Radiologists' recommendations following MRI for optic neuritis: influence of report wording and patient accessibility in a tertiary neuro-ophthalmology clinic.

OBJECTIVE

Optic neuritis is often managed by neuro-ophthalmologists. Neuro-imaging plays an important role in diagnosis. Radiologists can influence care by communicating pertinent findings and recommending next steps. Increasingly, patients have direct access to their reports, which may affect their understanding, anxiety, and interactions with clinicians. This study aimed to characterize the frequency and nature of radiologists' recommendations in magnetic resonance imaging (MRI) reports for optic neuritis.

DESIGN

A retrospective chart review.

PARTICIPANTS

Patients referred to a tertiary neuro-ophthalmology clinic between November 2007 and May 2025 with new-onset optic neuritis and no prior demyelinating disease

METHODS

Data on imaging protocols, diagnostic terminology, differential diagnoses, recommendations, and incidental findings were obtained from electronic medical records.

RESULTS

We included 219 MRI reports (73.1% female; mean age: 37.4 ± 13.1 years). MRI of the brain and orbit was the most common protocol (73.5%). Signs of demyelination or possible demyelination were noted in 109 cases (49.8%). Overall, recommendations were provided in 16.0% (35/219) to patients, with 20.2% (22/109) of those showing demyelination compared with 2.7% (3/110) without demyelination. The top 3 recommendations were an MRI of the spine (17/22; 77.3%), follow-up imaging (2/22; 9.1%), and follow-up appointment with patient and MRI of orbit (1/22; 4.5% each).

CONCLUSIONS

Among participating radiologists, recommendations were given to patients in a minority of optic neuritis cases, with MRI of the spine being the most common recommendation. There was a higher likelihood of a recommendation if there were brain changes (20%) compared with no brain changes (3%). These findings highlight variability in reporting practices and support the adoption of standardized language for describing optic nerve abnormalities and appropriate follow-up, reducing unnecessary testing and potential patient anxiety.