MR fat suppression combined with Gd-DTPA enhancement in optic neuritis and perineuritis

A fat suppression MR technique used in combination with Gd-DTPA enhancement was investigated to determine its value in cases of inflammatory optic nerve lesions. This technique, the so-called hybrid method, is a derivative of the chopper fat suppression technique and provides water-only images without increasing the imaging or postprocessing time. The study group consisted of four patients with acute visual loss, all of whom received Gd-DTPA. Conventional T2-weighted and fat suppression post-Gd-DTPA T1-weighted images were obtained in all patients; in addition, in one patient a post-Gd-DTPA T1-weighted image without fat suppression was obtained. In three patients, the conventional T2-weighted images failed to reveal any abnormality. In contrast, the enhanced optic nerve and enhanced perineural inflammatory infiltrate were easily identified on T1-weighted images after administration of Gd-DTPA and application of fat suppression technique. The lesions in inflammatory optic neuritis or perineuritis were easily distinguished from the surrounding fat, which had been suppressed. This combined technique resulted in significantly improved definition of normal anatomic structures and made the enhancing lesions more conspicuous, especially in areas with large amounts of fat such as the retrobulbar orbit.