Detectability of Retinal Diffusion Restriction in Central Retinal Artery Occlusion is Linked to Inner Retinal Layer Thickness

Purpose: To investigate retinal microstructure differences in central retinal artery occlusion (CRAO) patients with and without visible retinal diffusion restriction (RDR) on diffusion-weighted magnetic resonance imaging (DWI).

Methods: Consecutive CRAO patients with available optical coherence tomography (OCT) and DWI, both performed within 7 days after symptom onset, were included in a retrospective cohort study. The OCT scans were reviewed to assess retinal layer thickness, optical intensity and structural integrity. The OCT findings were compared between patients with and without visible RDR on DWI using Mann-Whitney U or Pearson's Χ² test.

Results: A total of 56 patients (mean age 70.8 ± 12.8 years) were included. RDR was observed in 38 subjects (67.9%) with visually correlating low ADC map in 26 of 38 cases (68.4%). Superior and inferior parafoveal macular thickness measurements (SMT, IMT) of RDR negative patients were significantly lower when compared to RDR+ patients (370.5 ± 43.8 µm vs. 418.2 ± 76.0 µm, p = 0.016; 374.4 ± 42.9 µm vs. 428.8 ± 63.2 µm, p = 0.004) due to differences in inner retinal layer thickness (IRLT, 188.8 ± 34.4 µm vs. 234.7 ± 49.0 µm, p = 0.002). IRLT values of RDR negative patients were higher in 1.5T compared to 3T the DWI (205.0 ± 26.0 µm vs. 168.6 ± 32.8 µm, p = 0.026).

Conclusions: Detectability of RDR is likely contingent upon the degree of ischemic retinal swelling in CRAO. Technical adjustments to the DWI protocol, such as increased field strength, may improve visibility of RDR.