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Radiation-induced optic neuropathy: characteristic appearances on gadolinium-enhanced MR
P A Hudgins1, N J Newman, W P Dillon
1Department of Radiology, Emory University School of Medicine, Atlanta, GA 30322.
Purpose:
To assess the value of contrast-enhanced MR in the evaluation of radiation-induced optic neuropathy.
Materials And Methods:
Three patients with rapid visual loss 1 1/2 to 3 years after radiation therapy to the optic nerves were studied with gadopentetate dimeglumine-enhanced MR images. All patients received over 5000 cGy, experienced rapid, permanent visual loss over several days to weeks, and underwent MR within weeks of presentation.
Results:
Enhanced MR images on each patient revealed focal discrete enhancement of the intracranial optic nerve. One patient underwent biopsy of the enhancing segment; this revealed pathologic changes of radiation optic neuropathy. Optic nerve enhancement in a patient with visual loss and a prior history of radiation therapy to the orbits or optic nerves suggests radiation optic neuropathy.
Conclusion:
Contrast-enhanced MR of the orbits, optic nerves, and chiasm is the imaging test of choice in patients with vision loss after radiation therapy for sellar or skull base disease; MR findings may obviate the need for biopsy.