Chronic optic neuropathy: correlating MR imaging features and etiology.
Optic nerve atrophy with increased T2/FLAIR signal is the dominant chronic optic neuropathy MRI pattern
Chronic optic neuropathy: correlating MR imaging features and etiology.
Chronic optic neuropathy (chronic optic neuropathy) represents a final common pathway of sustained optic nerve injury from diverse etiologies, yet characteristic MRI features and their clinical correlations are not well defined.
This study evaluated the predominant MR imaging findings of non-compressive chronic optic neuropathy and correlated these patterns with underlying clinical etiologies.
We retrospectively identified 186 patients with MRI reports referencing chronic optic neuritis or neuropathy from 2009 to 2024.
Among 162 patients, 66 (40.7%) demonstrated bilateral and 96 (59.3%) unilateral MRI findings.
Laterality mismatches were frequent: 42 patients (25.9%) demonstrated bilateral MRI findings despite unilateral clinical involvement, while 13 (8.0%) had bilateral clinical disease with unilateral imaging abnormalities.
The leading etiologies were multiple sclerosis (20.0%), glaucoma (16.7%), unspecified optic neuritis (13.0%), and post-traumatic injury (5.5%).
Across all etiologies, chronic changes were characterized by atrophy with or without T2/FLAIR hyperintensity.
Optic nerve atrophy with increased T2/FLAIR signal and absent enhancement constitutes the dominant MRI pattern of non-compressive chronic optic neuropathy, most likely reflecting chronic axonal degeneration rather than active inflammation.
These findings reliably indicate chronic optic nerve injury but have limited specificity for etiology. Frequent imaging and clinical laterality discrepancies suggest subclinical or asymmetric disease.