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Imaging the brain: diagnosis aided by structural features on neuroimaging studies

Eye (2024)Cite this article

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Abstract

The use of neuroimaging allows the ophthalmologist to identify structural lesions in the orbit or along the neuroaxis that allow for more accurate diagnosis and treatment of patients with neuro-ophthalmic diseases. The primary imaging tools include computed tomography (CT) and magnetic resonance imaging (MRI), both of which can be used to evaluate the brain, spinal cord and canal, and orbits. Neurovascular structures, both arterial and venous, also can be imaged in high resolution with modern CT and MR angiography and CT and MR venography. In many cases, invasive procedures such as catheter angiography can be avoided with these studies, and angiography is often reserved for confirmation of vascular lesions combined with endovascular treatment. In this article, we illustrate how the evaluation of patients presenting with neuro-ophthalmic diseases involving the afferent and efferent visual pathways can be optimized with the use of appropriate diagnostic imaging studies. The complementary value of ophthalmic imaging is also demonstrated, and the advantages and disadvantages of both CT and MRI as well as their use in longitudinal patient follow up is demonstrated.

摘要

神经成像的应用使眼科医生能够识别眼眶或神经轴上的结构性病变, 从而对神经眼科疾病患者进行更准确地诊断和治疗。主要成像工具包括计算机断层扫描(CT)和磁共振成像(MRI), 这两种影像都可以用来评估大脑、脊髓、椎管和眼眶。神经血管结构, 动脉和静脉的神经血管结构也可用CT和MR血管成像以及CT和MR静脉成像进行高分辨成像。在许多情况下, 研究可避免诸如导管血管造影术等侵入性的操作, 且血管造影术通常用于结合血管的治疗来确认血管病变。本文阐述了如何通过使用适当的影像诊断研究优化对涉及传入和传出视觉通路的神经眼科疾病患者的评估。并阐述了眼科影像的互补价值, 以及CT和MRI的优缺点及其在患者纵向随访中的应用。

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Fig. 1: MRI brain for evaluation of possible white matter lesions.
Fig. 2: Changes in visual fields (upper panel) and best corrected visual acuity (lower panel) observed during the follow-up period.
Fig. 3: Optic nerve oedema and visual status at presentation.
Fig. 4: MRI evaluation after identification of optic disc swelling.
Fig. 5: Axial MRI brain with contrast.
Fig. 6: Cerebral angiography and aneurysm treatment.
Fig. 7: Ophthalmic imaging after aneurysm treatment.
Fig. 8: MRI orbits, T1-weighted sequences with fat suppression and gadolinium contrast.
Fig. 9: Repeat MRI after a period of clinical observation.

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Funding

Funding

This work was supported in part by an unrestricted grant to the Department of Ophthalmology, University of Colorado School of Medicine, by Research to Prevent Blindness, Inc.

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Authors and Affiliations

  1. Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark

    Sanja Cejvanovic & Steffen Hamann

  2. Department of Neurology, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA

    Zahir Sheikh & Prem S. Subramanian

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Steffen Hamann

  4. Department of Ophthalmology, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA

    Prem S. Subramanian

  5. Department of Neurosurgery, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA

    Prem S. Subramanian

  6. Department of Surgery (Division of Ophthalmology), Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Prem S. Subramanian

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Conceived and/or designed the work that led to the submission (SH, PSS), drafted or revised the manuscript (SC, ZS, SH, PSS), approved the final version (SC, ZS, SH, PSS), agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (PSS).

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Correspondence to Prem S. Subramanian.

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Cejvanovic, S., Sheikh, Z., Hamann, S. et al. Imaging the brain: diagnosis aided by structural features on neuroimaging studies. Eye (2024). https://doi.org/10.1038/s41433-024-03142-w

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