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Alkhadrawi AM, Lin LY, Langarica SA, Kim K, Ha SK, Lee NG, Do S. Deep-Learning Based Automated Segmentation and Quantitative Volumetric Analysis of Orbital Muscle and Fat for Diagnosis of Thyroid Eye Disease. Invest Ophthalmol Vis Sci 2024; 65:6. [PMID: 38696188 PMCID: PMC11077914 DOI: 10.1167/iovs.65.5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Purpose Thyroid eye disease (TED) is characterized by proliferation of orbital tissues and complicated by compressive optic neuropathy (CON). This study aims to utilize a deep-learning (DL)-based automated segmentation model to segment orbital muscle and fat volumes on computed tomography (CT) images and provide quantitative volumetric data and a machine learning (ML)-based classifier to distinguish between TED and TED with CON. Methods Subjects with TED who underwent clinical evaluation and orbital CT imaging were included. Patients with clinical features of CON were classified as having severe TED, and those without were classified as having mild TED. Normal subjects were used for controls. A U-Net DL-model was used for automatic segmentation of orbital muscle and fat volumes from orbital CTs, and ensemble of Random Forest Classifiers were used for volumetric analysis of muscle and fat. Results Two hundred eighty-one subjects were included in this study. Automatic segmentation of orbital tissues was performed. Dice coefficient was recorded to be 0.902 and 0.921 for muscle and fat volumes, respectively. Muscle volumes among normal, mild, and severe TED were found to be statistically different. A classification model utilizing volume data and limited patient data had an accuracy of 0.838 and an area under the curve (AUC) of 0.929 in predicting normal, mild TED, and severe TED. Conclusions DL-based automated segmentation of orbital images for patients with TED was found to be accurate and efficient. An ML-based classification model using volumetrics and metadata led to high diagnostic accuracy in distinguishing TED and TED with CON. By enabling rapid and precise volumetric assessment, this may be a useful tool in future clinical studies.
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Affiliation(s)
- Adham M. Alkhadrawi
- Department of Radiology, Lab of Medical Imaging and Computation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Lisa Y. Lin
- Department of Ophthalmology, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Saul A. Langarica
- Department of Radiology, Lab of Medical Imaging and Computation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kyungsu Kim
- Department of Radiology, Lab of Medical Imaging and Computation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sierra K. Ha
- Department of Ophthalmology, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Nahyoung G. Lee
- Department of Ophthalmology, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States
| | - Synho Do
- Department of Radiology, Lab of Medical Imaging and Computation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- KU-Korea Institute of Science and Technology (KIST) Graduate School of Converging Science and Technology, Korea University, Seoul, Korea
- Kempner Institute, Harvard University, Boston, Massachusetts, United States
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Lv X, Gao Y, Ma Y, Li C, Ren Y, Zhang Z, Bao Y, Su S, Lu R. Comparison of surgical effect in active and inactive Dysthyroid Optic Neuropathy after Endoscopic Transnasal Medial Orbital Decompression. Graefes Arch Clin Exp Ophthalmol 2024; 262:281-293. [PMID: 37530848 DOI: 10.1007/s00417-023-06187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/03/2023] Open
Abstract
PURPOSE To evaluate and compare the changes in orbital soft tissue volume and visual function after endoscopic transnasal medial orbital decompression in patients with active and inactive dysthyroid optic neuropathy (DON). METHODS This prospective, cohort study recruited 112 patients (112 eyes) with DON who were divided into an active and inactive DON group (56 eyes each) by clinical activity scores. All patients underwent endoscopic transnasal medial orbital decompression. The pre- and post-operative orbital soft tissue volumes were measured with high-resolution computed tomography (CT) using Mimics software. Visual function, including best-corrected visual acuity (BCVA), visual field (VF), and visual evoked potential (VEP), was recorded before and after surgery. RESULTS Preoperatively, compared with the inactive DON group, the active DON group had greater extraocular muscle volume (EMV) and EMV/orbital volume (OV) ratio, but worse BCVA, VF, and exophthalmos. Postoperatively, although the EMV slightly increased, with the enlarged medial rectus muscle contributing dramatically, the EMV/OV ratio decreased in patients with DON. Besides, visual function including BCVA, VF, VEP and exophthalmos was also improved in both groups after surgery. There were no significant differences in postoperative OV; EMV; EMV/OV ratio; and the BCVA, VF, and VEP parameters between both groups (all P > 0.05). CONCLUSION Patients with DON who did not respond well to steroids, regardless of disease activity, may benefit from orbital decompression via the decrease in the proportion of EMV in OV, especially patients with active DON, who showed more improved visual function than patients with inactive DON.
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Affiliation(s)
- Xi Lv
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yang Gao
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yujun Ma
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Cheng Li
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yi Ren
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Zhihui Zhang
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Yuekun Bao
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Shicai Su
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China
| | - Rong Lu
- Department of Orbital Diseases and Ocular Oncology, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.
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Increased Orbital Muscle Fraction Diagnosed by Semi-Automatic Volumetry: A Risk Factor for Severe Visual Impairment with Excellent Response to Surgical Decompression in Graves’ Orbitopathy. J Pers Med 2022; 12:jpm12060937. [PMID: 35743721 PMCID: PMC9224537 DOI: 10.3390/jpm12060937] [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: 05/01/2022] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
Graves’ orbitopathy (GO) leads to increased orbital tissue and causes symptoms such as exophthalmos, functional complaints, or dysthyroid optic neuropathy. Different GO types with fat and/or muscle enlargement were identified, and increased muscle appears to particularly influence visual status and treatment response. The current study examines visual parameters dependent on orbital muscle volume fraction in a surgically treated GO cohort. After volumetric analysis of the preoperative orbital content, 83 orbits in 47 patients were categorized into predefined groups (increased or not-increased muscle fraction). All cases underwent pterional orbital decompression, and pre- and postoperative visual status was retrospectively analyzed. Forty-one orbits revealed increased and 42 orbits revealed not-increased muscle volume (mean fraction 29.63% versus (vs.) 15.60%). The preoperative visual acuity (VA) was significantly lower in orbits with increased vs. not-increased muscle volume (mean VA 0.30 vs. 0.53, difference 2.5 lines). After surgery, mean VA improved significantly by 1.7 lines in orbits with increased muscle volume. Not preoperative, but postoperative exophthalmos was significantly lower in orbits with not-increased muscle volume. Increased orbital muscle is associated with significantly reduced VA, but can be remarkably improved by pterional orbital decompression. Therefore, surgical therapy should be considered particularly in decreased VA with orbital muscle enlargement.
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Law JJ, Mundy KM, Kupcha AC, Chaganti S, Nelson KM, Harrigan RL, Landman BA, Mawn LA. Correlation of Automated Computed Tomography Volumetric Analysis Metrics With Motility Disturbances in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2021; 37:372-376. [PMID: 33229950 DOI: 10.1097/iop.0000000000001880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The authors sought to examine relationships between CT metrics derived via an automated method and clinical parameters of extraocular muscle changes in thyroid eye disease (TED). METHODS CT images of 204 orbits in the setting of TED were analyzed with an automated segmentation tool developed at the institution. Labels were applied to orbital structures of interest on the study images, which were then registered against a previously established atlas of manually indexed orbits derived from 35 healthy individuals. Point-wise correspondences between study and atlas images were then compared via a fusion algorithm to highlight metrics of interest where TED orbits differed from healthy orbits. RESULTS Univariate analysis demonstrated several correlations between CT metrics and clinical data. Metrics pertaining to the extraocular muscles-including average diameter, maximum diameter, and muscle volume-were strongly correlated (p < 0.05) with the presence of ocular motility deficits with regards to the superior, inferior, and lateral recti (with exception of superior rectus motility deficits being mildly correlated with muscle volume [p = 0.09]). Motility defects of the medial rectus were strongly correlated with muscle volume, and only weakly correlated with average and maximum muscle diameter. CONCLUSIONS The novel method of automated imaging metrics may provide objective, rapid clinical information which may have utility in prevention and recognition of visual impairments in TED before they reach an advanced or irreversible stage and while they are able to be improved with immunomodulatory treatments.
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Affiliation(s)
- James J Law
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center
- Vanderbilt University School of Medicine; Departments of
| | - Kevin M Mundy
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center
| | - Anna C Kupcha
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center
- Vanderbilt University School of Medicine; Departments of
| | | | | | | | | | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center
- Vanderbilt University School of Medicine; Departments of
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Garau LM, Manca G, Bola S, Aringhieri G, Faggioni L, Volterrani D. Correlation between 18F-FDG PET/CT and diffusion-weighted MRI parameters in head and neck squamous cell carcinoma at baseline and after chemo-radiotherapy. A retrospective single institutional study. Oral Radiol 2021; 38:199-209. [PMID: 34133000 DOI: 10.1007/s11282-021-00545-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The relationship between glucose metabolism and tumor cellularity before chemo-radiotherapy in patients with head and neck squamous cell carcinoma (SCC) has never been compared with that of patients evaluated after treatment. This retrospective study analyzed the correlation between glucose metabolism parameters expressed by standardized uptake value (SUV) derived from 18F-fluorodeoxyglucose (18F-FDG) PET/CT and cellularity tumor parameters expressed by apparent diffusion coefficients (ADC) derived from diffusion-weighted (DW) MRI in untreated and treated patients with head and neck SCC. METHODS In 19 patients with no previous exposure to any treatment and 17 different chemo-radiotreated patients with head and neck SCC, we correlated the semi-quantitative uptake values (SUVmax, SUVpeak, and SUVmean) with the ADC functional parameters (ADCmin, ADCmean) including the standard deviation of ADC values (ADCsd). RESULTS No significant correlation was found between glucose metabolism parameters and ADCmin or ADCmean in untreated and treated patient groups. However, in untreated patients, significant inverse correlations were found between ADCsd and SUVmax (P = 0.039, r = -0.476), SUVpeak (P = 0.003, r = -0.652) and SUVmean (P = 0.039, r = -0.477). Analyses after chemo-radiotherapy in 17 patients showed no significant correlation between glucose metabolism parameters and DW MRI values, excluding a persistent significant (but lower intensity) inverse correlation between SUVpeak and ADCsd (P = 0.033, r = -0.519). CONCLUSIONS The demonstrated relationships suggest complex interactions especially between metabolic activity and heterogeneity of tumoral tissue, which might play a complementary role in the assessment of head and neck SCC. TRIAL DATE OF REGISTRATION AND REGISTRATION NUMBER Our retrospective study was registered on April 9th, 2020 by the Ethics Committee of the Coordinating Center "Area Vasta Nord Ovest" (CEAVNO) with Registration Number CEAVNO09042020.
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Affiliation(s)
- Ludovico M Garau
- Department of Radiology, Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy.
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy.
| | - Gianpiero Manca
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Stefano Bola
- Department of Radiology, Nuclear Medicine Unit, University Hospital of Parma, Parma, Italy
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giacomo Aringhieri
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
| | - Lorenzo Faggioni
- Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Duccio Volterrani
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy
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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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Assessment of Orbital Computed Tomography (CT) Imaging Biomarkers in Patients with Thyroid Eye Disease. J Digit Imaging 2021; 32:987-994. [PMID: 31197558 DOI: 10.1007/s10278-019-00195-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To understand potential orbital biomarkers generated from computed tomography (CT) imaging in patients with thyroid eye disease. This is a retrospective cohort study. From a database of an ongoing thyroid eye disease research study at our institution, we identified 85 subjects who had both clinical examination and laboratory records supporting the diagnosis of thyroid eye disease and concurrent imaging prior to any medical or surgical intervention. Patients were excluded if imaging quality or type was not amenable to segmentation. The images of 170 orbits were analyzed with the developed automated segmentation tool. The main outcome measure was to cross 25 CT structural metrics for each eye with nine clinical markers using a Kendall rank correlation test to identify significant relationships. The Kendall rank correlation test between automatically calculated CT metrics and clinical data demonstrated numerous correlations. Extraocular rectus muscle metrics, such as the average diameter of the superior, medial, and lateral rectus muscles, showed a strong correlation (p < 0.05) with loss of visual acuity and presence of ocular motility defects. Hertel measurements demonstrated a strong correlation (p < 0.05) with volumetric measurements of the optic nerve and other orbital metrics such as the crowding index and proptosis. Optic neuropathy was strongly correlated (p < 0.05) with an increase in the maximum diameter of the superior muscle. This novel method of automated imaging metrics may provide objective, rapid clinical information. This data may be useful for appreciation of severity of thyroid eye disease and recognition of risk factors of visual impairment from dysthyroid optic neuropathy from CT imaging.
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Hu YF, Hua L, Tuo X, Shi TT, Yang YL, Liu YF, Yan ZY, Xin Z. Preliminary evidence of the association between DNAm and orbital volumetry in GO. Endocr Connect 2020; 9:EC-20-0147.R2. [PMID: 32508316 PMCID: PMC7354721 DOI: 10.1530/ec-20-0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The pathogenesis underlying the alterations of orbital architecture in Graves' orbitopathy (GO) is not yet fully understood. The present study aimed to investigate the association of DNA methylation in peripheral blood and orbital volumetry in Chinese patients with GO. METHODS A total of 35 GO subjects (70 orbits) were subjected to computed tomography (CT) scan. The total cross-sectional area of the extraocular muscles (orbital muscles, OM), total orbit area (TOA), and the exophthalmometry were measured, and OM/TOA ratio was calculated. Targeted bisulfite sequencing was performed on seven candidate genes. RESULTS No significant correlation was established between the DNA methylation levels of these genes and exophthalmometry. The MBP methylation level was found to be correlated with OM/TOA ratio (P<0.05). Multiple linear regression analysis on parameters, including age, sex, TRAb, duration of GO, and DNA methylation levels of seven genes with OM/TOA ratio confirmed that MBP and OM/TOA ratio had a significant correlation (P<0.05). The partial least squares analysis showed that the top three genes with the highest loadings were MBP, BOLL, and BECN1, and OM/TOA ratio affected the DNA methylation block than exophthalmometry. CONCLUSIONS This study provided preliminary evidence that MBP is a potential gene associated with OM enlargement in GO patients according to the combination of DNA methylation sequencing and orbital CT measurement.
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Affiliation(s)
- Ya-Fen Hu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Endocrinology, The People’s Hospital of Daxing District, Beijing, China
| | - Lin Hua
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Xiu Tuo
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ting-Ting Shi
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi-Lin Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yun-Fu Liu
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhong-Yu Yan
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Zah-Bi G, Abeillon-du Payrat J, Vie AL, Bournaud-Salinas C, Jouanneau E, Berhouma M. Minimal-Access Endoscopic Endonasal Management of Dysthyroid Optic Neuropathy: The Dysthone Study. Neurosurgery 2020; 85:E1059-E1067. [PMID: 31393984 DOI: 10.1093/neuros/nyz268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 04/16/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Dysthyroid optic neuropathy (DON) is a devastating complication of thyroid eye disease. Corticosteroids are the primary medical treatment for DON, but some refractory patients may require surgical management. OBJECTIVE To evaluate the efficacy of endoscopic endonasal decompression of the orbital apex in refractory DON. METHODS This study included patients with refractory DON who underwent endoscopic endonasal decompression of the orbital apex from February 2015 to October 2016. A total of 23 orbital apices were decompressed across 17 patients. Visual acuity, ophthalmometry, tonometry, and visual field were evaluated at the preoperative, early and delayed postoperative stages. Statistical analyses were performed using RStudio software. A Wilcoxon test for matched data was performed to determine if there was a statistically significant difference between pre- and postsurgical treatment for the following items: visual acuity, proptosis, visual field, and intraocular pressure. RESULTS Visual acuity improved in 69.5% of the cases with a mean gain of 2.5 points ± 1.6 (P < .05). Additionally, there was an 18.3% reduction in mean proptosis across all cases (P < .05) and a 13.7% decrease in intraocular pressure (P < .05) for all patients. Finally, visual field improved in 82.6% (P < .05) of the cases. The mean time for follow-up was of 6.28 ± 3.7 mo. There were 3 cases of transient postoperative rhinitis and 2 cases of transient diplopia. Two patients experienced recurrence at 4 and 8 mo, respectively. CONCLUSION Endoscopic endonasal decompression of the orbital apex significantly improves visual parameters. As a result, multidisciplinary screening for patients is crucial to ensure prompt surgical decompression.
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Affiliation(s)
- Gilles Zah-Bi
- Department of Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Anne Laure Vie
- Department of Neuro-Ophthalmology, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | - Claire Bournaud-Salinas
- Department of Nuclear Medicine, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France
| | - Moncef Berhouma
- Department of Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, Lyon, France.,Laboratory CREATIS, CNRS UMR5220, INSERM U1206, Lyon 1 University, INSA, Villeurbanne, France
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Chaganti S, Nelson K, Mundy K, Harrigan R, Galloway R, Mawn LA, Landman B. Imaging biomarkers in thyroid eye disease and their clinical associations. J Med Imaging (Bellingham) 2018; 5:044001. [PMID: 30345325 PMCID: PMC6191037 DOI: 10.1117/1.jmi.5.4.044001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 08/23/2018] [Indexed: 04/14/2024] Open
Abstract
The purpose of this study is to understand the phenotypes of thyroid eye disease (TED) through data derived from a multiatlas segmentation of computed tomography (CT) imaging. Images of 170 orbits of 85 retrospectively selected TED patients were analyzed with the developed automated segmentation tool. Twenty-five bilateral orbital structural metrics were used to perform principal component analysis (PCA). PCA of the 25 structural metrics identified the two most dominant structural phenotypes or characteristics, the "big volume phenotype" and the "stretched optic nerve phenotype," that accounted for 60% of the variance. Most of the subjects in the study have either of these characteristics or a combination of both. A Kendall rank correlation between the principal components (phenotypes) and clinical data showed that the big volume phenotype was very strongly correlated ( p - value < 0.05 ) with motility defects, and loss of visual acuity. Whereas, the stretched optic nerve phenotype was strongly correlated ( p - value < 0.05 ) with an increased Hertel measurement, relatively better visual acuity, and smoking. Two clinical subtypes of TED, type 1 with enlarged muscles and type 2 with proptosis, are recognizable in CT imaging. Our automated algorithm identifies the phenotypes and finds associations with clinical markers.
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Affiliation(s)
- Shikha Chaganti
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | - Katrina Nelson
- Vanderbilt University, Department of Electrical Engineering, Nashville, Tennessee, United States
| | - Kevin Mundy
- Vanderbilt University, School of Medicine, Vanderbilt Eye Institute, Nashville, Tennessee, United States
| | - Robert Harrigan
- Vanderbilt University, Department of Electrical Engineering, Nashville, Tennessee, United States
| | - Robert Galloway
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Louise A. Mawn
- Vanderbilt University, School of Medicine, Vanderbilt Eye Institute, Nashville, Tennessee, United States
| | - Bennett Landman
- Vanderbilt University, Department of Electrical Engineering, Nashville, Tennessee, United States
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Daldoul N, Knani L, Gatfaoui F, Mahjoub H. [Management of moderate and severe dysthyroid orbitopathy: about 22 cases]. Pan Afr Med J 2017; 27:257. [PMID: 29187926 PMCID: PMC5660303 DOI: 10.11604/pamj.2017.27.257.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/16/2017] [Indexed: 11/12/2022] Open
Abstract
Décrire la prise en charge thérapeutique des orbitopathies dysthyroidiennes modérées et sévères et évaluer par une étude statistique les facteurs associés à la neuropathie optique ainsi que les facteurs de mauvais pronostic visuel. Nous avons mené une étude rétrospective sur 22 patients présentant une ophtalmopathie dysthyroidienne modérée à sévère sur au moins un oeil, hospitalisés au service d'ophtalmologie du CHU Farhat Hached Sousse, sur une période s'étalant de 1998 à 2015. Les indications thérapeutiques sont basées sur les critères d'activité et de sévérité de l'Eugogo ainsi que l'évaluation des facteurs de mauvais pronostic visuel. L'âge moyen de nos patients était de 40 ans avec une légère prédominance masculine (54.5%). 68.2% des patients étaient en euthyroidie, 18.2% étaient tabagique. Le facteur le plus associé significativement à la neuropathie est la compression au niveau de l'apex orbitaire (P = 0.03). Le traitement était basé sur la corticothérapie intraveineuse et/ou la décompression orbitaire en fonction de l'activité et la sévérité de la maladie. L'évolution globale après traitement a été marquée par une amélioration des signes inflammatoires, réduction de l'exophtalmie. Le pronostic visuel était plus mauvais chez les patients plus âgés (P = 0.0001), de sexe masculin (P = 0.03) et traités par irathérapie (P = 0.04). Dans les limites d'une étude rétrospective, nos résultats étaient globalement concordants avec la littérature. L'orbitopathie dysthyroidienne reste une maladie dont l'évaluation et la prise en charge thérapeutique sont non encore bien élucidées. Des études de cohortes, probablement multicentriques, sont à envisager pour améliorer la prise en charge.
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Affiliation(s)
- Nadia Daldoul
- Service d'Ophtalmologie, CHU Farhat Hached, Sousse, Tunisie
| | - Leila Knani
- Service d'Ophtalmologie, CHU Farhat Hached, Sousse, Tunisie
| | - Faten Gatfaoui
- Service d'Ophtalmologie, CHU Farhat Hached, Sousse, Tunisie
| | - Hechmi Mahjoub
- Service d'Ophtalmologie, CHU Farhat Hached, Sousse, Tunisie
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Quantitative analysis of orbital soft tissues on computed tomography to assess the activity of thyroid-associated orbitopathy. Graefes Arch Clin Exp Ophthalmol 2016; 255:413-420. [DOI: 10.1007/s00417-016-3538-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 09/20/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022] Open
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Chaganti S, Nelson K, Mundy K, Luo Y, Harrigan RL, Damon S, Fabbri D, Mawn L, Landman B. Structural Functional Associations of the Orbit in Thyroid Eye Disease: Kalman Filters to Track Extraocular Rectal Muscles. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2016; 9784. [PMID: 27127330 DOI: 10.1117/12.2217299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pathologies of the optic nerve and orbit impact millions of Americans and quantitative assessment of the orbital structures on 3-D imaging would provide objective markers to enhance diagnostic accuracy, improve timely intervention and eventually preserve visual function. Recent studies have shown that the multi-atlas methodology is suitable for identifying orbital structures, but challenges arise in the identification of the individual extraocular rectus muscles that control eye movement. This is increasingly problematic in diseased eyes, where these muscles often appear to fuse at the back of the orbit (at the resolution of clinical computed tomography imaging) due to inflammation or crowding. We propose the use of Kalman filters to track the muscles in three-dimensions to refine multi-atlas segmentation and resolve ambiguity due to imaging resolution, noise, and artifacts. The purpose of our study is to investigate a method of automatically generating orbital metrics from CT imaging and demonstrate the utility of the approach by correlating structural metrics of the eye orbit with clinical data and visual function measures in subjects with thyroid eye disease. The pilot study demonstrates that automatically calculated orbital metrics are strongly correlated with several clinical characteristics. Moreover, the superior, inferior, medial and lateral rectus muscles obtained using Kalman filters are each correlated with different categories of functional deficit. These findings serve as foundation for further investigation in the use of CT imaging in the study, analysis and diagnosis of ocular diseases, specifically thyroid eye disease.
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Affiliation(s)
- Shikha Chaganti
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Katrina Nelson
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Kevin Mundy
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, 2311 Pierce Avenue, Nashville, TN USA 37232
| | - Yifu Luo
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Robert L Harrigan
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Steve Damon
- Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
| | - Daniel Fabbri
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, 2525 West End Avenue Nashville, TN USA 37203
| | - Louise Mawn
- Vanderbilt Eye Institute, Vanderbilt University School of Medicine, 2311 Pierce Avenue, Nashville, TN USA 37232
| | - Bennett Landman
- Computer Science, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235; Electrical Engineering, Vanderbilt University, 2301 Vanderbilt Place, Nashville, TN USA 37235
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