Retina and optic nerve diffusion restriction in acute central retinal artery occlusion: A case-control study

Area of Science:

• Ophthalmology
• Neurology
• Radiology

Background:

• Acute non-arteritic central retinal artery occlusion (CRAO) is a critical condition affecting vision.
• Brain magnetic resonance diffusion-weighted imaging (DWI-MRI) is a standard tool for stroke assessment.
• Detecting diffusion restriction (DR) in the retina and optic nerve (ON) on brain DWI-MRI may aid CRAO diagnosis.

Purpose of the Study:

• To determine the frequency and accuracy of retina and/or ON DR detection on standard brain DWI-MRI.
• To evaluate the diagnostic performance of DR detection in patients with acute non-arteritic CRAO compared to controls.

Main Methods:

• Retrospective case-control study of 128 CRAO patients and 128 matched controls.
• Brain MRIs were reviewed by neurologists and neuroradiologists for retina and ON DR.
• Sensitivity, specificity, and inter-rater reliability were calculated.

Main Results:

• Diffusion restriction (DR) in the retina or ON was identified in 39.8% of CRAO cases.
• High inter-rater reliability was observed for neuroradiologists (Kappa values 0.91 for retina, 0.83 for ON).
• Sensitivity for retina DR was 28.1% and for ON DR was 27.3%, with high specificity (99.2% and 96.1% respectively).

Conclusions:

• Retina and ON DR are infrequent findings on standard brain DWI-MRI in acute CRAO.
• While specific, the sensitivity of this finding is limited in real-world practice.
• Prospective studies and standardized orbit DWI-MRI protocols are needed to improve detection accuracy.