Tlaiss Y, Hmayed J, Mneimneh M, Sarraf G, Gharios R, Zalzali I, Tarchichi A. Magnetic resonance imaging in the diagnosis of optic nerve and chiasmal pathologies. World J Ophthalmol 2026; 10(1): 119850 [DOI: 10.5318/wjo.119850]
Corresponding Author of This Article
Yehya Tlaiss, MD, Department of Ophthalmology, University of Balamand, Hazmieh, Beirut 1100, Beyrouth, Lebanon. yehyatlaiss@hotmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
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review-article
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Tlaiss Y, Hmayed J, Mneimneh M, Sarraf G, Gharios R, Zalzali I, Tarchichi A. Magnetic resonance imaging in the diagnosis of optic nerve and chiasmal pathologies. World J Ophthalmol 2026; 10(1): 119850 [DOI: 10.5318/wjo.119850]
World J Ophthalmol. Sep 12, 2026; 10(1): 119850 Published online Sep 12, 2026. doi: 10.5318/wjo.119850
Magnetic resonance imaging in the diagnosis of optic nerve and chiasmal pathologies
Yehya Tlaiss, Jawad Hmayed, Mohammad Mneimneh, Georges Sarraf, Rhea Gharios, Issa Zalzali, Alaa Tarchichi
Yehya Tlaiss, Mohammad Mneimneh, Rhea Gharios, Alaa Tarchichi, Department of Ophthalmology, University of Balamand, Beirut 1100, Beyrouth, Lebanon
Jawad Hmayed, Georges Sarraf, Department of Radiology, University of Balamand, Beirut 0000, Beyrouth, Lebanon
Issa Zalzali, Department of Internal Medicine, Beirut Arab University, Beirut 0000, Beyrouth, Lebanon
Author contributions: Tlaiss Y was responsible for conceptualization, writing, supervision, and manuscript revision; Hmayed J was responsible for study design, literature review, and drafting; Mneimneh M was responsible for data curation, image selection, and manuscript drafting; Sarraf G was responsible for literature review, section drafting, and critical revision; Gharios R was responsible for data synthesis, editing, and formatting; Zalzali I was responsible for figure preparation, technical review, and editing; Tarchichi A was responsible for reference management, proofreading, and formatting; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Corresponding author: Yehya Tlaiss, MD, Department of Ophthalmology, University of Balamand, Hazmieh, Beirut 1100, Beyrouth, Lebanon. yehyatlaiss@hotmail.com
Received: February 7, 2026 Revised: February 28, 2026 Accepted: April 29, 2026 Published online: September 12, 2026 Processing time: 215 Days and 5.2 Hours
Abstract
Magnetic resonance imaging (MRI) is the reference modality for evaluating diseases of the optic nerve and optic chiasm due to its superior soft-tissue contrast, multiplanar capability, and ability to assess the entire anterior visual pathway in a single examination. However, diverse inflammatory, ischemic, compressive, neoplastic, and vascular pathologies often present with overlapping clinical features, making imaging pattern recognition essential for accurate diagnosis and management. This mini-review provides a practical, radiology-focused overview of MRI protocols and characteristic imaging patterns of optic nerve and chiasmal disorders. Key conventional and advanced MRI sequences are summarized, with emphasis on fat-suppressed orbital imaging, contrast enhancement patterns, diffusion-weighted imaging, and vascular imaging. Distinct MRI phenotypes are highlighted to differentiate typical demyelinating optic neuritis from antibody-mediated inflammatory disorders, infiltrative and granulomatous disease, compressive and neoplastic lesions, and ischemic or vascular pathologies affecting the anterior visual pathway. Common imaging pitfalls and limitations specific to orbital and chiasmal MRI are also discussed. A pattern-based MRI approach facilitates accurate localization, narrows differential diagnoses, and directly influences systemic workup and multidisciplinary management. This review aims to serve as a concise imaging reference for radiologists involved in the evaluation of optic nerve and chiasmal disease.
Core Tip: Magnetic resonance imaging plays a central role in evaluating optic nerve and optic chiasmal disorders, yet diagnostic uncertainty often arises from overlapping clinical presentations. This mini-review introduces a practical, pattern-based magnetic resonance imaging framework that emphasizes protocol optimization, key enhancement and diffusion features, and common imaging pitfalls specific to the anterior visual pathway. By highlighting distinguishing imaging phenotypes across inflammatory, ischemic, compressive, neoplastic, and vascular etiologies, this review provides radiologists with concise, high-yield guidance to improve diagnostic confidence and support timely multidisciplinary management.
