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Diffusion MR imaging of postoperative bilateral acute ischemic optic neuropathy.

Park JY, Lee IH, Song CJ, Hwang HY - Korean J Radiol (2012)

Bottom Line: Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves.A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath.Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chungnam National University School of Medicine, Daejeon, Korea.

ABSTRACT
A 57-year-old woman experienced bilateral acute ischemic optic neuropathy after spine surgery. Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves. A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath. Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves. Although MR findings of T2-weighted and contrast enhanced T1-weighted images may be nonspecific, the DWI finding of cytotoxic edema of bilateral optic nerves will be helpful for the diagnosis of acute ischemic optic neuropathy after spine surgery.

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Fiftyseven-year-old woman with postoperative bilateral acute ischemic optic neuropathy.A, B. Diffusion weighted image (A) and apparent diffusion coefficient map (B) shows restricted diffusion (arrows) on bilateral optic nerves. C. Axial T2 weighted image shows subtle high signal intensity (arrows) on bilateral optic nerves. D. Contrast enhanced axial T1 weighted image shows enhancement (arrows) along bilateral optic nerve sheath.
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Figure 1: Fiftyseven-year-old woman with postoperative bilateral acute ischemic optic neuropathy.A, B. Diffusion weighted image (A) and apparent diffusion coefficient map (B) shows restricted diffusion (arrows) on bilateral optic nerves. C. Axial T2 weighted image shows subtle high signal intensity (arrows) on bilateral optic nerves. D. Contrast enhanced axial T1 weighted image shows enhancement (arrows) along bilateral optic nerve sheath.

Mentions: A 57-year-old woman underwent a multilevel laminectomy with posterior lumbar interbody fusion for herniation of nucleus pulposus and spinal stenosis. She did not have a history of diabetes, hypertension, or any cardiac problem. For more than 11 hours of surgery in the prone position, a large blood transfusion (more than 16 units of packed red cells) was performed due to massive bleeding. After surgery, she complained of bilateral blindness and underwent an ophthalmologic examination. No significant abnormality was observed except for peripapillary hemorrhage on the right eyeball. The woman also underwent orbital MR imaging including DWI at five days after surgery. A T2 weighted image (repetition time [TR] = 3000, echo time [TE] = 100) showed subtle high signal intensity on bilateral optic nerves. After contrast injection, an axial T1 weighted image (TR = 500, TE = 12) shows enhancement along the bilateral optic nerve sheath. Moreover, the axial DWI (TR = 4338.2, TE = 46.7, b = 1000, section thickness = 3 mm, matrix = 128 × 126, field of view = 24 cm) showed high signal intensity on bilateral optic nerves and restricted diffusion on an apparent diffusion coefficient (ADC) map (Fig. 1). The ADC values were 0.425 × 10-3 mm2/s in the right optic nerve, 0.420 × 10-3 mm2/s in the left optic nerve, 0.656 × 10-3 mm2/s in the right temporal lobe, and 0.785 × 10-3 mm2/s in the left temporal lobe. These findings are consistent with postoperative bilateral acute ischemic optic neuropathy after spine surgery. One month later, the woman still experienced bilateral visual loss, except for a response to light on one eye.


Diffusion MR imaging of postoperative bilateral acute ischemic optic neuropathy.

Park JY, Lee IH, Song CJ, Hwang HY - Korean J Radiol (2012)

Fiftyseven-year-old woman with postoperative bilateral acute ischemic optic neuropathy.A, B. Diffusion weighted image (A) and apparent diffusion coefficient map (B) shows restricted diffusion (arrows) on bilateral optic nerves. C. Axial T2 weighted image shows subtle high signal intensity (arrows) on bilateral optic nerves. D. Contrast enhanced axial T1 weighted image shows enhancement (arrows) along bilateral optic nerve sheath.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3303908&req=5

Figure 1: Fiftyseven-year-old woman with postoperative bilateral acute ischemic optic neuropathy.A, B. Diffusion weighted image (A) and apparent diffusion coefficient map (B) shows restricted diffusion (arrows) on bilateral optic nerves. C. Axial T2 weighted image shows subtle high signal intensity (arrows) on bilateral optic nerves. D. Contrast enhanced axial T1 weighted image shows enhancement (arrows) along bilateral optic nerve sheath.
Mentions: A 57-year-old woman underwent a multilevel laminectomy with posterior lumbar interbody fusion for herniation of nucleus pulposus and spinal stenosis. She did not have a history of diabetes, hypertension, or any cardiac problem. For more than 11 hours of surgery in the prone position, a large blood transfusion (more than 16 units of packed red cells) was performed due to massive bleeding. After surgery, she complained of bilateral blindness and underwent an ophthalmologic examination. No significant abnormality was observed except for peripapillary hemorrhage on the right eyeball. The woman also underwent orbital MR imaging including DWI at five days after surgery. A T2 weighted image (repetition time [TR] = 3000, echo time [TE] = 100) showed subtle high signal intensity on bilateral optic nerves. After contrast injection, an axial T1 weighted image (TR = 500, TE = 12) shows enhancement along the bilateral optic nerve sheath. Moreover, the axial DWI (TR = 4338.2, TE = 46.7, b = 1000, section thickness = 3 mm, matrix = 128 × 126, field of view = 24 cm) showed high signal intensity on bilateral optic nerves and restricted diffusion on an apparent diffusion coefficient (ADC) map (Fig. 1). The ADC values were 0.425 × 10-3 mm2/s in the right optic nerve, 0.420 × 10-3 mm2/s in the left optic nerve, 0.656 × 10-3 mm2/s in the right temporal lobe, and 0.785 × 10-3 mm2/s in the left temporal lobe. These findings are consistent with postoperative bilateral acute ischemic optic neuropathy after spine surgery. One month later, the woman still experienced bilateral visual loss, except for a response to light on one eye.

Bottom Line: Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves.A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath.Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Chungnam National University School of Medicine, Daejeon, Korea.

ABSTRACT
A 57-year-old woman experienced bilateral acute ischemic optic neuropathy after spine surgery. Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves. A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath. Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves. Although MR findings of T2-weighted and contrast enhanced T1-weighted images may be nonspecific, the DWI finding of cytotoxic edema of bilateral optic nerves will be helpful for the diagnosis of acute ischemic optic neuropathy after spine surgery.

Show MeSH
Related in: MedlinePlus