1
|
Koizumi T, Tanaka T, Umeda K, Komiyama D, Obata H. Correlation between extraocular muscle enlargement and thyroid autoantibodies in thyroid eye disease. Jpn J Ophthalmol 2024; 68:250-258. [PMID: 38609717 PMCID: PMC11087308 DOI: 10.1007/s10384-024-01061-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/31/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE This study aimed to investigate the factors affecting extraocular muscle enlargement in thyroid eye disease (TED). STUDY DESIGN Retrospective study. METHODS The thyroid-stimulating hormone (TSH) receptor antibody (TRAb), thyroid-stimulating antibody (TSAb), antithyroid peroxidase antibody (ATPO), and antithyroglobulin antibody (ATG) levels in patients diagnosed with TED who underwent orbital magnetic resonance imaging were assessed. The control group comprised the contralateral eye of patients who underwent orbital magnetic resonance imaging (MRI) for unilateral eyelid tumors or orbital disease. The thickness of the bilateral rectus muscles and superior oblique muscles was measured on orbital MRI. Muscle enlargement was classified as unilateral/bilateral and symmetric/asymmetric. The effects of age, sex, smoking history, TSH, thyroid hormone, and thyroid autoantibodies on the muscle thickness and number of enlarged muscles were assessed by use of simple and multiple regression analyses. RESULTS The TED and control groups comprised 41 and 44 cases, respectively. The positivity rate of TSAb in patients with TED was 92.7% higher than that of the other autoantibodies. Muscle enlargement was observed in 29 of the 41 cases (70.7%). Older age and higher TSAb levels were identified as significant factors affecting the total muscle thickness and number of enlarged muscles. Bilateral muscle enlargement and asymmetrical muscle enlargement were observed in 17 (58.6%) and 23 (79.3%) of the 29 cases, respectively. The TSAb levels and age had no significant effect on the type of muscle enlargement. CONCLUSIONS TSAb showed significant associations with extraocular muscle enlargement. Measurement of TSAb, rather than of TRAb, may be more useful for diagnosing extraocular muscle enlargement in patients with TED.
Collapse
Affiliation(s)
- Takahiro Koizumi
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Takahiro Tanaka
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Kazuki Umeda
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Daisuke Komiyama
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Hiroto Obata
- Department of Ophthalmology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| |
Collapse
|
2
|
Kızılgöz V, Aydın S, Aydemir H, Kantarcı M. Normative measurements of orbital structures on magnetic resonance images; a cross-sectional study with mini review of the literature. Surg Radiol Anat 2024; 46:595-604. [PMID: 38565672 DOI: 10.1007/s00276-024-03349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Awareness of normative values of extra orbital structures would provide useful information to interpret the radiological images better and use them for diagnostic purposes. This study aimed to reveal the average values of major extraocular structures measured on magnetic resonance images. METHODS In this retrospective cross-sectional study, magnetic resonance (MR) images of 256 orbits of 128 patients were re-interpreted regarding the measurements of major orbital structures. Extraocular muscles, superior ophthalmic vein, and optic nerve-sheath complex were measured on orbital MR images of these patients. The data distributions were presented by box-plot analyses for each parameter, and the measurement results were analyzed regarding gender and age groups. RESULTS Lateral rectus muscle thickness (LR), inferior rectus muscle thickness (IR), globe position (GP), and interzygomatic line (IZL) values were higher in the male group than in the female group (p values were < 0.001, 0.003, 0.020, and < 0.001 respectively). LR, the thickness of the superior group muscles (SUP GR), IR, superior oblique muscle thickness (SOBL), and the thickness of optic nerve-sheath complex (ON) values indicated a significant relationship between age groups. There was a significant, positive, and low-level correlation between age and LR, SUP GR, and IR values (p values were < 0.001, 0.001, and < 0.001, respectively). CONCLUSION This study provides quantitative data on normative values of orbital structures with gender and age group comparisons. Clinicians or surgeons can easily use the measured values to gather diagnostic information from the orbital region.
Collapse
Affiliation(s)
- Volkan Kızılgöz
- Faculty of Medicine, Department of Radiology, Erzincan Binali Yıldırım University, Erzincan, 24100, Turkey
| | - Sonay Aydın
- Faculty of Medicine, Department of Radiology, Erzincan Binali Yıldırım University, Erzincan, 24100, Turkey
| | - Hüseyin Aydemir
- Faculty of Medicine, Department of Radiology, Erzincan Binali Yıldırım University, Erzincan, 24100, Turkey
| | - Mecit Kantarcı
- Faculty of Medicine, Department of Radiology, Erzincan Binali Yıldırım University, Erzincan, 24100, Turkey.
- Faculty of Medicine, Department of Radiology, Atatürk University, Erzurum, 25240, Turkey.
| |
Collapse
|
3
|
Ang T, Tong JY, Patel S, Juniat V, Rajak S, Selva D. Qualitative and Quantitative Magnetic Resonance Imaging in Bacterial Orbital Cellulitis. Semin Ophthalmol 2024:1-6. [PMID: 38661153 DOI: 10.1080/08820538.2024.2344029] [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: 01/30/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To summarise the qualitative and quantitative parameters of bacterial orbital cellulitis (OC) on magnetic resonance imaging (MRI) and explore their clinical correlations. METHODS Multi-centre retrospective study with inclusion of patients of all ages with OC who underwent MRI. Patients with isolated pre-septal cellulitis, bilateral disease and poor-quality scans were excluded. An enlargement ratio for extraocular muscles (EOMs) was calculated by dividing maximal EOM measurements from the affected side by the contralateral side. RESULTS Twenty MRI scans from twenty patients (Mean age: 40.8 ± 24.3 years old, M: F = 15:5) between 2011 and 2022 were analysed. Three (15.0%) cases were paediatric patients (<18 years old). All cases had both pre-septal and orbital fat involvement. The EOM were affected in nineteen cases, with the superior muscle complex (18/19, 94.7%) most commonly affected. Mean enlargement ratio (1.30, Range: 1.04-1.82) was greatest for the medial rectus on axial views on T1 and fat-suppressed contrast-enhanced T1 (FS CE T1). Optic peri-neuritis was present in eleven (55.0%) patients, whilst two (9.5%) cases had optic neuritis. A greater degree of proptosis was observed in patients with optic neuropathy and those who underwent surgical intervention compared to those without (p = .002 and p = .002, respectively). CONCLUSION MRI remains an important imaging modality for evaluating complicated OC. However, qualitative features may lack accuracy and is not a reproducible means of analysis. Simple quantitative parameters, such as proptosis and EOM measurements, correlate with high-risk clinical features and may have utility in predicting clinical course.
Collapse
Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jessica Y Tong
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sandy Patel
- Department of Medical Imaging, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Valerie Juniat
- Department of Ophthalmology, The Sussex Eye Hospital, University Hospitals Sussex, Brighton, UK
| | - Saul Rajak
- Department of Ophthalmology, The Sussex Eye Hospital, University Hospitals Sussex, Brighton, UK
| | - Dinesh Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
| |
Collapse
|
4
|
Ang T, Tong JY, Patel S, Hardy TG, McNab A, Selva D. Magnetic Resonance Imaging of Idiopathic Orbital Myositis. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00358. [PMID: 38427822 DOI: 10.1097/iop.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
PURPOSE To characterize the qualitative and quantitative features of idiopathic orbital myositis (IOM) on MRI. METHODS This was a multicenter retrospective study of patients with active IOM with MRI. Patients with incomplete clinical records, poor-quality or interval scans without active myositis, and specific orbital myositis (i.e., orbital myositis secondary to an identified condition) were excluded. An enlargement ratio was calculated by dividing the diameters of the affected extraocular muscle (EOM) by the contralateral unaffected EOM. RESULTS Twenty-four patients (mean age: 44.4 ± 17.8 years-old, male: 11) between 2011 and 2022 were included. One case (4.2%) was pediatric (17 years old), and 6 cases presented with recurrence. Active IOM was characterized by fusiform EOM enlargement, high T2 signal, and contrast enhancement. Average maximal EOM diameters ranged from 4.6 to 7.7 mm (enlargement ratio: 1.4-2.2). Eighteen (75%) patients had single EOM involvement, most commonly the medial rectus. Other ipsilateral structures affected included focal orbital fat (16/24, 66.7%) and lacrimal gland (8/24, 33.3%). Contralateral changes in the EOM and/or lacrimal gland were observed in 7 patients (29.2%). Patients presenting with recurrence were likely to develop ongoing recurrent episodes (p = 0.003). CONCLUSIONS Various radiological patterns of involvement described including EOM enlargement, contrast enhancement, abnormal signal, and involvement of other orbital structures are indicative of active IOM. IOM remains a heterogeneous spectrum of acute and chronic clinico-radiological presentations. Inflammation may involve other ipsilateral or contralateral orbital structures or may be bilateral despite presenting clinically as unilateral disease. Quantitative measurements may have utility in differentiating IOM from other causes of orbital myositis.
Collapse
Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide
| | | | - Sandy Patel
- Department of Medical Imaging, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Thomas G Hardy
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Alan McNab
- Orbital, Plastic, and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Rana K, Juniat V, Slattery J, Patel S, Selva D. Dilated superior ophthalmic vein: systemic associations. Int Ophthalmol 2023; 43:3725-3731. [PMID: 37392259 PMCID: PMC10504142 DOI: 10.1007/s10792-023-02782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/22/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE To review systemic associations of patients with dilated superior ophthalmic veins (SOV) in the absence of orbital, cavernous sinus, or neurological disease. METHODS Retrospective review of patients who had dilated SOVs with a diameter of ≥ 5.0 mm. Patients with a dilated SOV secondary to orbital, cavernous sinus or neurological disease were excluded. Patient demographics, past medical history, and SOV diameters on initial and follow up scans were collected. The maximum diameter of the SOV was taken perpendicular to the long axis of the SOV. RESULTS Nine cases were identified. Patients ranged in age from 58 to 89 years and six out of nine were female. The dilated SOV involved both eyes in two cases, left eye in five cases and right eye in two cases. Three patients had dilated SOV likely secondary to raised venous pressures from decompensated right heart failure (n = 1), pericardial effusion (n = 1) and left ventricle dysfunction secondary to a myocardial infarction (n = 1). Five patients had a significant history of previous ischaemic heart or peripheral vascular disease. Two patients had risk factors for venous clotting disease whilst one patient had a history of giant cell arteritis and vertebral artery dissection. CONCLUSION A dilated SOV may raise concern for life threatening conditions such as a carotid cavernous fistula and may prompt additional investigations. A dilated SOV may be reversible and secondary to raised venous pressures due to cardiac failure. Other cases may be seen in patients with significant cardiovascular risk factors, possibly due to changes in vasculature.
Collapse
Affiliation(s)
- Khizar Rana
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, 5000, Australia.
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia.
| | - Valerie Juniat
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - James Slattery
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| | - Dinesh Selva
- Department of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, 5000, Australia
| |
Collapse
|