Relevance of brain MRI in patients with uveitis: retrospective cohort on 402 patients

AimTo assess the diagnostic value of brain magnetic resonance imaging (bMRI) for the etiological diagnosis of uveitis and to establish predictive factors associated with its advantageous use. MethodsRetrospective study on all patients with de novo uveitis who were referred to our tertiary hospital and who underwent a bMRI between 2003 and 2018. The bMRI was considered useful if it served to confirm a diagnosis or correct a misdiagnosis. We also collected characteristics of uveitis and associated ophthalmological and neurological clinical signs. ResultsBrain MRI was contributive in 19 out of 402 cases (5%): 10 multiple sclerosis, 5 radiologically isolated syndromes, and 4 oculocerebral lymphomas. A total of 34 (8%) had neurological signs and 13 (38%) of those patients had a contributive bMRI. Meanwhile, in the absence of neurological signs, 1% of bMRIs were contributive, and none of them resulted in specific treatment. Among patients with a contributive bMRI, 68% had neurological signs. Univariate analysis established that neurological signs (p<0.001), granulomatous uveitis (p=0.003), retinal vasculitis (p=0.002), and intermediate uveitis (p<0.001) were all significantly associated with a contributive bMRI. Multivariate analysis confirms the significant association of neurological signs (p<0.001) and intermediate uveitis (p=0.01). Patients with oculocerebral lymphoma were significantly older (p<0.001) and all were above 40 years of age. ConclusionBrain MRI appears to be a relevant and contributive exam, but it should be performed in cases of intermediate/posterior uveitis or panuveitis accompanied by neurological signs, retinal vasculitis, or in patients older than 40, to rule out an oculocerebral lymphoma.