ArticleRMD open2026
Orbital MRI for diagnosing giant cell arteritis in cases of anterior ischaemic optic neuropathy.
Article in RMD open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
objectivesAcute anterior ischaemic optic neuropathy (AION) is a feared ischaemic complication of giant cell arteritis (GCA). However, distinguishing arteritic AION (A-AION) from its non-arteritic counterpart (NA-AION), which accounts for approximately 90% of cases, can be challenging. Rapid initiation of glucocorticoids is essential to prevent irreversible vision loss in GCA but is unnecessary in NA-AION. This study evaluated the use of orbital MRI in differentiating A-AION from NA-AION.
methodsIn this prospective single-centre study, patients >50 years who had recent-onset AION were enrolled between June 2021 and October 2024. The final diagnosis of GCA was confirmed after comprehensive assessments and ≥6 months follow-up. Orbital MRIs were independently evaluated by two experienced radiologists blinded to the clinical diagnosis.
resultsOf the 18 patients analysed, nine had A-AION (two with bilateral involvement), while nine had NA-AION. MRI demonstrated differences between the groups, notably in contrast enhancement of the ophthalmic artery (72.7% vs 22.2%; p=0.07), perineural fat (90.9% vs 22.2%; p=0.005) and retrobulbar fat (100% vs 11.1%; p<0.001). The most discriminative MRI feature was retrobulbar fat enhancement, achieving 100% (95% CI 72 to 100) sensitivity and 89% (95% CI 52 to 100) specificity. Bilateral orbital enhancement was identified in more than half of the unaffected contralateral eyes in A-AION patients.
conclusionThese results suggest that orbital MRI may help clinicians rapidly differentiate between A-AION and NA-AION to provide the most appropriate treatment.
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