MRI Head and Orbits MRI of the head and orbit with and without IV contrast is the most useful imaging modality in diagnosis and evaluation of the extent of the symptomatic OPG in patients with or without NF-1 [36,37]. The role of MRI in the early detection of OPG in asymptomatic children with NF-1 is controversial, because there is no evidence it could improve the clinical outcome of patients in reducing the incidence of visual loss [38,39]. The role of IV contrast in the surveillance and follow-up of the optic pathway glioma is not entirely clear, because tumor volume variation is sufficient in most cases to assess tumor progression [38,39]. MRI Head There is no relevant literature to support the use of MRI head alone in the initial evaluation of children with suspected OPG. MRI of the head is, however, often obtained in conjunction with MRI orbits. MRI Orbits Based on expert consensus, MRI orbits may be considered in cases of isolated OPG confined to the optic nerve and optic chiasm without NF-1. Radiography Orbit There is no relevant literature to support the use of radiography orbit in the initial evaluation of children with suspected OPG. Variant 6: Child. Six months of age or older. Papilledema detected on the ophthalmologic examination or signs of raised intracranial pressure. Initial imaging. This variant includes children (older infants or older children) presenting with signs and symptoms of raised intracranial hypertension (papilledema, headache, nausea, vomiting, or transient obscuration of vision) [40]. Increased intracranial pressure may be caused by intracranial structural lesions, like space occupying lesion or hydrocephalus. Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a syndrome defined by elevated intracranial pressure without evidence of a structural lesion or hydrocephalus on neuroimaging and a normal cerebrospinal fluid composition [41].
Orbital Imaging and Vision Loss Child. MRI Head and Orbits MRI of the head and orbit with and without IV contrast is the most useful imaging modality in diagnosis and evaluation of the extent of the symptomatic OPG in patients with or without NF-1 [36,37]. The role of MRI in the early detection of OPG in asymptomatic children with NF-1 is controversial, because there is no evidence it could improve the clinical outcome of patients in reducing the incidence of visual loss [38,39]. The role of IV contrast in the surveillance and follow-up of the optic pathway glioma is not entirely clear, because tumor volume variation is sufficient in most cases to assess tumor progression [38,39]. MRI Head There is no relevant literature to support the use of MRI head alone in the initial evaluation of children with suspected OPG. MRI of the head is, however, often obtained in conjunction with MRI orbits. MRI Orbits Based on expert consensus, MRI orbits may be considered in cases of isolated OPG confined to the optic nerve and optic chiasm without NF-1. Radiography Orbit There is no relevant literature to support the use of radiography orbit in the initial evaluation of children with suspected OPG. Variant 6: Child. Six months of age or older. Papilledema detected on the ophthalmologic examination or signs of raised intracranial pressure. Initial imaging. This variant includes children (older infants or older children) presenting with signs and symptoms of raised intracranial hypertension (papilledema, headache, nausea, vomiting, or transient obscuration of vision) [40]. Increased intracranial pressure may be caused by intracranial structural lesions, like space occupying lesion or hydrocephalus. Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a syndrome defined by elevated intracranial pressure without evidence of a structural lesion or hydrocephalus on neuroimaging and a normal cerebrospinal fluid composition [41].