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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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Vaishnav YJ, Mawn LA. Magnetic Resonance Imaging in the Management of Thyroid Eye Disease: A Systematic Review. Ophthalmic Plast Reconstr Surg 2023; 39:S81-S91. [PMID: 38054988 DOI: 10.1097/iop.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE MRI may potentially detect active thyroid eye disease prior to elevation of clinical activity score. We aimed to systematically review the existing literature pertaining to MRI thyroid eye disease and to assess the role of MRI in the diagnosis of thyroid eye disease. METHODS A Population, Intervention, Comparison, Outcome/Preferred Reporting Items for Systematic Reviews and Meta-Analyses selection criteria was applied to identify studies for inclusion published between the years 2000 and 2023. RESULTS Twenty-four articles were identified for inclusion in the systematic review. All included studies utilized MRI as the imaging modality. MRI sequences used included T2-weighted imaging in 87.5%, T1-weighted imaging in 54.2%, diffusion-weighted imaging in 20.8%, and short tau inversion recovery in 16.7%. The most common parameters quantified were signal intensity ratio in 10 studies (41.7%) and T2-relaxation time in 8 studies (33.3%). Signal intensity ratio and T2-relaxation time were shown to correlate with clinical activity score and identify the phase of the disease. CONCLUSIONS MRI has untapped potential for further elucidating the highly complex biological processes in thyroid eye disease. As we move away from clinical activity score as a predictor of response to biologic therapy, MRI may prove more important than ever in the risk-benefit analysis around the use of immunomodulators.
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Affiliation(s)
- Yash J Vaishnav
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
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Nakano M, Konishi H, Koshiba M. TSAb/TRAb ratio as a sensitive screening test for active Graves' orbitopathy. Endocr Pract 2022; 28:1050-1054. [PMID: 35870804 DOI: 10.1016/j.eprac.2022.07.007] [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: 04/28/2022] [Revised: 06/30/2022] [Accepted: 07/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Graves' orbitopathy (GO), an extrathyroidal manifestation of Graves' disease, can seriously threaten the patient's quality of life. Given that immunosuppressive treatment during the early active phase of GO has been found to reduce both disease activity and severity, sensitive screening tests are needed. METHODS The present study included 86 patients with GO, in whom serum levels of thyroid-stimulating hormone (TSH), free T3, free T4, thyroid-stimulating antibody, TSH receptor antibody, thyroid peroxidase antibody, thyroglobulin, and thyroglobulin antibody were measured within 2 months before magnetic resonance imaging (MRI)for orbit assessment. RESULTS The thyroid-stimulating antibody/TSH receptor antibody ratio was able to distinguish MRI results with a correct classification rate of 81%. When focusing on patients without T3 predominant Graves' diseases, the ratio distinguished MRI results at a rate of 92%. Receiver operating characteristic curve analysis revealed a cutoff antibody ratio of 87, which yielded a sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of 91%, 95%, 18.2, and 0.0957, respectively, for distinguished MRI results. CONCLUSIONS The thyroid-stimulating antibody/TSH receptor antibody ratio is a highly sensitive and specific indicator for active GO, especially in patients without T3 predominance, and serves as a good screening test for active GO in primary care settings.
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Affiliation(s)
- Masayoshi Nakano
- Department of Clinical Laboratory Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan.
| | - Hiroe Konishi
- Department of Clinical Laboratory Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
| | - Masahiro Koshiba
- Department of Clinical Laboratory Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Japan
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Correlation Analysis between Intraocular Pressure and Extraocular Muscles Based on Orbital Magnetic Resonance T2 Mapping in Thyroid-Associated Ophthalmopathy Patients. J Clin Med 2022; 11:jcm11143981. [PMID: 35887744 PMCID: PMC9318408 DOI: 10.3390/jcm11143981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/22/2022] [Accepted: 07/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The correlation between intraocular pressure (IOP) and the magnetic resonance imaging (MRI) parameters in thyroid-associated ophthalmopathy (TAO) patients was explored. Methods: This study included 82 eyes in 41 TAO patients who had a large difference in the IOP between each eye. We measured the T2 relaxation time (T2RT) of the extraocular muscles (EOMs), the orbital fat, and the area of the EOMs. Results: There was a positive correlation between IOP and exophthalmos, the clinical activity score (CAS), the T2RT (of the medial rectus (MR)), the area of the MR, inferior rectus (IR) and lateral rectus, and the mean area. We established a regression model with IOP as the dependent variable, and the area of the IR was statistically significant. Conclusions: High IOP in TAO patients was positively correlated with the degree of exophthalmos and EOM inflammation (especially the inferior rectus). The state of the EOMs in an orbital MRI may partially explain high IOP and provide the necessary clinical information for subsequent high IOP treatment.
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Bontzos G, Papadaki E, Mazonakis M, Maris TG, Tsakalis NG, Drakonaki EE, Detorakis ET. Extraocular Muscle Volumetry for Assessment of Thyroid Eye Disease. J Neuroophthalmol 2022; 42:e274-e280. [PMID: 34629402 DOI: 10.1097/wno.0000000000001339] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In this study we evaluate the diagnostic accuracy of extraocular muscle volumetry in detecting thyroid eye disease and to compare the results with simple measurements of maximal medial rectus (MR) diameter. METHODS Cross-sectional study that included 47 eyes of 47 patients with thyroid eye disease and 47 healthy controls. Patients underwent slitlamp examination and imaging consisting of computed tomography scans. Image segmentation and volume measurements were performed by 2 independent researchers. Intraobserver and interobserver reliability testing was also conducted. RESULTS Total extraocular muscle volume was 7.31 ± 1.88 cm3 and medial volume was 2.38 ± 0.73 cm3 in the study group. In this group, the maximum measured diameter of the MR was 6.67 ± 0.35 mm. MR volume was statistically associated with maximum MR diameter (r = 9.78; P < 0.001). Both MR volume and maximum MR diameter measurements showed good predictive efficacy as shown using receiver operator characteristic curve analysis. CONCLUSIONS Complications of thyroid eye disease are often sight threatening, and timely diagnosis is crucial for the management of the entity and its sequelae. The results of this study imply that simple measurements of maximum MR diameter are sensitive enough to establish diagnosis.
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Affiliation(s)
- Georgios Bontzos
- Departments of Ophthalmology (GB, NGT, ETD), and Radiology (EP), University Hospital of Heraklion, Heraklion, Greece ; Department of Medical Physics (MM, TGM), University of Crete, Heraklion, Greece; and Independent Imaging Services (EED), Heraklion, Crete, Greece
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Zhai L, Wang Q, Liu P, Luo B, Yuan G, Zhang J. T2 Mapping with and without Fat-Suppression to Predict Treatment Response to Intravenous Glucocorticoid Therapy for Thyroid-Associated Ophthalmopathy. Korean J Radiol 2022; 23:664-673. [PMID: 35555881 PMCID: PMC9174502 DOI: 10.3348/kjr.2021.0627] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/19/2022] [Accepted: 03/15/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the performance of baseline clinical characteristics and pretherapeutic histogram parameters derived from T2 mapping of the extraocular muscles (EOMs) in the prediction of treatment response to intravenous glucocorticoid (IVGC) therapy for active and moderate-to-severe thyroid-associated ophthalmopathy (TAO) and to investigate the effect of fat-suppression (FS) in T2 mapping in this prediction. Materials and Methods A total of 79 patients clinically diagnosed with active, moderate-to-severe TAO (47 female, 32 male; mean age ± standard deviation, 46.1 ± 10 years), including 43 patients with a total of 86 orbits in the responsive group and 36 patients with a total of 72 orbits in the unresponsive group, were enrolled. Baseline clinical characteristics and pretherapeutic histogram parameters derived from T2 mapping with FS (i.e., FS T2 mapping) or without FS (i.e., conventional T2 mapping) of EOMs were compared between the two groups. Independent predictors of treatment response to IVGC were identified using multivariable analysis. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of the prediction models. Differences between the models were examined using the DeLong test. Results Compared to the unresponsive group, the responsive group had a shorter disease duration, lower kurtosis (FS-kurtosis), lower standard deviation, larger 75th, 90th, and 95th (FS-95th) T2 relaxation times in FS mapping and lower kurtosis in conventional T2 mapping. Multivariable analysis revealed that disease duration, FS-95th percentile, and FS-kurtosis were independent predictors of treatment response. The combined model, integrating all identified predictors, had an optimized area under the ROC curve of 0.797, 88.4% sensitivity, and 62.5% specificity, which were significantly superior to those of the imaging model (p = 0.013). Conclusion An integrated combination of disease duration, FS-95th percentile, and FS-kurtosis was a potential predictor of treatment response to IVGC in patients with active and moderate-to-severe TAO. FS T2 mapping was superior to conventional T2 mapping in terms of prediction.
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Affiliation(s)
- Linhan Zhai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Qiuxia Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ban Luo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wu H, Luo B, Yuan G, Wang Q, Liu P, Zhao Y, Zhai L, Ma Y, Lv W, Zhang J. The diagnostic value of the IDEAL-T2WI sequence in dysthyroid optic neuropathy: a quantitative analysis of the optic nerve and cerebrospinal fluid in the optic nerve sheath. Eur Radiol 2021; 31:7419-7428. [PMID: 33993334 DOI: 10.1007/s00330-021-08030-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the optic nerve and CSF in the optic nerve sheath as imaging markers of dysthyroid optic neuropathy (DON). METHODS In this single-centre retrospective study, orbital images of 30 consecutive participants (54 orbits) with DON, 30 patients (60 orbits) with thyroid-associated ophthalmopathy (TAO) without DON, and 19 healthy controls (HCs; 38 orbits) were analysed. The diameter and cross-sectional area of the optic nerve and its sheath, water fraction of the optic nerve, and volume of the fluid in the optic nerve sheath were measured and compared. The associations between MR parameters and clinical measures were assessed using correlation analysis. RESULTS The diameter and water fraction of the optic nerve (3 mm and 6 mm behind the eyeball), optic nerve subarachnoid space (ONSS) (3 mm and 6 mm behind the eyeball), and subarachnoid fluid volume in the optic nerve sheath were significantly greater in the DON group than in the TAO group (p < 0.01) or HC group (p < 0.01). ROC analysis showed that ONSS 3 mm behind the eyeball (ONSS3) was a robust predictor of DON (AUC = 0.957, sensitivity = 0.907, specificity = 0.9). Water fraction of the optic nerve 3 mm behind the eyeball (water fraction3) had the best specificity (0.967). Water fraction3, fluid volume in the optic nerve sheath, and optic nerve diameter (3 mm behind the eyeball) were correlated with clinical measures (i.e. clinical activity score, mean defect, and pattern standard deviation). CONCLUSIONS Increased water fraction of the optic nerve and ONSS3 are promising and easily accessible radiological markers for diagnosing DON. KEY POINTS • The water fraction of the optic nerve and optic nerve subarachnoid space (ONSS) are greater in patients with dysthyroid optic neuropathy (DON) than in patients with thyroid-associated ophthalmopathy (TAO) without DON. • The optic nerve and the cerebrospinal fluid in the optic nerve sheath measures are associated with visual dysfunction. • The water fraction of the optic nerve and ONSS may be promising imaging markers for diagnosing DON.
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Affiliation(s)
- Hongyu Wu
- 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
| | - Gang Yuan
- Department of Endocrinology, 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
| | - Ping Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yali Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Linhan Zhai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yanqiang Ma
- Ultrasound Medical Center, Lanzhou University Sencond Hospital, Lanzhou University, Lanzhou, 730030, Gansu, China
| | - Wenzhi Lv
- Department of Artificial Intelligence, Julei Technology Company, 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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Liu P, Luo B, Chen L, Wang QX, Yuan G, Jiang GH, Zhang J. Baseline Volumetric T2 Relaxation Time Histogram Analysis: Can It Be Used to Predict the Response to Intravenous Methylprednisolone Therapy in Patients With Thyroid-Associated Ophthalmopathy? Front Endocrinol (Lausanne) 2021; 12:614536. [PMID: 33716970 PMCID: PMC7947366 DOI: 10.3389/fendo.2021.614536] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Prediction of therapy response to intravenous methylprednisolone pulses (ivMP) is crucial for thyroid-associated ophthalmopathy (TAO). Image histograms may offer sensitive imaging biomarkers for therapy effect prediction. This study aimed to investigate whether pretherapeutic, multiparametric T2 relaxation time(T2RT) histogram features of extraocular muscles (EOMs) can be used to predict therapy response. MATERIALS AND METHODS Forty-five active and moderate-severe TAO patients, who were treated with standard ivMP and underwent orbital MRI before therapy, were retrospectively included in this study. The patients were divided into responsive (n = 24, 48 eyes) and unresponsive group(n = 21, 42 eyes) according to clinical evaluation. Baseline clinical features of patients and histogram-derived T2RT parameters of the EOMs were analyzed and compared. Logistic regression model was conducted to determine independent predictors, and a histogram features nomogram was formulated for personalized prediction. RESULTS Responsive group displayed lower values for 5th, 10th percentiles (P < 0.050, respectively), and higher values for 75th, 90th, and 95th percentiles, skewness, entropy, and inhomogeneity (P < 0.050, respectively) than unresponsive group. Multivariate logistic regression analysis showed that 95th percentile of >88.1 [odds ratio (OR) = 12.078; 95% confidence interval (CI) = 3.98-36.655, p < 0.001], skewness of >0.31 (OR = 3.935; 95% CI = 2.28-6.788, p < 0.001) and entropy of >3.41 (OR = 4.375; 95% CI = 2.604-7.351, p < 0.001) were independent predictors for favorable response. The nomogram integration of three independent predictors demonstrated optimal predictive efficiency, with a C-index of 0.792. CONCLUSIONS Pre-treatment volumetric T2RT histogram features of EOMs could function to predict the response to ivMP in patients with TAO. The nomogram based on histogram features facilitates the selection of patients who will derive maximal benefit from ivMP.
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Affiliation(s)
- Ping Liu
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Ban Luo
- Department of Ophthalmology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Lang Chen
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Qiu-Xia Wang
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology and Metabolism, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Gui-hua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Jing Zhang
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
- *Correspondence: Jing Zhang,
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Liu X, Su Y, Jiang M, Fang S, Huang Y, Li Y, Zhong S, Wang Y, Zhang S, Wu Y, Sun J, Fan X, Zhou H. Application of Magnetic Resonance Imaging in the Evaluation of Disease Activity in Graves' Ophthalmopathy. Endocr Pract 2020; 27:198-205. [PMID: 33658136 DOI: 10.1016/j.eprac.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/01/2020] [Accepted: 09/17/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate magnetic resonance imaging parameters, T2 signal intensity ratios (SIRs), and normalized apparent diffusion coefficients (n-ADC) of the extraocular muscles (EOMs) in the identification of different stages of Graves' ophthalmopathy (GO) and to find out the correlation of T2-SIRs and n-ADC values with disease changes after anti-inflammatory treatment. METHODS Altogether, 43 patients (86 orbits) were enrolled and classified into "active" or "inactive" stages by clinical activity score (CAS). Twenty-three (53.5%) patients received anti-inflammatory treatment and underwent a follow-up evaluation. Fifteen age- and gender-matched control participants (30 orbits) were included. T2-SIRs and n-ADC values of EOMs were calculated among GO and healthy controls and were correlated with CAS. Changes in these parameters were also evaluated before and after anti-inflammatory treatment. RESULTS Mean T2-SIRs and n-ADC values were both significantly higher in GO patients than in controls and higher in active GO than in inactive GO. In the inactive stage, n-ADC values of inferior rectus muscles were still higher than those in healthy controls. Both T2-SIRs and n-ADC values decreased after intravenous steroid pulse therapy. The cutoff value of pretreatment n-ADC was 1.780 to detect stages with specificity of 93.7% and sensitivity of 48.3% (P = .035). CONCLUSION T2-SIRs and n-ADC values are valuable magnetic resonance imaging indicators of the inflammatory activity in GO by detecting involvement of EOMs. They are also ideal tools to monitor the efficacy of anti-inflammatory treatment in patients with active stage GO. n-ADC values, when combined with CAS, can be promising predictive factors in the detection of stages of diseases.
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Affiliation(s)
- Xingtong Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Yun Su
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011
| | - Sijie Fang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Yazhuo Huang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Yinwei Li
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Sisi Zhong
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Yang Wang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Shuo Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Yu Wu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011
| | - Jing Sun
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011.
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011.
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, 200011; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China, 200011.
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Liu P, Chen L, Wang QX, Luo B, Su HH, Yuan G, Jiang GH, Zhang J. Histogram analysis of T2 mapping for detecting early involvement of extraocular muscles in patients with thyroid-associated ophthalmopathy. Sci Rep 2020; 10:19445. [PMID: 33173086 PMCID: PMC7655798 DOI: 10.1038/s41598-020-76341-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
Using histogram analysis of T2 values to detect early involvement of extraocular muscles (EOMs) in patients with thyroid-associated ophthalmopathy (TAO). Five EOMs of each orbit were analyzed for 45 TAO patients and 22 healthy controls (HCs). Patients’ EOMs were grouped into involved or normal-appearing EOMs (NAEOMs). Histogram parameters and signal intensity ratios (SIRs) of EOMs were compared; receiver operating characteristic (ROC) curve analysis was performed to differentiate NAEOMs from EOMs of HCs. 24 patients were reassessed following immunosuppressive treatment. For SIRs, involved muscles showed higher values than those of NAEOMs and HCs (p < 0.05); there were no differences between NAEOMs and HCs (p = 0.26). Parameters of involved muscles showed no different from those of NAEOMs excluding 25th, 50th percentiles, and standard deviation (SD) (p < 0.05). NAEOMs displayed higher values of 90th, 95th percentiles, SD, skewness, inhomogeneity, and entropy than HCs (p < 0.05). ROC curve analysis of entropy yielded the best area under the ROC curve (AUC; 0.816) for differentiating NAEOMs and HCs. After treatment, histogram parameters including 5th, 75th, 90th, and 95th percentiles, SD, kurtosis, inhomogeneity, and entropy were reduced in NAEOMs (p < 0.05). T2 histogram analysis could detect early involvement of EOMs in TAO prior to detection on conventional orbital MRI.
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Affiliation(s)
- Ping Liu
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Lang Chen
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qiu-Xia Wang
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Ban Luo
- Department of Ophthalmology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Huan-Huan Su
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Gang Yuan
- Department of Endocrinology and Metabolism, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Gui-Hua Jiang
- Department of Medical Imaging, Guangdong Second Provincial General Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Jing Zhang
- Department of Radiology, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
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Kaichi Y, Tanitame K, Terada H, Itakura H, Ohno H, Yoneda M, Takahashi Y, Akiyama Y, Awai K. Thyroid-associated Orbitopathy: Quantitative Evaluation of the Orbital Fat Volume and Edema Using IDEAL-FSE. Eur J Radiol Open 2019; 6:182-186. [PMID: 31193388 PMCID: PMC6526225 DOI: 10.1016/j.ejro.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 01/19/2023] Open
Abstract
Background and Purpose To compare orbital quantitative data obtained by fast spin-echo iterative decomposition of water and fat with echo asymmetry and least-squares estimation (FSE-IDEAL) in patients with thyroid-associated orbitopathy (TAO) and healthy controls and to investigate the characteristics of these data in TAO patients. Materials and Methods Twenty-two TAO patients (4 males and 18 females; median age 51.0 years) and 22 healthy subjects (5 males and 17 females; median age 50.5 years) underwent orbital T2-weighted FSE-IDEAL. The water fraction in orbital fat was defined as the signal intensity (SI) water / (SI water + SI fat). The orbital fat volume was measured on fat images. The degree of proptosis was evaluated using in-phase imaging. Mann–Whitney U test was used to compare these quantitative data in the two groups. In TAO patients we ascertained the correlation among these values with the Spearman's rank correlation coefficient. Results In TAO patients, the water fraction (right and left, p = 0.04), fat volume (right and left, p = 0.03) and degree of proptosis (right and left, p < 0.01) were higher than in the controls. In TAO patients, only the water fraction and the fat volume of left orbit showed negative correlation (p = 0.01). Conclusion The water fraction of orbital fat, the orbital fat volume and the degree of proptosis obtained with FSE-IDEAL were higher in TAO patients than in the controls. The water fraction was a new parameter for differentiating between TAO patients and healthy subjects.
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Affiliation(s)
- Yoko Kaichi
- Diagnostic Radiology, Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
| | - Keizo Tanitame
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, Ujinakanda 1-5-54, Minami-ku, Hiroshima 734-8530, Japan
| | - Hiroaki Terada
- Diagnostic Radiology, Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Itakura
- Itakura Eye Clinic, Ochiai 5-24-8, Asakita-ku, Hiroshima 739-1731, Japan
| | - Haruya Ohno
- Department of Molecular and Internal Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
| | - Masayasu Yoneda
- Department of Molecular and Internal Medicine, Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Takahashi
- Department of Clinical Radiology, Hiroshima University Hospital, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Akiyama
- Diagnostic Radiology, Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551, Japan
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Koolstra K, Beenakker JM, Koken P, Webb A, Börnert P. Cartesian MR fingerprinting in the eye at 7T using compressed sensing and matrix completion-based reconstructions. Magn Reson Med 2019; 81:2551-2565. [PMID: 30421448 PMCID: PMC6519255 DOI: 10.1002/mrm.27594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/09/2018] [Accepted: 10/12/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To explore the feasibility of MR Fingerprinting (MRF) to rapidly quantify relaxation times in the human eye at 7T, and to provide a data acquisition and processing framework for future tissue characterization in eye tumor patients. METHODS In this single-element receive coil MRF approach with Cartesian sampling, undersampling is used to shorten scan time and, therefore, to reduce the degree of motion artifacts. For reconstruction, approaches based on compressed sensing (CS) and matrix completion (MC) were used, while their effects on the quality of the MRF parameter maps were studied in simulations and experiments. Average relaxation times in the eye were measured in 6 healthy volunteers. One uveal melanoma patient was included to show the feasibility of MRF in a clinical context. RESULTS Simulation results showed that an MC-based reconstruction enables large undersampling factors and also results in more accurate parameter maps compared with using CS. Experiments in 6 healthy volunteers used a reduction in scan time from 7:02 to 1:16 min, producing images without visible loss of detail in the parameter maps when using the MC-based reconstruction. Relaxation times from 6 healthy volunteers are in agreement with values obtained from fully sampled scans and values in literature, and parameter maps in a uveal melanoma patient show clear difference in relaxation times between tumor and healthy tissue. CONCLUSION Cartesian-based MRF is feasible in the eye at 7T. High undersampling factors can be achieved by means of MC, significantly shortening scan time and increasing patient comfort, while also mitigating the risk of motion artifacts.
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Affiliation(s)
- Kirsten Koolstra
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
| | - Jan‐Willem Maria Beenakker
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
- OphthalmologyLeiden University Medical CenterLeidenThe Netherlands
| | | | - Andrew Webb
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
| | - Peter Börnert
- RadiologyC.J. Gorter Center for High‐Field MRI, Leiden University Medical CenterLeidenThe Netherlands
- Philips ResearchHamburgGermany
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T2-relaxation mapping and fat fraction assessment to objectively quantify clinical activity in thyroid eye disease: an initial feasibility study. Eye (Lond) 2018; 33:235-243. [PMID: 30538310 DOI: 10.1038/s41433-018-0304-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/16/2018] [Indexed: 11/08/2022] Open
Abstract
Imaging in thyroid eye disease (TED) is used to exclude other diagnoses, assess for apical crowding and plan surgery. But to quantify TED activity objectively, subjective clinical scoring assessments remain the norm. Magnetic resonance imaging (MRI) T2-relaxation times correlate with extra-ocular muscle (EOM) inflammation, but are confounded by signal from fat. We investigated whether T2-relaxation mapping in combination with fat fraction (FF) measurements could quantify disease activity in EOMs objectively. Sixty-two TED patients and six controls were enroled for coronal short tau inversion recovery (STIR), T2 multi-echo fast-spin echo and multi-echo fast-gradient echo MRI of the orbits. STIR signal intensity ratios (SIRs), T2-relaxation times and percentage FF were derived for inferior, lateral, superior and medial recti bilaterally. Twelve patients were re-scanned following immunosuppressive treatment. The results found a positive correlation for all subjects between T2 and SIR (p < 0.001), but only mean T2 differed significantly between patients and controls (p < 0.001). We measured FF in EOMs for the first time and found it greater in TED (p < 0.001). There was also a significant reduction in mean T2 after treatment, with a corresponding reduction in the clinical activity score (CAS) in almost all patients. We show that T2-relaxation times differentiate between normal and inflamed EOMs and are responsive to treatment. Combined, uniquely, with FF measurement in EOMs, an objective, quantitative marker of inflammation in TED-affected muscles could be derived. T2-relaxation times mirrored improvements in CAS after treatment, occasionally preceding them. Rarely, they diverged, suggesting limitations in the CAS as a disease burden marker.
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Kozaki A, Nakamura H, Inoue T. Clinical efficacy of transcutaneous triamcinolone acetonide injection for upper eyelid retraction and swelling in patients with thyroid eye disease. Int Med Case Rep J 2018; 11:325-331. [PMID: 30519121 PMCID: PMC6233704 DOI: 10.2147/imcrj.s177671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim To evaluate the efficacy of transcutaneous triamcinolone acetonide (TA) injection for the treatment of upper eyelid retraction and swelling in thyroid eye disease (TED) patients. Patients and methods This is a case series. Three euthyroid TED patients with features of both upper eyelid retraction and swelling were recruited. TED signs appeared within 6 months prior to treatment. Next, 0.5 mL of TA (40 mg/mL) was transcutaneously injected targeting the orbital fat around the levator palpebrae superioris (LPS) muscle. At each visit, eyelid retraction was evaluated by palpebral fissure height and the presence of scleral show above the superior corneoscleral limbus. Eyelid swelling was judged by the appearance of upper eyelid bulging and the lack of an eyelid sulcus. In addition, the LPS muscle, orbital and retro-orbicularis oculi fat were observed using MRI before and after treatment. Results Two patients had resolution of their upper lid retraction and swelling within 12 months. In the other patient who had proptosis, eyelid retraction resolved, while eyelid swelling remained mild. In all cases, MRI revealed that treatment resulted in thinner LPS muscle and reduced fat swelling. In addition, both high-intensity signals on T2 images and prolonged T2 relaxation time were normalized. No adverse signs were observed. Conclusion Transcutaneous TA injection was effective as a treatment for upper eyelid retraction and swelling in euthyroid TED patients who had signs within 6 months prior to treatment. Transcutaneous TA injection induced reduction of LPS muscle enlargement and fat tissue swelling. These reductions by transcutaneous TA injection were verified using MRI.
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Hiwatashi A, Togao O, Yamashita K, Kikuchi K, Momosaka D, Honda H. Diffusion-weighted magnetic resonance imaging of extraocular muscles in patients with Grave's ophthalmopathy using turbo field echo with diffusion-sensitized driven-equilibrium preparation. Diagn Interv Imaging 2018; 99:457-463. [DOI: 10.1016/j.diii.2018.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 12/26/2022]
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Watanabe M, Buch K, Fujita A, Jara H, Qureshi MM, Sakai O. Quantitative MR imaging of intra-orbital structures: Tissue-specific measurements and age dependency compared to extra-orbital structures using multispectral quantitative MR imaging. Orbit 2017; 36:189-196. [PMID: 28436752 DOI: 10.1080/01676830.2017.1310254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The orbit can be affected by unique pathologic conditions and often requires MRI evaluation. The purpose of this study was to investigate the age-related changes in multiple intra-orbital structures using quantitative MRI (qMRI). Thirty-eight subjects (20 males, 18 females; ages 0.5-87 years) underwent MRI with a mixed turbo spin echo sequence. T1 and T2 measurements were obtained within ROI in 6 intra-orbital structures (medial and lateral rectus muscles, medial and lateral retrobulbar fat, lacrimal gland, and optic nerve), and compared with those of corresponding extra-orbital structures (masseter muscle, subcutaneous cheek fat, buccal fat, parotid gland, and frontal white matter). Statistical analyses were performed using Pearson's correlation coefficients. T1 and T2 values of the extra-ocular muscles increased with age, with higher T1 and T2 values compared to the masseter muscles. Retrobulbar fat showed significant age-associated increases in T1 values in the lateral side and in T2 values in both sides. T1 and T2 values in the lacrimal gland increased with age, while the parotid gland showed an age-associated increase in T2 values and decrease in T1 values. Optic nerves demonstrated age-related changes, similar to that of frontal white matter; rapid decreases with age in T1 and T2 times in early stages of life, and slight increases in T1 and T2 times later in life. Intra-orbital structures demonstrated specific qMRI measurements and aging patterns, which were different from extra-orbital structures. Location-specific age-related changes of intra-orbital structures should be considered in the qMRI assessment of the orbital pathology.
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Affiliation(s)
- Memi Watanabe
- a Department of Radiology, Boston Medical Center , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Karen Buch
- a Department of Radiology, Boston Medical Center , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Akifumi Fujita
- a Department of Radiology, Boston Medical Center , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Hernán Jara
- a Department of Radiology, Boston Medical Center , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Muhammad Mustafa Qureshi
- a Department of Radiology, Boston Medical Center , Boston University School of Medicine , Boston , Massachusetts , USA
- b Department of Radiation Oncology , Boston Medical Center, Boston University School of Medicine , Boston , Massachusetts , USA
| | - Osamu Sakai
- a Department of Radiology, Boston Medical Center , Boston University School of Medicine , Boston , Massachusetts , USA
- b Department of Radiation Oncology , Boston Medical Center, Boston University School of Medicine , Boston , Massachusetts , USA
- c Department of Otolaryngology - Head and Neck Surgery , Boston Medical Center, Boston University School of Medicine , Boston , Massachusetts , USA
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He Y, Mu K, Liu R, Zhang J, Xiang N. Comparison of two different regimens of intravenous methylprednisolone for patients with moderate to severe and active Graves' ophthalmopathy: a prospective, randomized controlled trial. Endocr J 2017; 64:141-149. [PMID: 27853049 DOI: 10.1507/endocrj.ej16-0083] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The intravenous methylprednisolone (iv MP) strategy for Graves' ophthalmopathy (GO) and evaluation of its activity against the disease warrants further exploration. A prospective randomized controlled trial for 3 months was performed in a tertiary referral teaching hospital to compare the efficacy and safety of two different regimens of iv MP, and determine the value of clinical activity score (CAS) and T2 relaxation time (T2RTs) and areas of extraocular muscles (EOMs) by magnetic resonance imaging for diagnosis of active GO. Forty patients with moderate to severe GO and CAS ≥ 3 or 1 ≤ CAS < 3 with prolonged T2RTs on EOMs were randomly assigned to a monthly (MR: 1.5 g iv MP monthly for 3 months) or weekly (WR: 0.5 g iv MP weekly for 6 weeks, followed by 0.25 g weekly for 6 weeks) regimen. Overall response based on ophthalmic symptoms, T2RTs, areas of EOMs and adverse effects were recorded at each visit. The total rate of response was 71.9%. Rates of improved, unchanged, deteriorated were similar between the MR and WR groups (p>0.05). The maximum T2RTs and areas significantly decreased at the end of intervention in both groups (p<0.05). Results show that both MR and WR are effective and safe in treatment of GO. T2RTs combined with CAS can sensitively detect active GO and predict the response to iv MP.
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Affiliation(s)
- Yebing He
- Department of Endocrinology and Metabolism, The Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430030, P.R. China
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Kaichi Y, Tanitame K, Itakura H, Ohno H, Yoneda M, Takahashi Y, Akiyama Y, Awai K. Orbital Fat Volumetry and Water Fraction Measurements Using T2-Weighted FSE-IDEAL Imaging in Patients with Thyroid-Associated Orbitopathy. AJNR Am J Neuroradiol 2016; 37:2123-2128. [PMID: 27365323 DOI: 10.3174/ajnr.a4859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/08/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The quantitative evaluation of orbital fat proliferation and edema and the assessment of extraocular muscles are useful for diagnosing and monitoring thyroid-associated orbitopathy. To evaluate therapy-induced quantitative changes in the orbital fat of patients with thyroid-associated orbitopathy, we performed volumetric and water fraction measurements by using T2-weighted FSE iterative decomposition of water and fat with echo asymmetry and least-squares estimation (FSE-IDEAL) imaging. MATERIALS AND METHODS Orbital FSE-IDEAL images of 30 volunteers were acquired twice within 1 week. Nine patients with thyroid-associated orbitopathy underwent FSE-IDEAL imaging before and after methylprednisolone pulse therapy, and the treatment results were assessed by using their pre- and post-methylprednisolone pulse therapy clinical activity scores. We performed volumetric and water fraction measurements of orbital fat by using FSE-IDEAL imaging and evaluated interscan differences in the volunteers. In patients with thyroid-associated orbitopathy, we compared pre- and posttherapy orbital fat measurements and assessed the correlation between the pretherapy values and clinical activity score improvement. RESULTS The reproducibility of results obtained by the quantitative evaluation of orbital fat in volunteers was acceptable. After methylprednisolone pulse therapy, the water fraction in the orbital fat of patients with thyroid-associated orbitopathy was significantly decreased (P < .001). There was a significant positive correlation between the pretherapy water fraction and clinical activity score improvement (right, r = 0.82; left, r = 0.79) and a significant negative correlation between the pretherapy volume and clinical activity score improvement (bilateral, r = -0.84). CONCLUSIONS Volumetric and water fraction measurements of orbital fat by using FSE-IDEAL imaging are feasible and useful for monitoring the effects of therapy and for predicting the response of patients with thyroid-associated orbitopathy to methylprednisolone pulse therapy.
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Affiliation(s)
- Y Kaichi
- From the Department of Diagnostic Radiology (Y.K., K.A.), Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - K Tanitame
- Department of Radiology (K.T.), Chugoku Rosai Hospital, Kure, Japan
| | - H Itakura
- Department of Ophthalmology and Visual Science (H.I.)
| | - H Ohno
- Department of Molecular and Internal Medicine (H.O., M.Y.), Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - M Yoneda
- Department of Molecular and Internal Medicine (H.O., M.Y.), Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Y Takahashi
- Department of Clinical Radiology (Y.T., Y.A.), Hiroshima University Hospital, Hiroshima, Japan
| | - Y Akiyama
- Department of Clinical Radiology (Y.T., Y.A.), Hiroshima University Hospital, Hiroshima, Japan
| | - K Awai
- From the Department of Diagnostic Radiology (Y.K., K.A.), Graduate School and Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Schiffman JS, Sales-Sanz M, Rebolleda G, Pass AF, Cruz RA, Tang RA. Thyroid orbitopathy. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.13.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Pająk M, Loba P, Wieczorek-Pastusiak J, Antosik-Biernacka A, Stefańczyk L, Majos A. Signal intensity and T2 time of extraocular muscles in assessment of their physiological status in MR imaging in healthy subjects. Pol J Radiol 2012; 77:7-12. [PMID: 23269930 PMCID: PMC3529717 DOI: 10.12659/pjr.883622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/04/2012] [Indexed: 12/25/2022] Open
Abstract
Background: Lack of standardised orbital MR protocols leads to a situation, when each institution/centre may arbitrarily choose sequence parameters. Therefore, the results obtained and published by the authors may not be compared freely, and what is most important may not be considered fully reliable. Signal intensity (IS) and T2 time (T2) are important parameters in estimation of inflammatory processes of extraocular muscles in the clinical practice. The aim of this study was to determine the reference values (i.e. cut-off values) for absolute signal intensity and T2 relaxation time in healthy subjects, their relativised values to white matter (WM) and temporal muscles (TM) and to evaluate the correlation between those parameters. Material/Methods: The orbital examination was performed in healthy volunteers according to the protocol prepared in the Radiology-Imaging Diagnostic Department of the Medical University of Lodz for patients with suspected/diagnosed thyroid orbitopathy. Using two of the standard sequences IS and T2 time were calculated for the muscles and two relativisation tissues in realtion to WM and TM. Subsequently cut-off values for healthy volunteers were calculated. Results: The differences between muscles for IS, IS MAX, IS/TM, IS/WM, IS MAX/TM, IS MAX/WM and T2 MAX/WM were not statistically significant. Therefore one cut-off value of these parameters for all the rectus muscles was calculated. T2-relaxation time and T2 relativised to white matter had to be calculated separately for each muscle. Conclusions: No statistical correlation was found between IS and T2-time for extraocular muscles in healthy volunteers. We calculated the reference ranges (cut-off values) for absolute IS and T2-time values and relativised parameters. In the clinical practice the objectification of IS and T2-time values should be done to WM, than to IS or T2 of the temporal muscle. The T2 MAX/WM seems to have the highest clinical utility for the assessment of the pathophysiological status of extraocular muscles.
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Affiliation(s)
- Michał Pająk
- Department of Radiology - Diagnostic Imaging Medical University, ŁódŸ, Poland
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Krueger PC, Stachs O, Hadlich S, Falke K, Erbersdobler A, Hosten N, Langner S. MR Microscopy of the human eye at 7.1 T and correlation with histopathology-proof of principle. Orbit 2012; 31:390-393. [PMID: 23231062 DOI: 10.3109/01676830.2012.723783] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) at 1.5 and 3.0 Tesla with small surface coils is a well-established procedure in the diagnosis of masses of the eye and orbital cavity. Until now histological examination has been required to obtain definitive information on tumor extent or possible infiltration of surrounding structures. With ultra-high-field MRI, however, it is possible to evaluate tumor morphology as well as possible extension into surrounding structures with submillimeter spatial resolution. MATERIALS AND METHODS We present a female patient with a uveal melanoma who underwent a preoperative MRI at 1.5 T (spatial resolution = 0.9 x 0.9 x 4 mm/voxel). Postoperatively, the enucleated specimen was examined in a 7.1 Tesla high-field MRI scanner (slice thickness = 500 µm, matrix size = 512 x 512 pixels, spatial resolution = 78 x 78 x 500 µm/voxel, acquisition time = 8:20 min per plane). Finally, the specimen was examined histologically, and the histological and MRI results were correlated. RESULTS Ultra-high-field MRI at 7.1 Tesla visualized the uveal melanoma and anatomical structures of the bulb with high resolution, enabling definitive assessment of tumor morphology and extent. Subsequent histological examination confirmed the MRI findings regarding origin, internal structure, and extent of the tumor. CONCLUSION MR microscopy correlates strongly with histology, suggesting that this new imaging modality has the potential for noninvasively assessing tumor morphology, extent, and infiltration of surrounding structures. The examination was performed ex vivo and demonstrates that diagnostic assessment of malignant masses is feasible using high-resolution MR microscopy.
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Affiliation(s)
- Paul-Christian Krueger
- Department of Radiology and Neuroradiology, Ernst-Moritz-Arndt-University, Greifswald, Germany.
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Retrobulbar vasculature using 7-T magnetic resonance imaging with dedicated eye surface coil. Graefes Arch Clin Exp Ophthalmol 2012; 251:271-7. [DOI: 10.1007/s00417-012-2154-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 07/24/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022] Open
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[Short-tau inversion-recovery (STIR) sequence magnetic resonance imaging evaluation of orbital structures in Graves' orbitopathy]. ACTA ACUST UNITED AC 2011; 86:351-7. [PMID: 22040641 DOI: 10.1016/j.oftal.2011.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 05/18/2011] [Accepted: 06/14/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the orbital structures and to establish correlations with disease activity and severity in patients with Graves' hyperthyroidism and orbitopathy (GO) using short-tau inversion-recovery (STIR) sequence magnetic resonance imaging (MRI). METHODS Observational, cross-sectional, case-control study. Twenty-eight patients with euthyroid status after treatment and GO (GO group) and 15 control subjects (control group) were included. Patients underwent a complete ophthalmologic examination and were then assessed according to the EUGOGO (European Group on Graves' Orbitopathy) recommendations. Muscle cross-sectional areas, orbital tissue volumes and the signal intensity ratio (SIR) from the most inflamed extraocular muscle were calculated using a STIR-T2 weighted sequence MRI. Correlations between clinical and MRI measurements were analyzed. RESULTS Enlargements in the cross-sectional areas and volumes were significant for most EOMs (P<.001), but not for the lateral rectus muscle cross-sectional area. A significant difference in SIR values between patients with GO and control subjects (P<.001) was found. No significant correlations were found between muscle cross-sectional areas, orbital tissue volumes, SIR values and the clinical activity parameters. CONCLUSIONS Given the small sample size of our study, with the obvious need for larger clinical trials, we were unable to demonstrate that the STIR sequences in MRI are a sensitive tool in assessing patients with longstanding GO in order to detect inflammatory changes and activity follow-up, possibly because it is in inactive phase. Meanwhile, it is still necessary to continue performing a thorough clinical evaluation in the therapeutic management of GO.
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Iván Villaseca C. Tratamiento quirúrgico del estrabismo en la enfermedad de graves. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
Thyroid eye disease (TED) is the most common cause of proptosis in adults, and should always be a consideration in patients with unexplained diplopia, pain, or optic nerve dysfunction. At least 80% of TED is associated with Graves disease (GD), and at least 50% of patients with GD develop clinically evident symptomatic TED. The most confusing patients for doctors of all subspecialties are the patients with eye symptoms and signs that precede serum evidence of a thyroid imbalance. Management of TED may include immunosuppressive medications, radiation, or surgery. Although the prognosis for optic nerve function is excellent, the restrictive dysmotility can result in permanent disability. Orbit and eyelid reconstruction are reserved for stable, inactive patients and are the final steps in minimizing facial alterations and enhancing the patient's daily functioning.
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Tachibana S, Murakami T, Noguchi H, Noguchi Y, Nakashima A, Ohyabu Y, Noguchi S. Orbital magnetic resonance imaging combined with clinical activity score can improve the sensitivity of detection of disease activity and prediction of response to immunosuppressive therapy for Graves' ophthalmopathy. Endocr J 2010; 57:853-61. [PMID: 20733265 DOI: 10.1507/endocrj.k10e-156] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to demonstrate that the addition of orbital magnetic resonance (MR) imaging can provide improvement in sensitivity of detection of active disease and the prediction of the response to intravenous glucocorticoid therapy (ivGC), over clinical activity score (CAS) alone. A prospective case series was studied at our institution. Forty eight patients were examined by CAS and orbital MR imaging. The maximum of T2 relaxation times of extraocular muscles (maxT2RT) and other parameters were evaluated by MR imaging. Thirty five of 48 patients underwent ivGC. Twenty of 35 patients, whose CAS was 2 points or less, were evaluated for the response to ivGC. The correlation between CAS and maxT2RT was evaluated. Differentiation of active and inactive GO was performed by CAS and orbital MR imaging. The response to ivGC was evaluated by CAS, orbital MR imaging and ophthalmic parameters. As a result, CAS and maxT2RT showed significant positive correlation (r=0.58, p<0.0001), and 15 patients were positive by CAS and orbital MR imaging. However, 20 patients were positive by only MR imaging. In those 20 patients, there was significant improvement after ivGC. We concluded that orbital MR imaging combined with CAS could improve the sensitivity of detection of active disease and the prediction of the response to ivGC. In addition, even if only one parameter of CAS is positive, further examination with orbital MR imaging is advised.
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Affiliation(s)
- Seigo Tachibana
- Department of Endoclinology, Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan.
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Correlation of signal intensity ratio on orbital MRI-TIRM and clinical activity score as a possible predictor of therapy response in Graves’ orbitopathy—a pilot study at 1.5 T. Neuroradiology 2009; 52:91-7. [DOI: 10.1007/s00234-009-0590-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 08/18/2009] [Indexed: 10/20/2022]
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Abstract
A oftalmopatia tireoidea é doença orbitária autoimune intimamente associada com o hipertireoidismo, porém podendo existir separadamente. Pode preceder, coincidir ou suceder o início da disfunção tireoidea, raramente ocorrendo em eutireoideos ou hipotireoideos. Os músculos extraoculares são os principais alvos acometidos e tornam-se aumentados de volume, determinando oftalmoplegia e proptose. Outros sinais importantes incluem retração palpebral, hiperemia conjuntival e edema periorbitário. Perda visual pode ocorrer se há compressão do nervo óptico no ápice orbitário. A oftalmopatia tireoidea é caracterizada por inflamação, congestão, hipertrofia e fibrose da gordura e músculos orbitários. A atividade da doença é dividida em fase aguda ou inflamatória, seguida pela fase inativa associada com alterações fibróticas e infiltração gordurosa. O diagnóstico é clínico, e quando este é difícil ou se suspeita de neuropatia óptica os métodos de imagem são indicados. A tomografia computadorizada e a ressonância magnética podem confirmar o diagnóstico e avaliar a área crítica do ápice orbitário. A ressonância magnética é superior, em virtude da resolução tecidual e da sua capacidade de avaliar a atividade da doença (mediante sequências com TR longo) e detectar alterações inflamatórias, auxiliando o planejamento terapêutico no momento certo, melhorando o prognóstico.
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Lennerstrand G, Tian S, Isberg B, Landau Högbeck I, Bolzani R, Tallstedt L, Schworm H. Magnetic resonance imaging and ultrasound measurements of extraocular muscles in thyroid-associated ophthalmopathy at different stages of the disease. ACTA ACUST UNITED AC 2007; 85:192-201. [PMID: 17305734 DOI: 10.1111/j.1600-0420.2006.00807.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess extraocular muscle (EOM) involvement in thyroid-associated orbitopathy (TAO) of different stages with magnetic resonance imaging (MRI) and ultrasound techniques. METHODS A total of 32 patients with TAO were divided into three groups according to whether they had mild active, pronounced active or longstanding inactive disease. Six patients with Graves' disease but no clinical signs of TAO and 10 healthy control subjects were also studied. Muscle volume and cross-sectional area were measured with MRI. A-scan ultrasound was used to measure muscle thickness. RESULTS The average MRI volume and maximal cross-sectional area of the EOM were significantly larger in patients with pronounced active and longstanding inactive TAO than in control subjects. Increased average muscle thickness measured by ultrasound was found mainly in patients with longstanding disease. Muscle enlargement was seen with MRI and ultrasound in individual patients in all patient groups, including those with Graves' disease but no TAO. Bilateral muscle enlargement was revealed by MRI in about two-thirds of patients with mild active TAO and in all patients with pronounced active and longstanding inactive TAO. Bilateral involvement estimated with ultrasound was less common in all patient groups. The MRI and ultrasound findings were not well correlated in any patient group. CONCLUSIONS Extraocular muscle enlargement was seen in all patient groups with TAO of differing levels of severity. Measurements with MRI of muscle volume or maximal cross-sectional area are considered good indicators of muscle enlargement in TAO.
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Affiliation(s)
- Gunnar Lennerstrand
- Department of Ophthalmology, St Erik's Eye Hospital, Karolinska Institutet, Stockholm, Sweden
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Kubota T, Kano H. Assessment of inflammation in idiopathic orbital myositis with fat-suppressed T2-weighted magnetic resonance imaging. Am J Ophthalmol 2007; 143:718-20. [PMID: 17386294 DOI: 10.1016/j.ajo.2006.11.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 11/09/2006] [Accepted: 11/14/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the inflammation in idiopathic orbital myositis by fat-suppressed T2-weighted magnetic resonance imaging (MRI). DESIGN Observational case series. METHODS The inflammation in nine patients with orbital myositis was evaluated with fat-suppressed T2-weighted MRI within three weeks of onset. Patients were mainly treated with steroid pulse therapy and followed to the acute improvement or chronic ocular motility restriction phases. RESULTS Each patient was found to have localized inflammations in the extraocular muscles or associated fascial structures. Of the five patients with acute improvement, none had inflammation of the extraocular muscles, whereas the four patients with chronic ocular motility restriction had inflammation of the extraocular muscles. CONCLUSION These results suggest that acute or chronic pattern in orbital myositis is correlated with the localized inflammation. The inflammation in the extraocular muscles may be one of the factors that lead to the chronic ocular motility restriction.
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Georgouli T, James T, Tanner S, Shelley D, Nelson M, Chang B, Backhouse O, McGonagle D. High-resolution microscopy coil MR-Eye. Eye (Lond) 2007; 22:994-6. [PMID: 17332767 DOI: 10.1038/sj.eye.6702755] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The eye is involved in several pathologies where precise identification of the underlying condition is essential for the optimal patient care. This preliminary report presents the potential of high-resolution microscopy coil magnetic resonance imaging (HR-MRI) to undertake this task being actively used in the clinical setting. We used a commercially available MRI scanner and a microscopy surface coil. Exquisite anatomic detail of the eye and orbit with depiction of previously unobserved structures and clear demonstration of the underlying pathology was achieved. This report supports the idea that orbital imaging can be revolutionized with the introduction of HR-MRI with broad clinical implications.
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Affiliation(s)
- T Georgouli
- Eye Department, School of Medicine, University of Leeds, UK.
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Kousoubris PD, Rosman DA. Radiologic Evaluation of Lacrimal and Orbital Disease. Otolaryngol Clin North Am 2006; 39:865-93, vi. [PMID: 16982252 DOI: 10.1016/j.otc.2006.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article discusses the evaluation of specific lacrimal disorders and orbital trauma using CT, MRI, and other radiologic techniques.
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Affiliation(s)
- Philip D Kousoubris
- Neuroradiology Division, Department of Diagnostic Radiology, Lahey Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
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Mayer EJ, Fox DL, Herdman G, Hsuan J, Kabala J, Goddard P, Potts MJ, Lee RWJ. Signal intensity, clinical activity and cross-sectional areas on MRI scans in thyroid eye disease. Eur J Radiol 2005; 56:20-4. [PMID: 15896938 DOI: 10.1016/j.ejrad.2005.03.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2004] [Revised: 03/22/2005] [Accepted: 03/25/2005] [Indexed: 10/25/2022]
Abstract
The signal intensity from inflamed extra-ocular muscles on short tau inversion recovery (STIR)-sequence magnetic resonance imaging (MRI) is known to correlate with clinical scores of thyroid eye disease (TED) severity. Twenty-one patients who had undergone repeated MRI scanning for TED were studied retrospectively. Signal intensity of extra-ocular muscles (from STIR-sequence MRI) and cross-sectional area (from STIR and T1 MRI) were correlated with Mourits' clinical activity score (CAS). The area of highest signal intensity within the most inflamed extra-ocular muscle, and the average cross-sectional signal intensity of the most inflamed extra-ocular muscle reliably correlated with CAS, and this was maintained as disease activity changed over time. In contrast, isolated measures of muscle cross-sectional area did not correlate with CAS. The extra-ocular muscle cross-sectional area calculated from STIR-sequence MR images was greater than that measured on T1 images. This suggests that muscle area from STIR-sequence MRI may also detect peri-muscular inflammation. We conclude that the peak signal intensity from the most inflamed extra-ocular muscle remains the most reliable correlate of clinical disease activity obtained from these images. STIR-sequence MRI scans provide a number of useful measures of disease activity in TED.
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Affiliation(s)
- E J Mayer
- Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1 2LX, UK
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Lee JM, Kim YK, Kim SW, Han JK, Kim SH, Choi BI. Combined radiofrequency ablation and acetic acid hypertonic saline solution instillation: an in vivo study of rabbit liver. Korean J Radiol 2004; 5:31-8. [PMID: 15064557 PMCID: PMC2698111 DOI: 10.3348/kjr.2004.5.1.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to determine whether combined radiofrequency ablation (RFA) and acetic acid-hypertonic saline solution (AHS) instillation can increase the extent of thermally mediated coagulation in in vivo rabbit liver tissue. We also wished to determine the optimal concentration of the solution in order to maximize its effect on extent of the RFA-induced coagulation. Materials and Methods Forty thermal ablation zones were produced in 40 rabbits by using a 17-gauge internally cooled electrode with a 1-cm active tip under ultrasound guidance. The rabbits were assigned to one of four groups: group A: RFA alone (n=10); group B: RFA with 50% AHS instillation (n=10); group C: RFA with 25% AHS instillation (n=10); group D: RFA with 15% AHS instillation (n=10). A range of acetic acid concentrations diluted in 36% NaCl to a total volume of 1 mL were instilled into the liver before RFA. The RF energy (30 W) was applied for three minutes. After RFA, in each group, the maximum diameters of the thermal ablation zones in the gross specimens were compared. Technical success and the complications that arose were evaluated by CT and on the basis of autopsy findings. Results All procedures are technically successful. There were six procedure-related complications (6/40; 15%): two localized perihepatic hematomas and four chemical peritonitis. The incidence of chemical peritonitis was highest for group B with the 50% AHS solution instillation (30%). With instillation of 15% AHS solution, a marked decrease of tissue impedance (24.5 ± 15.6 Ω) and an increase of current (250 mA) occurred as compared to RFA alone. With instillation of the solutions before RFA (group B, C and D), this produced a greater mean diameter of coagulation necrosis than the diameters for rabbits not instilled with the solution (group A) (p < 0.05). However, there was no significant difference between group B, C, and D. Conclusion Combined AHS instillation and RFA can increase the dimension of coagulation necrosis in the liver with a single application. A low concentration of AHS (15%) showed similar effects in increasing the extent of RF-induced coagulation, but there were less side effects as compared to the high concentration of AHS.
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Affiliation(s)
- Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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37
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Abstract
Orbital ultrasound, computed tomography, and magnetic resonance are commonly used as imaging techniques to demonstrate pathological changes in ocular adnexa of patients with Graves' ophthalmopathy. Low cost, short time of investigation, and lack of radiation characterize ultrasound. Nevertheless, a clear differentiation regarding disease activity is not possible, nor is the evaluation of orbital tissue precise enough. Short investigation time, precise imaging of the orbital apex and moderate costs are advantages of tomography. This method delivers a significant radiation dose to the lens, which if repeated constitutes a risk for cataract development. For this reason, magnetic resonance imaging is preferable, particularly if repeated scans are required to assess response to treatment. Precise tissue differentiation and lack of ionizing radiation uniquely suit magnetic resonance for eye studies. Although sensitive in demonstrating interstitial edema within the rectos muscles in active disease, as well as providing a good predictive value with respect to immunosuppressive therapy, quantitative magnetic resonance imaging is an expensive method and is non-specific for the orbital changes in ophthalmopathy. Because of a favorable target to background ratio, octreoscan carries a high sensitivity and may be regarded as a semi-objective tool in the evaluation of patients with Graves' ophthalmopathy, both at initial stages as well as during treatment. A positive orbital octreoscan indicates a clinically active disease in which immunosuppressive treatment might be of therapeutic benefit. However, it is an expensive method with a non-negligible radiation burden. Also, it is neither specific nor does it offer detailed orbital imaging. In summary, in unclear cases of proptosis or recently developed diplopia, prior to orbital decompression surgery, or if imaging is needed in subjects with ophthalmopathy, magnetic resonance actually is the imaging method of choice.
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Affiliation(s)
- G J Kahaly
- Department of Medicine I, Gutenberg-University, Mainz, Germany.
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Cakirer S, Cakirer D, Basak M, Durmaz S, Altuntas Y, Yigit U. Evaluation of extraocular muscles in the edematous phase of Graves ophthalmopathy on contrast-enhanced fat-suppressed magnetic resonance imaging. J Comput Assist Tomogr 2004; 28:80-6. [PMID: 14716237 DOI: 10.1097/00004728-200401000-00013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Extraocular muscles (EOMs) reveal characteristic contrast-enhancement patterns on magnetic resonance (MR) imaging due to their rich vascular supply. The objective of this study was to evaluate contrast-enhancement patterns of EOMs in patients with edematous phase of Graves ophthalmopathy (GO) using contrast-enhanced fat-suppressed MR imaging in comparison with normal volunteers. METHODS EOMs of 15 patients with edematous phase of GO and those of 15 normal volunteers were evaluated using coronal T1-weighted MR images with fat suppression before and after intravenous administration of gadolinium. The image sequence was a fast spin-echo with chemical shift selective fat saturation. The degree of contrast enhancement for EOMs and temporal muscles (TMs) was assessed via a 4-step grading system and by 2 reviewers. RESULTS There were statistically significant differences for the degrees of contrast enhancement in all EOMs between the patients with GO and normal volunteers. The degrees of contrast enhancement for all EOMs were significantly decreased in patients with edematous phase of GO. CONCLUSIONS The microcirculation within the EOMs tends to be impaired during the progress of disease, and the MR imaging pattern gives a semiquantitative measurement of the microcirculatory impairment of the EOMs during the edematous phase of the disease.
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Affiliation(s)
- Sinan Cakirer
- Neuroradiology Section, Department of Radiology, Istanbul Sisli Etfal Hospital, 67 Ada, Kardenel 4/2, Daire 37, 81120 Atasehir-Istanbul, Turkey.
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Aydin K, Güven K, Sencer S, Cikim A, Gül N, Minareci O. A new MRI method for the quantitative evaluation of extraocular muscle size in thyroid ophthalmopathy. Neuroradiology 2003; 45:184-7. [PMID: 12684723 DOI: 10.1007/s00234-002-0930-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2002] [Accepted: 10/31/2002] [Indexed: 11/28/2022]
Abstract
In cross section, extraocular muscles are more or less elliptical, with short and long diameters. We studied the ratio (R) of short to long diameter and investigated its use in quantitative assessment of the extraocular muscles in patients with Graves's disease. We measured the diameters on T1-weighted axial and coronal MRI and computed R for each extraocular muscle in 80 patients without and 40 with Graves's disease. We compared the measurements and R of the right and left orbits, and of men and women. The short diameter of all extraocular muscles apart from the superior oblique showed significant differences between men and women, and that of the inferior rectus varied significantly with age. R, however, was unrelated to sex or age. All patients with Graves's disease and an increased short diameter also had an increased R, but 6% of the muscles showed an increase in R, even though their short diameter was within the normal range.
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Affiliation(s)
- K Aydin
- Department of Radiology, Istanbul Medical School, Istanbul University, Capa, Turkey.
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Ott M, Breiter N, Albrecht CF, Pradier O, Hess CF, Schmidberger H. Can contrast enhanced MRI predict the response of Graves' ophthalmopathy to orbital radiotherapy? Br J Radiol 2002; 75:514-7. [PMID: 12124238 DOI: 10.1259/bjr.75.894.750514] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to try to determine by means of contrast-enhanced MRI, a subset of patients with Graves' ophthalmopathy who will not respond to orbital radiotherapy. 54 patients with Graves' ophthalmopathy were treated with orbital radiotherapy (10 x 2 Gy) and symptom relief was recorded. MRI examinations prior to radiotherapy were retrospectively evaluated for enlargement, contrast enhancement and fibrotic changes in extraocular muscles and surrounding soft tissue. Imaging data were correlated with clinical features and response. Symptom relief was observed in 61% of patients but this could not be predicted by any of the MRI signs investigated. However, there is a trend for a better treatment reponse in patients who show contrast enhancement of extraocular muscles prior to orbital radiotherapy (p=0.08). MRI could not adequately predict the efficacy of orbital radiotherapy in this group of patients. Clinical assessment of disease activity is still the most reliable method.
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Affiliation(s)
- M Ott
- Departments of Radiotherapy and Neuroradiology, University Hospital, 37075 Göttingen, Germany
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Abstract
The major focus of this study is to evaluate the ophthalmic surgery performed to treat patients with various eye changes of dysthyroid ophthalmopathy (DO) in Japan. The medical charts of DO cases that underwent eye surgery at the Olympia Eye Hospital in 1999 were reviewed. In 1999, 898 patients underwent ophthalmologic examination at the thyroid eye clinic in our hospital, and 51 cases were excluded out of the first visiting cases because they were hyperthyroid only and not associated with ophthalmopathy. This study consists of 847 cases (151 male, 696 female), mean age of 40.9 +/- 14.7 years, age distribution of 10-84 years. Surgical therapy was used on 129 eyes of 93 cases (11%) among the 847 patients. Orbital decompression was performed on 26 eyes of 15 cases. Most Japanese patients are not associated with a strong degree of proptosis, showing on average less than 20 mm. Cases with 25 mm of proptosis were scarcely observed. Extraocular muscle surgery was performed on 84 eyes of 60 cases (bilateral 17 cases, unilateral 33 cases). Types of diplopia are as follows: upward gaze, 28 cases; outward gaze, 10 cases; downward gaze, 2 cases; and complex type, 10 cases. Concerning the pathogenesis of diplopia in DO, fibrotic change plays a dominant role, in which cicatrical adhesion to the surface of the muscle is always observed in extraocular muscle surgery. After removal of cicatrical adhesion, the forced duction is completely recovered. This explains the precise mechanism of this involvement. Eyelid surgery was used on 39 eyes of 30 cases (upper eyelid, 33 eyes; lower eyelid, 6 eyes). Eyelid surgery was indicated for treatment of various anterior eye changes including upper eyelid retraction, entropion of eyelids. Better results and few complications are considered attributable to the stabilization of orbitopathy.
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Firbank MJ, Coulthard A. Evaluation of a technique for estimation of extraocular muscle volume using 2D MRI. Br J Radiol 2000; 73:1282-9. [PMID: 11205672 DOI: 10.1259/bjr.73.876.11205672] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Measurements of extraocular muscle volume may be useful as an outcome indicator in the assessment of treatment options in thyroid-associated ophthalmopathy. In this study, a technique for estimating extraocular muscle volume from two-dimensional T1 weighted MR images acquired in the coronal plane is described. For each image slice, the cross-sectional area of individual extraocular muscles was estimated using a combination of semi-automated outlining based on a local thresholding technique and manual outlining where thresholding was not possible. The technique was assessed using three sets of images: a computer-generated virtual image set with "extraocular muscles" of known volumes; a set of images from 19 biochemically and clinically euthyroid patients; and images from 7 patients with thyroid-associated ophthalmopathy. From the computer-generated images, the accuracy was determined as 7.6%. Intraobserver agreement was investigated using repeated MRI scans on a single subject and repeat outlining of muscles on five sets of images from different subjects. The mean difference between repeat measurements was 2% (SD 5.9%). We conclude that two-dimensional MR images can be used to determine changes in muscle volume of greater than 12% during treatment of thyroid-associated ophthalmopathy.
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Affiliation(s)
- M J Firbank
- University Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Durak H, Söylev M, Durak I, Değirmenci B, Capa Kaya G, Uysal B. Tc-99m polyclonal human immunoglobulin G imaging in Graves' ophthalmopathy. Clin Nucl Med 2000; 25:704-7. [PMID: 10983759 DOI: 10.1097/00003072-200009000-00011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors evaluated the utility of Tc-99m-labeled human immunglobulin G (HIG) in determining the severity of orbital inflammation and the relation of orbital Tc-99m HIG uptake and clinical parameters in patients with Graves' ophthalmopathy. MATERIALS AND METHODS Images were obtained in 23 patients (13 women, 10 men; mean age, 51+/-10 years) with Graves' ophthalmopathy. Planar orbital images were obtained and SPECT was performed using a triple-detector gamma camera 4 hours after 370 MBq (10 mCi) Tc-99m HIG injection. Tc-99m HIG uptake was classified using transaxial and coronal slices as 1, mild; 2, moderate; and 3, severe. The clinical severity of orbital disease was categorized, according to the criteria described by Feldon and Unsold, as class I, mild involvement; class II, moderate; and class III, severe. Disease was considered to be clinically inactive if symptoms and signs were stable or improved in the last two examinations performed at least 6 months apart. RESULTS Sixteen patients were clinically inactive, and seven patients were active. The mean Tc-99m HIG classes were 1.5+/-0.5 and 2.6+/-0.5, respectively (P = 0.02). There was not a good correlation between the clinical classification and Tc-99m HIG classification, whereas the presence of active disease showed a good correlation with Tc-99m HIG classification (r = 0.703; P = 0.0002). CONCLUSIONS Tc-99m HIG imaging showed possible ongoing subclinical inflammation in the orbits of the patients with Graves' ophthalmopathy regardless of the clinical classification. Tc-99m HIG SPECT seems a promising procedure for evaluating the presence of active orbital inflammation.
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Affiliation(s)
- H Durak
- Dokuz Eylül University Medical School, Department of Nuclear Medicine, Inciralt, Izmir, Turkey.
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Kung AW, Michon J, Tai KS, Chan FL. The effect of somatostatin versus corticosteroid in the treatment of Graves' ophthalmopathy. Thyroid 1996; 6:381-4. [PMID: 8936659 DOI: 10.1089/thy.1996.6.381] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Uncontrolled study has demonstrated the usefulness of somatostatin in the treatment of mild Graves' ophthalmopathy (GO). We performed a prospective study to evaluate the usefulness of somatostatin as compared to corticosteroid in the treatment of moderately severe GO. All patients were rendered euthyroid and observed for 3 months to exclude spontaneous improvement without active treatment. They were randomized to receive either somatostatin (SS, octreotide 200 micrograms q8h subcutaneously, n = 8) or corticosteroid (CS, prednisone 1 mg/kg/day in decreasing doses, n = 10). Assessments of soft tissue inflammation, exophthalmos, palpebral aperture, intraocular pressure, diplopia, cornea, and visual acuity were made every 4 weeks for 3 months. MRI of the orbit was performed before and after treatment. Both SS and CS therapy decreased the palpebral aperture and activity score after 3 months (p < 0.05), but those treated with CS had a lower activity score after treatment when compared to SS [2.5 (1-7) v.s. 3.5 (0-4), median (range), p < 0.05]. Only CS, but not SS, was able to reduce intraocular pressure and muscle size as documented by MRI, but no significant reduction in proptosis was observed in either group. Also, patients' self-assessments of the eye changes after treatment were similar between the two groups. Both groups showed significant elevation of urinary glycosaminoglycan (GAG) excretion before therapy (SS 24.6 +/- 10.8; CS 27.8 +/- 11.4 mg/24 h), which was reduced after treatment (SS 12.5 +/- 7.3; CS 10.8 +/- 6.3 mg/24 h, p < 0.05). However, no significant correlation could be observed between the degree of GAG reduction and the clinical outcome of the patients. In conclusion, the long acting SS octreotide was effective in reducing soft tissue inflammation and providing symptomatic relief in GO but not as effective as corticosteroid in reducing muscle size. In view of the minimal side-effects and similar efficacy as compared to corticosteroid in patients with minimal extraocular muscle enlargement, it is suggested that a trial of SS may be considered in selected patients with GO.
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Affiliation(s)
- A W Kung
- Department of Medicine, University of Hong Kong, Hong Kong
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DEMER JOSEPHL, KERMAN BARRYM. Comparison of Standardized Echography With Magnetic Resonance Imaging to Measure Extraocular Muscle Size: Author Reply. Am J Ophthalmol 1995. [DOI: 10.1016/s0002-9394(14)71195-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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