Shanil Dhanji, Mitchell Lawlor
Purpose: Neuroimaging is commonly required when investigating neuro-ophthalmic complaints. It is imperative that the correct neuroimaging is performed timely and appropriately to beneftt patients, clinicians and the healthcare system.
Methods: We performed a retrospective audit of all neuroimaging ordered for patients attending the Sydney Eye Hospital (SEH) with a neuro-ophthal- mic presentation between June 2011 and 2016.
Results: 1042 neuroimaging studies, including 596
(57%) CTs and 446 (43%) MRIs were performed for 839 patients in this time period. The mean age was
53 and 403 (48%) were women. CT orbits per- formed for isolated proptosis detected an orbital pathology in 50% of patients. For a preimaging diagnosis of a space occupying lesion, CT with con- trast lead to less unknown diagnoses compared with non-contrast studies (9% versus 33%). A pre-imag- ing diagnosis of optic neuropathy was conftrmed in 94% of patients undergoing an MRI brain with gad- olinium, in 63% undergoing CT with contrast stud- ies, 60% undergoing MRI non-contrast and only 53% in those undergoing a CT brain noncontrast. CTA (n=13) and MRA (n=11) were nearly equally utilized to investigate diplopia with CTA demon- strating 2 aneurysms.
Conclusion: An MRI brain in most clinical circum- stances was the most appropriate imaging with some exceptions including suspicion of acute haemorrhage, a calcifted pathology, proptosis, or a rapidly evolving emergency situation. Irrespective of imaging modal- ity, contrast improved the sensitivity of pathology detection and should be requested unless contraindi- cated, or not clinically required.