Abstract：
BACKGROUND: Recent diagnostic criteria for optic neuritis include T2-hyperintensity of the optic nerve (ON), even without associated contrast enhancement. However, isolated ON-T2-hyperintensity is a nonspecific finding found in any optic neuropathy or severe retinopathy. We applied the 2022 optic neuritis diagnostic criteria to a cohort of patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one eye, to assess the rate of optic neuritis misdiagnosis using these criteria.
METHODS: Retrospective study of consecutive patients who underwent brain/orbit MRI with/without contrast between 07/01/2019 and 06/30/2022. Patients with ON-T2-hyperintensity in at least one eye were included. The 2022 optic neuritis diagnostic criteria were applied to patients with noninflammatory optic neuropathies who had an ophthalmologic examination available for review.
RESULTS: Of 150 patients included, 85/150 had compressive optic neuropathy; 32/150 had glaucoma; 12/150 had papilledema; 8/150 had hereditary (3), radiation-induced (3), nutritional (1), traumatic (1) optic neuropathies (none fulfilled the criteria); 13/150 had ischemic optic neuropathy and 4 fulfilled the criteria as definite optic neuritis due to contrast enhancement of the ON head. Seven additional patients would have satisfied the diagnostic criteria if red flags for alternative diagnoses had been overlooked.
CONCLUSIONS: The application of the 2022 optic neuritis diagnostic criteria in patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one ON resulted in misdiagnosis of optic neuritis in only 4 patients because of ON head enhancement, all with nonarteritic anterior ischemic optic neuropathy. Neuro-ophthalmologic evaluation and exclusion of the ON head as a location in the MRI criteria would have prevented optic neuritis misdiagnosis in our study.
METHODS: Retrospective study of consecutive patients who underwent brain/orbit MRI with/without contrast between 07/01/2019 and 06/30/2022. Patients with ON-T2-hyperintensity in at least one eye were included. The 2022 optic neuritis diagnostic criteria were applied to patients with noninflammatory optic neuropathies who had an ophthalmologic examination available for review.
RESULTS: Of 150 patients included, 85/150 had compressive optic neuropathy; 32/150 had glaucoma; 12/150 had papilledema; 8/150 had hereditary (3), radiation-induced (3), nutritional (1), traumatic (1) optic neuropathies (none fulfilled the criteria); 13/150 had ischemic optic neuropathy and 4 fulfilled the criteria as definite optic neuritis due to contrast enhancement of the ON head. Seven additional patients would have satisfied the diagnostic criteria if red flags for alternative diagnoses had been overlooked.
CONCLUSIONS: The application of the 2022 optic neuritis diagnostic criteria in patients with noninflammatory optic neuropathy and ON-T2-hyperintensity in at least one ON resulted in misdiagnosis of optic neuritis in only 4 patients because of ON head enhancement, all with nonarteritic anterior ischemic optic neuropathy. Neuro-ophthalmologic evaluation and exclusion of the ON head as a location in the MRI criteria would have prevented optic neuritis misdiagnosis in our study.
摘要：
背景：最近的视神经炎诊断标准包括T2-视神经高强度（ON），即使没有相关的对比度增强。然而,孤立的ON-T2-高强度是在任何视神经病变或严重视网膜病变中发现的非特异性发现。我们将2022年视神经炎诊断标准应用于至少一只眼睛患有非炎性视神经病变和ON-T2高强度的患者队列，使用这些标准评估视神经炎的误诊率。
方法：回顾性研究连续患者在2019年7月1日至2022年6月30日期间接受脑/眼眶MRI检查，有无对比。包括至少一只眼睛中具有ON-T2-高强度的患者。2022年视神经炎诊断标准适用于接受眼科检查的非炎性视神经病变患者。
结果：包括150名患者，85/150患有压缩性视神经病变；32/150患有青光眼；12/150患有乳头水肿；8/150患有遗传性（3），辐射诱导（3），营养（1），外伤性（1）视神经病变（均未符合标准）；13/150患有缺血性视神经病变，由于ON头部的对比增强，4例符合明确的视神经炎标准。如果忽略了替代诊断的危险信号，则另外7名患者将满足诊断标准。
结论：将2022年视神经炎诊断标准应用于非炎性视神经病变和至少一次ON中的ON-T2-高强度的患者，导致仅4例因ON头部增强而误诊为视神经炎，均为非动脉炎性前部缺血性视神经病变。在我们的研究中，神经眼科评估和排除ON头作为MRI标准中的位置可以防止视神经炎的误诊。
方法：回顾性研究连续患者在2019年7月1日至2022年6月30日期间接受脑/眼眶MRI检查，有无对比。包括至少一只眼睛中具有ON-T2-高强度的患者。2022年视神经炎诊断标准适用于接受眼科检查的非炎性视神经病变患者。
结果：包括150名患者，85/150患有压缩性视神经病变；32/150患有青光眼；12/150患有乳头水肿；8/150患有遗传性（3），辐射诱导（3），营养（1），外伤性（1）视神经病变（均未符合标准）；13/150患有缺血性视神经病变，由于ON头部的对比增强，4例符合明确的视神经炎标准。如果忽略了替代诊断的危险信号，则另外7名患者将满足诊断标准。
结论：将2022年视神经炎诊断标准应用于非炎性视神经病变和至少一次ON中的ON-T2-高强度的患者，导致仅4例因ON头部增强而误诊为视神经炎，均为非动脉炎性前部缺血性视神经病变。在我们的研究中，神经眼科评估和排除ON头作为MRI标准中的位置可以防止视神经炎的误诊。
