Utility of MR Imaging in the Evaluation of Nontraumatic Orbital Emergencies: A Validation Study

Aim: The current study aimed to evaluate the utility of the magnetic resonance imaging (MRI) in nontraumatic orbital emergencies. Methods and Materials: This observational study, included 102 patients with acute non-traumatic orbital symptoms, who underwent MRI orbit. The demographic characteristics, clinical presentations, and MRI findings of various etiologies were evaluated and correlated with clinical and pathological examinations to calculate the overall diagnostic utility of the MRI. Results: Hundred and two patients (55 men, 47 women), included in the study had mean age of 42.6 ± 19.22 years. Common presenting symptoms were diminution of vision (58.33%), followed by eye pain (25%) and swelling (12.5%). MRI abnormalities were present in 86/102 patients, which were mainly attributed to inflammatory lesions (45/102, 44.11%), followed by infectious lesions (20/102, 19.60%), vascular lesions (16/102, 15.68%), and other miscellaneous pathologies (4.9%). Inflammatory pathologies were predominantly optic neuritis (33/45, 73.33%) and Tolosa hunt syndrome (9/45, 20%). Common infective lesions were orbital cellulitis (8/20, 40%) and fungal infections (9/20, 45%), which included two false positive cases later proved to be of non-fungal etiology. The common conditions in vascular group included ischemic optic neuropathy (9/16, 56.25%) and nontraumatic carotid-cavernous fistulas (2/16, 12.50%). MRI demonstrated high sensitivity (94.12%) and accuracy (91.92%), with moderate specificity (78.57%) in diagnosing various non-traumatic orbital emergent pathologies. Conclusion: MRI is an essential and reliable imaging modality for evaluating non-traumatic orbital emergencies with high sensitivity and accuracy. It is critical for diagnosing and differentiating different lesion types and guiding clinical decision-making.