of left MCA distribution (arrow).

Figure 4

MRI of brain (sagittal, T1, post contrast) shows a clival chondroma (arrow) in a 29 year-old patient with a left 6th nerve palsy.

Figure 5

A 30 year old female with thyroid eye disease status post left orbital wall decompression. The T1 weighted MRI sequence of coronal (A) and axial (B) views show markedly enlarged extraocular muscles.

Figure 6

A 20 year old male with allergic fungal sinusitis with severe expansion of the ethmoid sinus pressing on the medial rectus and pushing the orbital content anteriorly. The CT scan (A) shows great details of the bony structure, while the T1sequence MRI with fat suppression (B) shows the great details of the soft tissue in orbit and sinus.

Figure 7

A 46 year old white male presenting with left ptosis and anisocoria from left Horner’s syndrome. Patient had left carotid artery dissection. T1 weighted sequence with contrast in axial view shows classic “crescent sign” (arrow) in distal portion of the left internal carotid artery.