Advances in neuroimaging of the visual pathways

To provide a practical review for the ophthalmologist of advances in neuroimaging of the visual pathways.

We reviewed recent advances in computed tomography, magnetic resonance imaging, and angiography that are applicable to visual pathways imaging.

For detailed ocular imaging, computed tomography complements ocular sonography for imaging of calcification, trauma, and masses. Magnetic resonance imaging may be helpful for localization and characterization of ocular masses in the setting of hemorrhage. For orbital imaging, computed tomography is most appropriate in the evaluation of suspected thyroid ophthalmopathy, infection, and trauma; otherwise, either computed tomography or magnetic resonance imaging is useful for detection and characterization of abnormality. For disorders affecting the sellar, retrochiasmal, and brainstem pathways, magnetic resonance imaging is the study of choice, except for acute hemorrhage, for which noncontrast computed tomography is preferable. Although magnetic resonance angiography has a role in the elective evaluation of cerebrovascular disease, conventional angiography is the definitive study for suspected aneurysm and for surgical planning.

A practical approach for selection of the most appropriate imaging modalities by the ophthalmologist is suggested on the basis of the anatomic location and type of disease suspected.