Abstract Details

Title Retina and optic nerve diffusion restriction in acute central retinal artery occlusion

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-007

Objective To determine whether diffusion restriction (DR) of the retina and/or optic nerve (ON) in acute central retinal artery occlusion (CRAO) can be accurately identified on brain diffusion-weighted magnetic resonance imaging (DW-MRI) by junior versus senior neurology residents and vascular neurologists.

Background Retina and/or ON DR in CRAO was described with various accuracies and fair inter-rater reliability even between experienced neuroradiologists. The identification of these subtle DW-MRI findings by the forefront neurology residents or vascular neurologists was not previously investigated.

Design/Methods Retrospective cohort study of consecutive acute CRAO patients that had stroke-protocol DW-MRI at our tertiary academic center (2013-2020). Two neurology residents (junior and senior), vascular neurologist, and two neuroradiologists blinded to the CRAO site independently reviewed the DW-MRI for retina and/or ON DR. Their inter-rater reliability was calculated using kappa statistics. The neuroradiologists’ consensus agreement was the reference for the non-radiologists.

Results We included 128 patients (mean age 68 years; 55% right eye, median time from CRAO to DW-MRI 2 days (IQR 1-4). 28/128 (21.8%) had a discrepancy between the neuroradiologists. After neuroradiologist consensus, DR was correctly identified in the retina or ON in 51/128 (39.8%), retina alone 35/128 (27.3%), ON alone 31/128 (24.2%), both retina and ON 15/128 (11.7%). Upon comparing the neurology trainees and vascular neurologist, the positive agreement was low (22.2% to 43.9%) but the negative agreement was high (88.0% to 92.9%). The senior resident had the highest observer agreement. Overall substantial agreement (P-B adjusted Kappa > 0.6) between the readings, excepting for moderate (P-B adjusted kappa= 0.59) for ON DR for the junior resident.

Conclusions Incongruities in identifying retina and/or ON DR in CRAO are encountered by various specialists. When compared to experienced neuroradiologists, neurology trainees and attending have substantial agreement on the negative findings but low agreement for the positive findings.

Authors/Disclosures
Ehab Y. Harahsheh, MBBS PRESENTER	Dr. Harahsheh has nothing to disclose.
Daniel Gomez Ramos, DO (Mayo Clinic)	Dr. Gomez Ramos has nothing to disclose.
Nan Zhang	Nan Zhang has nothing to disclose.
Parth P. Parikh	Mr. Parikh has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Oana M. Dumitrascu, MD, FAAN (Mayo Clinic)	Dr. Dumitrascu has nothing to disclose.

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