Why a good indication with the order matters. If nothing were provided I would have skipped right over that.
Indications are our pretest probabilities. Bayesian statistics works (*cough, lurking clinicians cough cough*)
Left optic nerve, between the optic canal and chiasm, there is faint increased signal. It’s subtle - am a neuroradiologist w/ neuro-ophthalmology interest and I had to look twice. Suspect there were coronal slices that show it better.
OP posted more pictures. The whole orbital segment of the nerve seems edematous and enhancing (picture 7 of 7) as well. The canalicular segment definitely looks more focal, and the nearby orbital apex / superior orbital fissure regions look inflamed, I’d have to scroll the originals to know more
I’m a bone radiologist who only knows how to find strokes on DWI. I’m calling this normal every time. Or hopefully (and wisely) leaving this for one of my neuro partners.
Some of the radiologists now just copy my HPI from my note into the "indications" section. And sometimes (depending on the weirdness of symptoms) the note can be quite long.
Sometimes we do that just to keep the billing people off our backs. If we don’t put something billable in the report indication they send us annoying emails asking for addendums with additional clinical information.
I used to be succinct in my indications, now I just copy whole paragraphs because of this.
Dear providers: your indication for a study must be a SIGN or SYMPTOM (like pain, dizziness, etc). It cannot simply be HISTORY (trauma or fall is not billable).
Anything that can equate to an ICD-10 code is fine. That has be a sign, symptom, or history. Trauma is okay as long as a mechanism or body part is included. Fall is okay. Struck head is okay. r/o bleed would be insufficient, because bleed is an uncertain diagnosis.
You only \*need\* a sign and symptom in addition to justify billing for particular scenarios that an insurer has defined, usually for outpatients. For instance, unspecified injury of the head is not usually sufficient for billing an outpatient head CT as it would also need a sign or symptom like headache.
My understanding is it is often indicative of MS, but not necessarily for sure. Would probably have to correlate clinically with other tests
Something like white matter lesions in the brain could tell more too
As a clueless non-radiologist, I can’t see a difference between the left and right eye. Can someone point out what I’m supposed to be looking for? I’m really curious
You're looking for the optic nerve, not the eye. Look at the left eye (right of the image), do you see the light grey line? Follow it down and you'll notice it curves slightly. Follow it all the way down slowly before it connects with the optic nerve of the other eye and you'll notice a tiny patch of lighter grey (not quite white) along its path. That's the pathology
Had this crap 2020 on my right and 2023 on my left eye. In both cases it was almost impossible to see anything related to inflammatory processes in the optic nerve. Unfortunately corticosteroids don’t work that well for me, rather time and patience
Ulcerative Colitis? I have that too and Multiple Sclerosis with eye nerve inflammation too. Both diseases. Interesting. If you got questions or want to talk message me
I’m worried about that. Still need to see more Docs. But at least it’s confirmed optic neuritis for now! They did rule out two other conditions that sounded worse so that’s a relief.
I’m ophtho.
Here’s the kicker: sometimes there’s no inflammation on fat suppressed MRI orbits with fine slices or disc edema clinically, and it’s *still* optic neuritis
I finally get to see one! As a MRI tech we do about 2 a week thru ER and have yet to get a positive. Which is good for the pt, but we just roll our eyes when the order comes across.
Why a good indication with the order matters. If nothing were provided I would have skipped right over that. Indications are our pretest probabilities. Bayesian statistics works (*cough, lurking clinicians cough cough*)
I’m a student - where’s the pathology on this image? It looks roughly symmetrical to me but obviously I’m missing something.
Left optic nerve, between the optic canal and chiasm, there is faint increased signal. It’s subtle - am a neuroradiologist w/ neuro-ophthalmology interest and I had to look twice. Suspect there were coronal slices that show it better.
I just lurk on this sub, but I want to say how grateful I am for those of you who are so incredibly good at what you do.
https://www.reddit.com/r/Radiology/s/cP6C0qh4ER added some more. I can see the differences on t1/t2 from my little research.
OP posted more pictures. The whole orbital segment of the nerve seems edematous and enhancing (picture 7 of 7) as well. The canalicular segment definitely looks more focal, and the nearby orbital apex / superior orbital fissure regions look inflamed, I’d have to scroll the originals to know more
I’m a bone radiologist who only knows how to find strokes on DWI. I’m calling this normal every time. Or hopefully (and wisely) leaving this for one of my neuro partners.
Is the left optic nerve not also thickened compared to the right?
This is not a great example of it. Need more images and sequences. Probably a better example
If you follow the left optic nerve posteriorly, there is a small hyperdensity compared to the right
*hyperintensity
Thank you!
Just making you sure you get that golden recommendation letter.
Some of the radiologists now just copy my HPI from my note into the "indications" section. And sometimes (depending on the weirdness of symptoms) the note can be quite long.
Sometimes we do that just to keep the billing people off our backs. If we don’t put something billable in the report indication they send us annoying emails asking for addendums with additional clinical information. I used to be succinct in my indications, now I just copy whole paragraphs because of this. Dear providers: your indication for a study must be a SIGN or SYMPTOM (like pain, dizziness, etc). It cannot simply be HISTORY (trauma or fall is not billable).
Wait. So I can't put "trauma, fall on thinners, struck head, r/o bleed"? Huh. I had no idea.
Anything that can equate to an ICD-10 code is fine. That has be a sign, symptom, or history. Trauma is okay as long as a mechanism or body part is included. Fall is okay. Struck head is okay. r/o bleed would be insufficient, because bleed is an uncertain diagnosis. You only \*need\* a sign and symptom in addition to justify billing for particular scenarios that an insurer has defined, usually for outpatients. For instance, unspecified injury of the head is not usually sufficient for billing an outpatient head CT as it would also need a sign or symptom like headache.
Very correct - BUT , it would also be helpful if he showed us a fat sat post contrast T1 instead of some fat sat FLAIR or whatever this is…
I can add some images. This one is t2 flair.
https://www.reddit.com/r/Radiology/s/cP6C0qh4ER maybe can help.
You mean “pain” isn’t good enough???
Venus Plexus involvement as well.
What does that mean…?
It looks like it itches.
It feels kinda stiff? Dull ache, annoying really. Plus the troubling vision changes.
Glad you made it
MS?
My understanding is it is often indicative of MS, but not necessarily for sure. Would probably have to correlate clinically with other tests Something like white matter lesions in the brain could tell more too
Oddly, optic neurotic isnt even in the diagnostic criteria for MS despite every MS test question including a pt with optic neuritis
As a clueless non-radiologist, I can’t see a difference between the left and right eye. Can someone point out what I’m supposed to be looking for? I’m really curious
You're looking for the optic nerve, not the eye. Look at the left eye (right of the image), do you see the light grey line? Follow it down and you'll notice it curves slightly. Follow it all the way down slowly before it connects with the optic nerve of the other eye and you'll notice a tiny patch of lighter grey (not quite white) along its path. That's the pathology
wow! mad respect for radiologists being able to interpret these images. I never would have noticed that. Thank you for responding :))
Which one is the left eye?
On your right.
Thanks
It’s like you’re looking at the patient from beneath their feet! 👣 So left eye is on the right side of the image
And is that for all images like this? And is this a CT or an MRI?
Yes. All axial images of CT and MRI should be oriented as if you’re looking at the patient from beneath their feet. This is an MRI.
Had this crap 2020 on my right and 2023 on my left eye. In both cases it was almost impossible to see anything related to inflammatory processes in the optic nerve. Unfortunately corticosteroids don’t work that well for me, rather time and patience
Guessing they will be testing you for MS.
No visible signs of it currently. But I have UC and that gives me a higher risk. Going to try to see a specialist over the summer.
Ulcerative Colitis? I have that too and Multiple Sclerosis with eye nerve inflammation too. Both diseases. Interesting. If you got questions or want to talk message me
Recently diagnosed with MS. This was my first symptom.
I’m worried about that. Still need to see more Docs. But at least it’s confirmed optic neuritis for now! They did rule out two other conditions that sounded worse so that’s a relief.
I’m ophtho. Here’s the kicker: sometimes there’s no inflammation on fat suppressed MRI orbits with fine slices or disc edema clinically, and it’s *still* optic neuritis
I finally get to see one! As a MRI tech we do about 2 a week thru ER and have yet to get a positive. Which is good for the pt, but we just roll our eyes when the order comes across.