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Chronic optic neuropathy: correlating MR imaging features and etiology
Steven Cajamarca1, Rohini N Nadgir2, Suyang Li1
1Departments of Radiology and Ophthalmology. Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, United States.
Neuroradiology
|May 4, 2026
Summary
Magnetic Resonance Imaging (MRI) reveals chronic optic neuropathy (CON) as optic nerve atrophy with T2/FLAIR signal changes, indicating axonal degeneration. These MRI findings help identify chronic optic nerve injury but are not specific to the cause.
Area of Science:
- Neurology
- Radiology
- Ophthalmology
Background:
- Chronic optic neuropathy (CON) is a common endpoint for various optic nerve injuries.
- Characteristic MRI findings and their correlation with clinical causes of CON are not well-defined.
Purpose of the Study:
- To evaluate predominant MRI findings in non-compressive CON.
- To correlate these MRI patterns with underlying clinical etiologies.
Main Methods:
- Retrospective analysis of 162 patients with high-resolution orbital MRI and ophthalmologic confirmation of CON.
- Assessment of optic nerve caliber, T2/FLAIR signal abnormality, and post-contrast enhancement.
- Review of ophthalmologic records for laterality and etiology.
Main Results:
- Optic nerve atrophy with increased T2/FLAIR signal was the predominant pattern (n=125).
- Enhancement was rare (n=7) and associated with active demyelination.
- Frequent discrepancies between MRI findings and clinical laterality were observed.
Conclusions:
- The dominant MRI pattern of CON is optic nerve atrophy with T2/FLAIR hyperintensity, suggesting chronic axonal degeneration.
- MRI findings indicate chronic injury but lack specificity for etiology.
- Discrepancies in laterality highlight the need for integrated clinical and imaging interpretation.
