Matthew Boyko1, Oana Dumitrascu2, Amit M Saindane3, Joseph M Hoxworth4, Ranliang Hu5, Tanya Rath4, Wesley Chan1, Alexis M Flowers1, Ehab Harahsheh6, Parth Parikh7, Omer Elshaigi7, Benjamin I Meyer1, Nancy J Newman8, Valérie Biousse9. 1. Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States. 2. Departments of Neurology and Ophthalmology, Mayo Clinic College of Medicine, Scottsdale, AZ 480-301-4151, United States. 3. Departments of Radiology and Imaging Sciences and Neurological Surgery, Emory University School of Medicine, Atlanta, GA 404-778-2020, United States. 4. Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine Scottsdale, AZ 480-301-4151, United States. 5. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 404-778-2020, United States. 6. Department of Neurology, Mayo Clinic College of Medicine Scottsdale, AZ 480-301-4151, United States. 7. Mayo Clinic Alyx School of Medicine, Scottsdale, AZ 480-301-4151, United States. 8. Departments of Ophthalmology, Neurology and Neurological Surgery, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States. 9. Departments of Ophthalmology and Neurology, Emory University School of Medicine, Atlanta, GA 404-778-5158, United States. Electronic address: vbiouss@emory.edu.
Abstract
OBJECTIVES: Diffusion weighted imaging hyperintensity (DWI-H) has been described in the retina and optic nerve during acute central retinal artery occlusion (CRAO). We aimed to determine whether DWI-H can be accurately identified on standard brain magnetic resonance imaging (MRI) in non-arteritic CRAO patients at two tertiary academic centers. MATERIALS AND METHODS: Retrospective cross-sectional study that included all consecutive adult patients with confirmed acute non-arteritic CRAO and brain MRI performed within 14 days of CRAO. At each center, two neuroradiologists masked to patient clinical data reviewed each MRI for DWI-H in the retina and optic nerve, first independently then together. Statistical analysis for inter-rater reliability and correlation with clinical data was performed. RESULTS: We included 204 patients [mean age 67.9±14.6 years; 47.5% females; median time from CRAO to MRI 1 day (IQR 1-4.3); 1.5 T in 127/204 (62.3%) and 3.0 T in 77/204 (37.7%)]. Inter-rater reliability varied between centers (κ = 0.27 vs. κ = 0.65) and was better for retinal DWI-H. Miss and error rates significantly differed between neuroradiologists at each center. After consensus review, DWI-H was identified in 87/204 (42.6%) patients [miss rate 117/204 (57.4%) and error rate 11/87 (12.6%)]. Significantly more patients without DWI-H had good visual acuity at follow-up (p = 0.038). CONCLUSIONS: In this real-world case series, differences in agreement and interpretation accuracy among neuroradiologists limited the role of DWI-H in diagnosing acute CRAO on standard MRI. DWI-H was identified in 42.6% of patients and was more accurately detected in the retina than in the optic nerve. Further studies are needed with standardized novel MRI protocols.
OBJECTIVES: Diffusion weighted imaging hyperintensity (DWI-H) has been described in the retina and optic nerve during acute central retinal artery occlusion (CRAO). We aimed to determine whether DWI-H can be accurately identified on standard brain magnetic resonance imaging (MRI) in non-arteritic CRAO patients at two tertiary academic centers. MATERIALS AND METHODS: Retrospective cross-sectional study that included all consecutive adult patients with confirmed acute non-arteritic CRAO and brain MRI performed within 14 days of CRAO. At each center, two neuroradiologists masked to patient clinical data reviewed each MRI for DWI-H in the retina and optic nerve, first independently then together. Statistical analysis for inter-rater reliability and correlation with clinical data was performed. RESULTS: We included 204 patients [mean age 67.9±14.6 years; 47.5% females; median time from CRAO to MRI 1 day (IQR 1-4.3); 1.5 T in 127/204 (62.3%) and 3.0 T in 77/204 (37.7%)]. Inter-rater reliability varied between centers (κ = 0.27 vs. κ = 0.65) and was better for retinal DWI-H. Miss and error rates significantly differed between neuroradiologists at each center. After consensus review, DWI-H was identified in 87/204 (42.6%) patients [miss rate 117/204 (57.4%) and error rate 11/87 (12.6%)]. Significantly more patients without DWI-H had good visual acuity at follow-up (p = 0.038). CONCLUSIONS: In this real-world case series, differences in agreement and interpretation accuracy among neuroradiologists limited the role of DWI-H in diagnosing acute CRAO on standard MRI. DWI-H was identified in 42.6% of patients and was more accurately detected in the retina than in the optic nerve. Further studies are needed with standardized novel MRI protocols.
Authors: Raul G Nogueira; Ashutosh P Jadhav; Diogo C Haussen; Alain Bonafe; Ronald F Budzik; Parita Bhuva; Dileep R Yavagal; Marc Ribo; Christophe Cognard; Ricardo A Hanel; Cathy A Sila; Ameer E Hassan; Monica Millan; Elad I Levy; Peter Mitchell; Michael Chen; Joey D English; Qaisar A Shah; Frank L Silver; Vitor M Pereira; Brijesh P Mehta; Blaise W Baxter; Michael G Abraham; Pedro Cardona; Erol Veznedaroglu; Frank R Hellinger; Lei Feng; Jawad F Kirmani; Demetrius K Lopes; Brian T Jankowitz; Michael R Frankel; Vincent Costalat; Nirav A Vora; Albert J Yoo; Amer M Malik; Anthony J Furlan; Marta Rubiera; Amin Aghaebrahim; Jean-Marc Olivot; Wondwossen G Tekle; Ryan Shields; Todd Graves; Roger J Lewis; Wade S Smith; David S Liebeskind; Jeffrey L Saver; Tudor G Jovin Journal: N Engl J Med Date: 2017-11-11 Impact factor: 91.245
Authors: Götz Thomalla; Claus Z Simonsen; Florent Boutitie; Grethe Andersen; Yves Berthezene; Bastian Cheng; Bharath Cheripelli; Tae-Hee Cho; Franz Fazekas; Jens Fiehler; Ian Ford; Ivana Galinovic; Susanne Gellissen; Amir Golsari; Johannes Gregori; Matthias Günther; Jorge Guibernau; Karl Georg Häusler; Michael Hennerici; André Kemmling; Jacob Marstrand; Boris Modrau; Lars Neeb; Natalia Perez de la Ossa; Josep Puig; Peter Ringleb; Pascal Roy; Enno Scheel; Wouter Schonewille; Joaquin Serena; Stefan Sunaert; Kersten Villringer; Anke Wouters; Vincent Thijs; Martin Ebinger; Matthias Endres; Jochen B Fiebach; Robin Lemmens; Keith W Muir; Norbert Nighoghossian; Salvador Pedraza; Christian Gerloff Journal: N Engl J Med Date: 2018-05-16 Impact factor: 91.245