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Luccas R, Riguetto CM, Alves M, Zantut-Wittmann DE, Reis F. Computed tomography and magnetic resonance imaging approaches to Graves' ophthalmopathy: a narrative review. Front Endocrinol (Lausanne) 2024; 14:1277961. [PMID: 38260158 PMCID: PMC10801040 DOI: 10.3389/fendo.2023.1277961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Graves' ophthalmopathy (GO) affects up to 50% of patients with Graves' disease (GD) ranging from mild ocular irritation to vision loss. The initial diagnosis is based on clinical findings and laboratory tests. Orbital imaging, such as magnetic resonance imaging (MRI) and computed tomography (CT), is an important tool to assess orbital changes, being also useful for understanding disease progression and surgical planning. In this narrative review, we included 92 studies published from 1979 to 2020 that used either MRI and/or CT to diagnose and investigate GO, proposing new methods and techniques. Most of the methods used still need to be corroborated and validated, and, despite the different methods and approaches for thyroid eye disease (TED) evaluation, there is still a lack of standardization of measurements and outcome reports; therefore, additional studies should be performed to include these methods in clinical practice, facilitating the diagnosis and approach for the treatment of TED.
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Affiliation(s)
- Rafael Luccas
- Graduate Program of Neuroscience, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Cinthia Minatel Riguetto
- Division of Endocrinology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | | | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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Zhang H, Lu T, Liu Y, Jiang M, Wang Y, Song X, Fan X, Zhou H. Application of Quantitative MRI in Thyroid Eye Disease: Imaging Techniques and Clinical Practices. J Magn Reson Imaging 2023. [PMID: 37974477 DOI: 10.1002/jmri.29114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
Thyroid eye disease (TED) is a complex autoimmune disorder that impairs various orbital structures, leading to cosmetic damage and vision loss. Magnetic resonance imaging (MRI) is a fundamental diagnostic tool utilized in clinical settings of TED, for its accurate demonstration of orbital lesions and indication of disease conditions. The application of quantitative MRI has brought a new prospect to the management and research of TED, offering more detailed information on morphological and functional changes in the orbit. Therefore, many researchers concentrated on the implementation of different quantitative MRI techniques on TED for the exploration of clinical practices. Despite the abundance of studies utilizing quantitative MRI in TED, there remain considerable barriers and disputes on the best exploitation of this tool. This could possibly be attributed to the complexity of TED and the fast development of MRI techniques. It is necessary that clinical and radiological aspects of quantitative MRI in TED be better integrated into comprehensive insights. Hence, this review traces back 30 years of publications regarding quantitative MRI utilized in TED and elucidates this promising application in the facets of imaging techniques and clinical practices. We believe that a deeper understanding of the application of quantitative MRI in TED will enhance the efficacy of the multidisciplinary management of TED. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Haiyang Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ting Lu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuting Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yishi Wang
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Xuefei Song
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Rogge B, Heldmann M, Chatterjee K, Moran C, Göttlich M, Uter J, Wagner-Altendorf TA, Steinhardt J, Brabant G, Münte TF, Cirkel A. Changes in brain structure in subjects with resistance to thyroid hormone due to THRB mutations. Thyroid Res 2023; 16:34. [PMID: 37592301 PMCID: PMC10433577 DOI: 10.1186/s13044-023-00176-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Being critical for brain development and neurocognitive function thyroid hormones may have an effect on behaviour and brain structure. Our exploratory study aimed to delineate the influence of mutations in the thyroid hormone receptor (TR) ß gene on brain structure. METHODS High-resolution 3D T1-weighted images were acquired in 21 patients with a resistance to thyroid hormone ß (RTHß) in comparison to 21 healthy matched-controls. Changes in grey and white matter, as well as cortical thickness were evaluated using voxel-based morphometry (VBM) and diffusion tensor imaging (DTI). RESULTS RTHß patients showed elevated circulating fT4 & fT3 with normal TSH concentrations, whereas controls showed normal thyroid hormone levels. RTHß patients revealed significantly higher scores in a self-rating questionnaire for attention deficit hyperactivity disorder (ADHD). Imaging revealed alterations of the corticospinal tract, increased cortical thickness in bilateral superior parietal cortex and decreased grey matter volume in bilateral inferior temporal cortex and thalamus. CONCLUSION RTHb patients exhibited structural changes in multiple brain areas. Whether these structural changes are causally linked to the abnormal behavioral profile of RTHß which is similar to ADHD, remains to be determined.
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Affiliation(s)
- Berenike Rogge
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Marcus Heldmann
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Psychology II, University of Lübeck, Lübeck, Germany
| | - Krishna Chatterjee
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Carla Moran
- Beacon Hospital, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Martin Göttlich
- Department of Psychology II, University of Lübeck, Lübeck, Germany
| | - Jan Uter
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | | | - Julia Steinhardt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Georg Brabant
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Department of Psychology II, University of Lübeck, Lübeck, Germany
| | - Anna Cirkel
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Ugradar S, Zimmerman E, Parunakian E, Kang J, Cockerham K, Douglas RS. Change in lacrimal gland volume and aqueous tear production following treatment with teprotumumab. Clin Exp Ophthalmol 2023. [PMID: 36723406 DOI: 10.1111/ceo.14208] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Dry eye syndrome occurs in up to 85% of patients with thyroid eye disease (TED). Lacrimal gland enlargement correlates with subjective tearing and a reduction in quality of life in patients with TED. METHODS In this prospective longitudinal study, patients presenting for the treatment of TED were considered for eligible. Primary outcomes included a change in the volume of the lacrimal gland and the production of tears following treatment with teprotumumab. The volume of lacrimal glands and proptosis was calculated using 3D volumetric analysis. Tear production was measured by Schirmer's test and associated symptoms were assessed using the VLSQ-8. The orbit with the most proptosis was designated the study orbit and the contralateral orbit was designated the fellow orbit. RESULTS Twenty patients were included. Mean (SD) age was 61 (18) and mean duration of TED prior to therapy was 48 months (47). Lacrimal gland volume in the study orbit decreased from 768 mm3 (288) to 486 mm3 (173) (p < 0.01) following therapy. For the fellow orbit, volume reduced from 637 mm3 (261) to 379 mm3 (147) (p < 0.01). Schirmer's test reading (STR) in the study orbit increased from 14.5 mm (8.2) to 23 mm (10) (p < 0.01) (59%) following treatment. In the fellow orbit, STR increased from 12.7 mm (7) to 21 mm (9) post therapy (69%) (p < 0.01). There was a significant improvement on all parts of the VLSQ-8. CONCLUSION Teprotumumab significantly reduces TED related expansion of the lacrimal gland, increases tear production, and improves dry eye symptoms.
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Affiliation(s)
- Shoaib Ugradar
- The Jules Stein Eye Institute University of California, Los Angeles, California, USA
| | - Erin Zimmerman
- The Jules Stein Eye Institute University of California, Los Angeles, California, USA
| | | | - Julia Kang
- Cedars-Sinai Medical Centre, Los Angeles, California, USA
| | - Kimberly Cockerham
- Central Valley Eye Medical Group, Stockton, California, USA.,Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, USA
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Čivrný J, Karhanová M, Hübnerová P, Schovánek J, Heřman M. MRI in the assessment of thyroid-associated orbitopathy activity. Clin Radiol 2022; 77:925-934. [PMID: 36116966 DOI: 10.1016/j.crad.2022.08.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
Management of patients with thyroid-associated orbitopathy (also called Graves' disease) is dependent on the assessment of the disease activity. Evaluation of disease activity is based on ophthalmological examination. Magnetic resonance imaging (MRI) is an auxiliary method that may help quantify the activity and is also helpful in obtaining anatomical information concerning muscle thickness, exophthalmos, or optic neuropathy. We present a review of MRI techniques of the orbits with emphasis on the evaluation of disease activity. The most convincing seems to be the group of T2-weighted techniques such as conventional T2 weighting, T2 relaxometry, and T2 mapping. Dynamic contrast-enhanced MRI is another promising method.
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Affiliation(s)
- J Čivrný
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic.
| | - M Karhanová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - P Hübnerová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - J Schovánek
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - M Heřman
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic
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Wen Z, Wan X, Qi CX, Huang X. Local-to-Remote Brain Functional Connectivity in Patients with Thyroid-Associated Ophthalmopathy and Assessment of Its Predictive Value Using Machine Learning. Int J Gen Med 2022; 15:4273-4283. [PMID: 35480997 PMCID: PMC9037891 DOI: 10.2147/ijgm.s353649] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/24/2022] [Indexed: 12/21/2022] Open
Abstract
Purpose To explore the alterations in both local and remote brain connectivity in patients with thyroid-associated ophthalmopathy (TAO) and to investigate whether the alterations of local neural function could be used to distinguish patients with TAO from healthy controls (HCs) using support vector machine (SVM) classifier. Materials and Methods In total, 21 patients with TAO and 21 well-matched HCs were enrolled in our study and underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning. We employed regional homogeneity (ReHo) algorithm to evaluate local neural function and selected significantly altered brain regions as seed areas for subsequent study of the remote functional connectivity (FC). Moreover, we chose the observed alterations in the ReHo analysis as classification features to differentiate patients with TAO from HCs through SVM classification method. Results Compared with the HCs, TAO patients showed significantly lower ReHo values in the right middle occipital gyrus (MOG) and right angular (ANG). In contrast, TAO patients displayed higher ReHo values in the left hippocampus (Hipp). We further found TAO patients exhibited decreased FC between the left and right Hipp, right MOG and left cerebellum (CER), right ANG and left rectus, right superior temporal pole gyrus (PSTG) (voxel-level p < 0.01, Gaussian random field correction, cluster-level p < 0.05). The alterations in local neural function exhibited an accuracy of 78.57% and area under curve of 0.81 for distinguishing the patients from HCs. Conclusion We mainly found the results that patients with TAO showed significantly dysfunctional local and remote brain functional connectivity in several brain regions associated with visual and cognitive functions. The ReHo variability has potential value in differentiating patients with TAO from HCs. These findings may provide novel insights into the neurological mechanisms underlying visual and cognitive disorders in patients with TAO.
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Affiliation(s)
- Zhi Wen
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Xin Wan
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Chen-Xing Qi
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, 330006, People’s Republic of China
- Correspondence: Chen-Xing Qi; Xin Huang, Department of Ophthalmology, Jiangxi Provincial People’s Hospital, No. 152, Ai Guo Road, Dong Hu District, Nanchang, Jiangxi, People’s Republic of China, Email ;
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital, Nanchang, Jiangxi, 330006, People’s Republic of China
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Rui L, Jing L, Zhenchang W. Diffusion Tensor Imaging Technology to Quantitatively Assess Abnormal Changes in Patients With Thyroid-Associated Ophthalmopathy. Front Hum Neurosci 2022; 15:805945. [PMID: 35185495 PMCID: PMC8855114 DOI: 10.3389/fnhum.2021.805945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective We aim to investigate the feasibility of using diffusion tensor imaging (DTI) to evaluate changes in extraocular muscles (EOMs) and lacrimal gland (LG) in patients with thyroid-associated ophthalmopathy (TAO) and to evaluate disease severity. Materials and Methods A total of 74 participants, including 17 healthy controls (HCs), 22 patients with mild TAO, and 35 patients with moderate-severe TAO, underwent 3-Tesla DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) of the EOMs and LG. Ophthalmological examinations, including visual acuity, exophthalmos, intraocular pressure, and fundoscopy, were performed. FA and MD values were compared among patients with different disease severity. Multiple linear regression was adopted to predict the impact of clinical variables on DTI parameters of orbital soft tissue. Results TAO patients’ EOMs and LG showed significantly lower FA values and higher MD compared to HCs’ (P < 0.05). Moderate-severe TAO patients’ EOMs and LG had dramatically lower FA and higher MD compared with HCs (P < 0.05). In addition, only the DTI parameters of the medial rectus were considerably different between mild and moderate-severe TAO patients (P = 0.017, P = 0.021). Multiple linear regression showed that disease severity had a significant impact on the DTI parameters of orbital soft tissue. Conclusion DTI is a useful tool for detecting microstructural changes in TAO patients’ orbital soft tissue. DTI findings, especially medial rectus DTI parameters, can help to indicate the disease severity in TAO patients.
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Spontaneous brain activity alterations in thyroid-associated ophthalmopathy patients using amplitude of low-frequency fluctuation: A resting-state fMRI study. Neuroreport 2021; 32:1416-1422. [PMID: 34776504 DOI: 10.1097/wnr.0000000000001745] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Previous studies demonstrated that thyroid-associated ophthalmopathy (TAO) patients were accompanied by cognitive decline. However, The exact neural mechanisms of cognitive decline in TAO patients remain unclear. Our study aimed to investigate the spontaneous brain activity alterations using amplitude of low-frequency fluctuation (ALFF) method and their relationships with clinical features in TAO patients. MATERIALS AND METHODS In total, twenty-one patients with TAO (14 men and 7 women) and 21 healthy control (HC) subjects (14 men and 7 women) were enrolled in this study. The ALFF method was used to assess the spontaneous brain activity changes. Meanwhile, receiver operating characteristic (ROC) curve was used to distinguish TAO group and HCs group. And Pearson correlation was performed to calculate the relationship between the observed mean ALFF values of the altered regions in patients with TAO and their clinical features. RESULTS Compared with the HCs, TAO patients had significantly lower ALFF values in the right superior occipital gyrus (SOG) and bilateral precuneus (preCUN). In contrast, TAO patients showed higher ALFF values in the left cerebellum (CER) and left insula (INS). CONCLUSION our result highlighted that TAO patients showed altered intrinsic brain activities in the preCUN, left CER, left INS and right SOG, which might provide useful information for explaining neural mechanisms in patients with TAO.
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Usefulness of readout-segmented EPI-based diffusion tensor imaging of lacrimal gland for detection and disease staging in thyroid-associated ophthalmopathy. BMC Ophthalmol 2021; 21:281. [PMID: 34284740 PMCID: PMC8290601 DOI: 10.1186/s12886-021-02044-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/09/2021] [Indexed: 11/19/2022] Open
Abstract
Background Dysfunction of lacrimal gland (LG) gains increasing attention in patients with thyroid-associated ophthalmopathy (TAO), while the underlying pathological change is still not fully established. This study aimed to evaluate the utility of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in non-invasively detecting microstructural alterations of LG in patients with TAO, as well as in discriminating disease activity. Methods Thirty TAO patients and 15 age- and sex- matched healthy controls, who underwent rs-EPI-based DTI, were retrospectively enrolled. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of LG, and clinical-endocrinological variables were collected and compared. The correlations between FA and ADC values of LG and serum thyroid biochemical markers were also assessed. Results TAO group showed significantly lower FA (P < 0.001) and higher ADC (P = 0.014) of LG than healthy group. Active subgroup had significantly lower FA (P < 0.001) and higher ADC (P < 0.001) than inactive subgroup. In TAO group, FA of LG was significantly and negatively correlated with TRAb (r=-0.475, P = 0.008), while ADC of LG showed no significant correlation (P > 0.05). The area under receiver operating characteristic curve of FA was significantly greater than that under curve of ADC for discriminating disease activity (0.832 vs. 0.570, P = 0.009). Conclusions rs-EPI-based DTI is a useful tool to characterize the microstructural change of LG in patients with TAO. The derived metrics, particularly FA, can help to reveal disease activity.
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Zhai L, Luo B, Wu H, Wang Q, Yuan G, Liu P, Ma Y, Zhao Y, Zhang J. Prediction of treatment response to intravenous glucocorticoid in patients with thyroid-associated ophthalmopathy using T2 mapping and T2 IDEAL. Eur J Radiol 2021; 142:109839. [PMID: 34252869 DOI: 10.1016/j.ejrad.2021.109839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the performance of combined T2 mapping and T2 iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) in orbital tissues to predict the therapeutic efficacy of intravenous glucocorticoids (IVGCs) for active and moderate-to-severe thyroid-associated ophthalmopathy (TAO). METHOD Sixty-three active and moderate-to-severe TAO patients (responsive group, n = 35; unresponsive group, n = 28) who underwent orbital MRI before receiving IVGCs were retrospectively enrolled. Baseline clinical characteristics and imaging parameters were analyzed and compared between the two groups of different therapeutic efficacy. Binary logistic regression analysis was conducted to determine the independent predictors, the predictive performance of which was evaluated using receiver operating characteristic curve analysis. RESULTS The mean T2 relaxation time of extraocular muscle (EOM-T2RTmean) (P = 0.001), maximum T2RT of EOM (EOM-T2RTmax) (P = 0.001), mean water fraction of EOM (EOM-WFmean) (P < 0.001), maximum WF of EOM (EOM-WFmax) (P < 0.001) and exophthalmos (P = 0.007) were significantly higher in the responsive group than in the unresponsive group. EOM-T2RTmean (P < 0.001) and EOM-WFmax (P < 0.001) were determined as independent predictors for responsive patients with TAO in the multivariable analysis. Combining EOM-T2RTmean ≥ 77.1 and EOM-WFmax ≥ 91.52 demonstrated optimal efficiency for prediction (area under the curve = 0.844) and optimal predictive sensitivity (77.1%). Setting EOM-WFmax ≥ 91.52 achieved the optimal predictive specificity (89.3%). CONCLUSIONS Pretherapeutic quantitative measurements, based on combining T2 mapping and T2 IDEAL in orbital tissues, are valuable for predicting IVGC treatment response in active and moderate-to-severe TAO. EOM-T2RTmean and EOM-WFmax may become promising IVGC treatment response predictors.
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Affiliation(s)
- Linhan Zhai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Ban Luo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Hongyu Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Qiuxia Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Ping Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yanqiang Ma
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yali Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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Hu H, Chen HH, Chen W, Wu Q, Chen L, Zhu H, Shi HB, Xu XQ, Wu FY. Thyroid-Associated Ophthalmopathy: Preliminary Study Using T2 Mapping to Characterize Intraorbital Optic Nerve Changes Before Dysthyroid Optic Neuropathy. Endocr Pract 2021; 27:191-197. [PMID: 33630733 DOI: 10.1016/j.eprac.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the performance of T2 mapping in detecting intraorbital optic nerve (ON) changes in patients with thyroid-associated ophthalmopathy (TAO) before the onset of dysthyroid optic neuropathy (DON). METHODS Thirty-five patients with TAO and without DON (21 active, 14 inactive) and 21 healthy controls (HCs) were enrolled. Magnetic resonance imaging-derived parameters of T2 relaxation time (T2RT) at the intraorbital ON, extraocular muscle (EOM), orbital fat, exophthalmos, summed thickness of EOMs, orbital fat thickness, and clinical variables were compared. Correlations between T2RT at the ON and other variables were assessed. RESULTS Patients with TAO showed significantly higher T2RTs at the intraorbital ON than HCs (P < .001). Patients with active TAO had significantly higher T2RTs than those with inactive TAO and HCs (P < .001). Differences between patients with inactive TAO and HCs were insignificant (P > .05/3). T2RT at the intraorbital ON was positively correlated with clinical activity score, modified NOSPECS score, T2RT at EOM, exophthalmos, and summed thickness of EOMs in the TAO group (P ≤ .003) and negatively correlated with visual acuity (P = .033) and visual field indices (P = .030) in patients with active TAO. A T2RT cutoff of 82.9 ms for the intraorbital ON distinguished active TAO and healthy eyes optimally (area under the curve, 0.800; sensitivity, 85.7%; specificity, 64.3%). CONCLUSION T2RT detects disturbance in the intraorbital ON in patients with TAO, especially active TAO, before DON develops. T2 mapping has a potential for noninvasive evaluation of ON changes in patients with TAO.
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Affiliation(s)
- Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Chen W, Hu H, Chen HH, Su GY, Yang T, Xu XQ, Wu FY. Utility of T2 mapping in the staging of thyroid-associated ophthalmopathy: efficiency of region of interest selection methods. Acta Radiol 2020; 61:1512-1519. [PMID: 32053002 DOI: 10.1177/0284185120905032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Discriminating the stage of thyroid-associated ophthalmopathy (TAO) is crucial for the treatment strategy and prognosis prediction. Utility of conventional magnetic resonance imaging in the disease staging is limited. PURPOSE To investigate the performance of T2 mapping based on different region of interest (ROI) selection methods in the staging of TAO. MATERIAL AND METHODS Thirty-two patients with TAO were retrospectively enrolled. Two radiologists independently measured the T2 relaxation time (T2RT) of extraocular muscles using two different ROIs (hotspot [ROIHS]: T2RT-hot; single-slice [ROISS]: T2RT-mean, T2RT-max, T2RT-min). Independent-samples t test, Wilcoxon signed rank test, Spearman correlation analysis, receiver operating characteristic (ROC) curves analyses, multiple ROC comparisons, and intra-class correlation coefficient (ICC) were used for statistical analyses. RESULTS No significant difference was found in the measuring time between ROIHS and ROISS methods (P = 0.066). T2RT-mean demonstrated the highest ICC for measurement, followed by T2RT-max and T2RT-min, and T2RT-hot showed the poorest reproducibility. Active TAOs showed significantly higher values for all the T2RTs than inactive mimics (all P < 0.001). Significant positive correlations were found between T2RTs and CAS (all P < 0.005). T2RT-hot and T2RT-max showed significantly higher areas under the curve than that of T2RT-mean (P = 0.013 and 0.024, respectively), while the difference between T2RT-hot and T2RT-max was not significant (P = 0.970). CONCLUSION The T2RTs derived from both ROI selection methods could be useful for the staging of TAO. The results of measuring time, reproducibility, and diagnostic performance suggest that T2RT-max would be the optimal indicator for staging.
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Affiliation(s)
- Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Hu H, Xu XQ, Chen L, Chen W, Wu Q, Chen HH, Zhu H, Shi HB, Wu FY. Predicting the response to glucocorticoid therapy in thyroid-associated ophthalmopathy: mobilizing structural MRI-based quantitative measurements of orbital tissues. Endocrine 2020; 70:372-379. [PMID: 32504380 DOI: 10.1007/s12020-020-02367-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to evaluate the performance of structural magnetic resonance imaging (MRI)-based quantitative measurements at extraocular muscle (EOM), orbital fat (OF), and especially lacrimal gland (LG) in predicting response to glucocorticoid (GC) in patients with active and moderate-severe thyroid-associated ophthalmopathy (TAO). METHODS Forty-seven active and moderate-severe TAOs (responsive group, 29 patients and 58 eyes; unresponsive group, 18 patients and 36 eyes) were enrolled. Pretreatment MRI-based parameters of EOM, OF, and LG, and clinical factors were retrospectively collected and compared between two groups. Logistic regression and receiver operating characteristic curve analyses were used to assess the predictive value of identified independent variables. RESULTS Responsive group showed significantly higher minimum signal intensity ratio of EOM (EOM-SIRmin) (p < 0.001), higher EOM-SIRmean (p = 0.034), higher LG herniation (LGH) (p = 0.019), lower OF thickness (OFT) (p = 0.017), higher LGH/OFT ratio (p = 0.001), and shorter disease duration (p = 0.004) than unresponsive group. Multivariate analysis showed that EOM-SIRmin, LGH/OFT ratio, and disease duration were independent predictors for responsive TAOs (all p < 0.05). Integration of three independent predictors demonstrated optimal predictive efficiency (area under curve, 0.829). Combining EOM-SIRmin ≥1.43 and LGH/OFT ratio ≥1.65, optimal predictive specificity (94.4%) could be obtained, while optimal predictive sensitivity (82.8%) was achieved when integrating disease duration ≤3.5 and LGH/OFT ratio ≥1.65. CONCLUSIONS Structural MRI-based quantitative measurements at EOM, OF, and LG, specially EOM-SIRmin and LGH/OFT ratio, together with disease duration, may serve as promising markers to predict response to GC in patients with active and moderate-severe TAO.
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Affiliation(s)
- Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lu Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qian Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Chen HH, Hu H, Chen W, Cui D, Xu XQ, Wu FY, Yang T. Thyroid-Associated Orbitopathy: Evaluating Microstructural Changes of Extraocular Muscles and Optic Nerves Using Readout-Segmented Echo-Planar Imaging-Based Diffusion Tensor Imaging. Korean J Radiol 2020; 21:332-340. [PMID: 32090526 PMCID: PMC7039723 DOI: 10.3348/kjr.2019.0053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/07/2019] [Indexed: 01/13/2023] Open
Abstract
Objective We aimed to investigate the ability of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in assessing the microstructural change of extraocular muscles (EOMs) and optic nerves in patients with thyroid-associated orbitopathy (TAO) as well as in evaluating disease activity. Materials and Methods We enrolled 35 TAO patients and 22 healthy controls (HCs) who underwent pre-treatment rs-EPI-based DTI. Mean, axial, and radial diffusivity (MD, AD, and RD) and fractional anisotropy (FA) of the medial and lateral EOMs and optic nerve for each orbit were calculated and compared between TAO and HC groups and between active and inactive TAO groups. Factors such as age, sex, disease duration, mediation, and smoking history between groups were also compared. Logistic regression analysis was used to evaluate the predictive value of significant variables for disease activity. Results Disease duration was significantly shorter in active TAOs than in inactive ones (p < 0.001). TAO patients showed significantly lower FA and higher MD, AD, and RD than HCs for both medial and lateral EOMs (p < 0.001), but not the AD value of lateral EOMs (p = 0.619). Active patients had significantly higher FA, MD, and AD than inactive patients for medial EOMs (p < 0.005), whereas only FA differed significantly in the lateral EOMs (p = 0.018). The MD, AD, and RD of optic nerves were significantly lower in TAO patients than HCs (p < 0.05), except for FA (p = 0.129). Multivariate analysis showed that the MD of medial EOMs and disease duration were significant predictors for disease activity. The combination of these two parameters showed optimal diagnostic efficiency for disease activity (area under the curve, 0.855; sensitivity, 68.4%; specificity, 96.9%). Conclusion rs-EPI-based DTI is promising in assessing microstructural changes of EOMs and optic nerves and can help to indicate the disease activity of TAO, especially through the MD of medial EOMs.
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Affiliation(s)
- Huan Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dai Cui
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fei Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Yang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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15
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Hu H, Chen HH, Chen W, Wu Q, Chen L, Zhu H, Xu XQ, Shi HB, Wu FY. T2 mapping histogram at extraocular muscles for predicting the response to glucocorticoid therapy in patients with thyroid-associated ophthalmopathy. Clin Radiol 2020; 76:159.e1-159.e8. [PMID: 33010933 DOI: 10.1016/j.crad.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the performance of T2 mapping histograms at the extraocular muscles (EOMs) in predicting the response to glucocorticoid therapy in the patients with active and moderate-severe thyroid-associated ophthalmopathy (TAO). MATERIALS AND METHODS Thirty active and moderate-severe TAO patients (responsive group, n=20; unresponsive group, n=10) were enrolled, and evaluated using T2 mapping before treatment. Histogram parameters (mean, median, max, min, 10th, 90th percentiles, skewness, and kurtosis) of T2 relaxation time (T2RT) at the EOMs for each orbit, and clinical variables (age, sex, disease duration, anti-thyroid treatment, smoking habit, pre-treatment thyroid function, thyrotrophin receptor antibody, diplopia presence, activity and severity scores) were collected and compared between groups. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the predictive value of identified independent variables for treatment response. RESULTS The responsive group showed significantly shorter disease duration (p=0.003), while higher T2RTmin than unresponsive group (p<0.001). Multivariate analysis showed that T2RTmin and disease duration were independent predictors for responsive TAOs. ROC curve analyses indicated that setting a cut-off value of ≥54.3 for T2RTmin demonstrated the optimal predicting specificity for responsive TAOs (100%), while a combination of T2RTmin ≥54.3 and disease duration ≤4.5 showed optimal predicting efficiency and sensitivity (area under the curve, 0.820; sensitivity, 65%). CONCLUSIONS Histogram analysis can help to exhibit the heterogeneity of T2RT at the EOMs. T2RTmin, together with disease duration may be the promising marker for predicting response to glucocorticoid therapy in the patients with active and moderate-severe TAO.
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Affiliation(s)
- H Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H-H Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - W Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Q Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - L Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - X-Q Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H-B Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - F-Y Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Yuksel N, Unal O, Mutlu M, Ergeldi G, Caglayan M. Real-time ultrasound elastographic evaluation of extraocular muscle involvement in Graves' ophthalmopathy. Orbit 2019; 39:160-164. [PMID: 31296093 DOI: 10.1080/01676830.2019.1639770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the affected extraocular muscles (EOMs) of patients with Graves' ophthalmopathy (GO) using real-time ultrasound elastography (UE) and to compare these results with those of healthy subjects.Methods: This prospective, comparative case series included 70 eyes of 35 patients with moderate-to-severe GO with type 2 orbitopathy (myogenic variant) according to their computed tomography (CT) scans. Forty-six eyes of 23 healthy subjects were evaluated as the control group. The strain ratio of orbital fat to medial rectus was calculated as the ratio of the medial rectus to orbital fat tissue, and the strain ratio of orbital fat to lateral rectus was calculated as the ratio of lateral rectus to orbital fat tissue.Results: The strain ratio of orbital fat to medial rectus was 3.03 ± 1.25 (range: 1.05-5.07) in the GO group, and 0.54 ± 0.20 (range: 0.14-1.08) in the control group (p = .0001). The strain ratio of orbital fat to lateral rectus was 0.97 ± 0.29 (range: 0.56-1.55) in the GO group, and 0.63 ± 0.23 (range: 0.18-1.09) in the control group (p = .0001).Conclusion: By using real-time UE, we found the medial and the lateral recti of GO patients to be stiffer compared to those of healthy subjects.
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Affiliation(s)
- Nilay Yuksel
- Ophthalmology Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ozlem Unal
- Radiology Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | | | - Gulcin Ergeldi
- Ophthalmology Department, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Ophthalmology Department, Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
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Assessment of lacrimal glands in thyroid eye disease with diffusion-weighted magnetic resonance imaging. Pol J Radiol 2019; 84:e142-e146. [PMID: 31019608 PMCID: PMC6479144 DOI: 10.5114/pjr.2019.84096] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/14/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To assess the lacrimal glands in patients with thyroid eye disease with diffusion-weighted magnetic resonance (MR) imaging. Material and methods This study was carried out on 44 consecutive patients (17 males, 27 females, with mean age 36 years) with thyroid eye disease and 20 age- and sex-matched volunteers. They underwent diffusion-weighted MR imaging of the orbit. The apparent diffusion coefficient (ADC) values of the lacrimal glands were calculated and correlated with the clinical activity score (CAS). Results The mean ADC of lacrimal glands in thyroid eye disease (1.73 × 10-3 mm2/s) was significantly higher (p = 0.001) than that of volunteers (1.52 × 10-3 mm2/s). The cutoff ADC value of lacrimal gland used for differentiation of thyroid eye disease from volunteers was 1.62 × 10-3 mm2/s with an area under the curve value of 0.95 and an accuracy of 96%. There was significant difference (p = 0.03) in the ADC of the lacrimal glands in patients with active (n = 24) and inactive (n = 20) disease. The cutoff ADC value of the lacrimal gland used to suspect active disease was 1.76 × 10-3 mm2/s with an area under the curve value of 0.80 and an accuracy of 82%. There was positive correlation between the ADC value of the lacrimal glands and CAS (r = 0.73, p = 0.001). Conclusions The ADC of the lacrimal glands is a non-invasive imaging parameter that can be used for diagnosis of thyroid eye disease and to predict the active form of the disease.
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Diffusion Tensor Imaging of the Lateral Rectus Muscle in Duane Retraction Syndrome. J Comput Assist Tomogr 2019; 43:467-471. [DOI: 10.1097/rct.0000000000000859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lo C, Ugradar S, Rootman D. Management of graves myopathy: Orbital imaging in thyroid-related orbitopathy. J AAPOS 2018; 22:256.e1-256.e9. [PMID: 30055270 DOI: 10.1016/j.jaapos.2018.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
Abstract
A broad understanding of the different imaging modalities used to assess the physiologic changes seen in Graves' orbitopathy complement clinical examination. Subtle applications of radiographic imaging techniques allow for a better understanding of the overall physiology of the orbit, quantify progression of disease, and differentiate it from orbital diseases with overlapping features. A nuanced approach to interpreting imaging features may allow us to delineate inactive from active thyroid eye disease, and advances within this field may arm clinicians with the ability to better predict and prevent dysthyroid optic neuropathy.
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Affiliation(s)
- Christopher Lo
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye institutes, University of California, Los Angeles
| | - Shoaib Ugradar
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye institutes, University of California, Los Angeles
| | - Daniel Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Stein and Doheny Eye institutes, University of California, Los Angeles.
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Abdel Razek AA, El-Hadidy M, Moawad ME, El-Metwaly N, El-Said AA. Performance of apparent diffusion coefficient of medial and lateral rectus muscles in Graves' orbitopathy. Neuroradiol J 2017; 30:230-234. [PMID: 28379055 DOI: 10.1177/1971400917691993] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective The purpose of this study was to determine the performance of the apparent diffusion coefficient in the detection of involvement of the medial and lateral rectus muscles in patients with Graves' orbitopathy. Methods and materials This prospective study was conducted on 33 consecutive patients (16 males, 17 females with a mean age of 36 years) with Graves' orbitopathy and 18 age- and sex-matched volunteers. The patients and volunteers underwent diffusion-weighted magnetic resonance imaging of the orbit in the axial plane using echo-planar imaging. The apparent diffusion coefficient of the medial and lateral rectus muscles was calculated. Results The medial rectus muscle was more affected than the lateral rectus muscle. The mean apparent diffusion coefficient value of the medial and lateral rectus muscles was 1.81 ± 0.19 and 1.72 ± 0.07 × 10-3 mm2/s in patients with Graves' orbitopathy and 1.59 ± 0.06 and 1.51 ± 0.06 × 10-3 mm2/s in volunteers, respectively. There was a significant difference in apparent diffusion coefficient values of the medial and lateral rectus muscles between patients with Graves' orbitopathy and volunteers ( p = 0.001). The classification performance as measured with area under the receiver operator characteristic curve was 0.89 (95% confidence interval: 0.732-0.904). The best performing threshold of the apparent diffusion coefficient value of the medial rectus muscle was 1.69 × 10-3 mm2/s and associated efficiency was 86%, sensitivity was 97%, and specificity was 97%. Conclusion We concluded that the apparent diffusion coefficient of the medial rectus muscle can be used for diagnosis of Graves' orbitopathy.
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Affiliation(s)
| | - Mohamed El-Hadidy
- 2 Department of Internal medicine, Mansoura Faculty of Medicine, Egypt
| | - Mohamed E Moawad
- 2 Department of Internal medicine, Mansoura Faculty of Medicine, Egypt
| | - Nader El-Metwaly
- 3 Department of Ophthalmology , Mansoura Faculty of Medicine, Egypt
| | - Amr A El-Said
- 2 Department of Internal medicine, Mansoura Faculty of Medicine, Egypt
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