Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis
Danyel, Leon Alexander (2022), Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis, Dryad, Dataset, https://doi.org/10.5061/dryad.59zw3r2bk
Purpose: To assess diffusion abnormalities of the optic nerve (ON) in giant cell arteritis (GCA) patients with acute onset of visual impairment (VI) using diffusion-weighted magnetic resonance imaging (DWI).
Methods: DWI scans of GCA patients with acute VI were evaluated in a case-control study. Two blinded neuroradiologists assessed randomized DWI scans of GCA and controls for ON restricted diffusion. Statistical quality criteria and inter-rater reliability (IRR) were calculated. DWI findings were compared to ophthalmological assessments.
Results: 35 GCA patients (76.2 ± 6.4 years; 37 scans) and 35 controls (75.7±7.6 years; 38 scans) were included. ON restricted diffusion was detected in 81.1% (Reader 1) of GCA scans. Localization of ON restricted diffusion was at the optic nerve head in 80.6%, intraorbital in 11.1% and affecting both segments in 8.3%. DWI discerned affected from unaffected ON with a sensitivity, specificity, positive and negative predictive value of 87%/99%/96%/96%. IRR for ON restricted diffusion was κinter = 0.72 (95% CI 0.59‑0.86). DWI findings challenged ophthalmologic diagnoses in 4 cases (11.4%).
Conclusions: DWI visualizes anterior and posterior ON ischemia in GCA patients with high sensitivity and specificity, as well as substantial inter-rater reliability. DWI may complement the ophthalmological assessment in patients with acute VI.