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Pu XY, Chen L, Hu H, Wu Q, Jiang WH, Lu JL, Chen HH, Xu XQ, Wu FY. Dixon MRI-based quantitative parameters of extraocular muscles, intraorbital fat, and lacrimal glands for staging thyroid-associated ophthalmopathy. Insights Imaging 2024; 15:136. [PMID: 38853188 PMCID: PMC11162983 DOI: 10.1186/s13244-024-01693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/08/2024] [Indexed: 06/11/2024] Open
Abstract
OBJECTIVE To investigate the value of Dixon magnetic resonance imaging (MRI)-based quantitative parameters of extraocular muscles (EOMs), intraorbital fat (IF), and lacrimal glands (LGs) in staging patients with thyroid-associated ophthalmopathy (TAO). METHODS Two hundred patients with TAO (211 active and 189 inactive eyes) who underwent Dixon MRI for pretreatment evaluation were retrospectively enrolled and divided into training (169 active and 151 inactive eyes) and validation (42 active and 38 inactive eyes) cohorts. The maximum, mean, and minimum values of the signal intensity ratio (SIR), fat fraction (FF), and water fraction (WF) of EOMs, IF, and LGs were measured and compared between the active and inactive groups in the training cohort. Binary logistic regression analysis, receiver operating characteristic curve analysis, and the Delong test were used for further statistical analyses, as appropriate. RESULTS Compared with inactive TAOs, active TAOs demonstrated significantly greater EOM-SIRmax, EOM-SIRmean, EOM-SIRmin, IF-SIRmax, IF-SIRmean, LG-SIRmax, LG-SIRmean, EOM-WFmean, EOM-WFmin, IF-WFmax, IF-WFmean, and LG-WFmean and lower EOM-FFmax, EOM-FFmean, IF-FFmean, IF-FFmin, and LG-FFmean values (all p < 0.05). The EOM-SIRmean, LG-SIRmean, and LG-FFmean values were independently associated with active TAO (all p < 0.05). The combination of the EOM-SIRmean, LG-SIRmean, and LG-FFmean values showed better performance than the EOM-SIRmean value alone in staging TAO in both the training (AUC, 0.820 vs 0.793; p = 0.016) and validation (AUC, 0.751 vs 0.733, p = 0.341) cohorts. CONCLUSION Dixon MRI-based parameters of EOMs, LGs, and IF are useful for differentiating active from inactive TAO. The integration of multiple parameters can further improve staging performance. CRITICAL RELEVANCE STATEMENT In this study, the authors explored the combined value of quantitative parameters of EOMs, IF, and LGs derived from Dixon MRI in staging TAO patients, which can support the establishment of a proper therapeutic plan. KEY POINTS The quantitative parameters of EOMs, LGs, and IF are useful for staging TAO. The EOM-SIRmean, LG-SIRmean, and LG-FFmean values were found to independently correlate with active TAO. Joint evaluation of orbital tissue improved the ability to assess TAO activity.
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Affiliation(s)
- Xiong-Ying Pu
- 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
| | - Hao Hu
- 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
| | - Wen-Hao Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jin-Ling Lu
- 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
| | - 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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Caltabiano C, Rana K, Beecher MB, Selva D. Radiological measurements of lacrimal gland in thyroid eye disease. Int Ophthalmol 2024; 44:11. [PMID: 38319433 PMCID: PMC10847191 DOI: 10.1007/s10792-024-02991-4] [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: 05/30/2023] [Accepted: 10/19/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE Lacrimal gland enlargement is a common feature of thyroid eye disease (TED) and has been positively correlated with the clinical activity score. Although lacrimal gland volume is the preferred measure of lacrimal gland size, its calculation is not clinically translatable due to the expertise, time and advanced software required. The aim of our study is to determine whether the lacrimal gland volume in patients with TED undergoing magnetic resonance imaging (MRI) can be estimated using simpler lacrimal gland linear and area measurements. METHODS A retrospective review of 102 orbits (51 patients) with TED who underwent orbital MRI was conducted. The maximum length, width, and area of the lacrimal gland were measured in axial and coronal sections. Lacrimal gland volume was calculated by using a manual segmentation technique on all consecutive axial slices on commercially available software, OsiriX. All quantitative measurements were correlated with the lacrimal gland volume. RESULTS Mean age of participants was 59 ± 16 years, and 67% (n = 34) were females. With multivariate analyses, combined lacrimal gland axial and coronal areas strongly correlated with volume (r = 0.843, p < 0.01). Strong univariate predictors of volume included axial area (r = 0.704, p < 0.01) and coronal area (r = 0.722, p < 0.01), while moderate predictors included axial length (r = 0.523, p < 0.01), axial width (r = 0.521, p < 0.01), coronal length (r = 0.450, p < 0.01), and coronal width (r = 0.649, p < 0.01). CONCLUSION In patients with thyroid eye disease, lacrimal gland volume can be estimated using axial and coronal areas, which is simpler and more time efficient than calculating volumes.
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Affiliation(s)
- Carmelo Caltabiano
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
| | - Khizar Rana
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Mark B Beecher
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Dinesh Selva
- Discipline of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia
- South Australian Institute of Ophthalmology, Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
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Lai EW, Tai YH, Wu HL, Dai YX, Chen TJ, Cherng YG, Lai SC. The Association between Autoimmune Thyroid Disease and Ocular Surface Damage: A Retrospective Population-Based Cohort Study. J Clin Med 2023; 12:jcm12093203. [PMID: 37176642 PMCID: PMC10179488 DOI: 10.3390/jcm12093203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/27/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Autoimmune thyroid diseases (ATDs) are potentially connected to lacrimal gland dysfunction and ocular surface disruption. This study aimed to evaluate the relationships between ATD, dry eye disease (DED), and corneal surface damage. In a matched nationwide cohort study, we used Taiwan's National Health Insurance research database to compare the incidences of DED and corneal surface damage between subjects with and without ATD. Multivariable Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the ophthalmological outcomes. A total of 50,251 matched pairs with 748,961 person-years of follow-up were included for analysis. The incidence of DED was 16.37 and 8.36 per 1000 person-years in the ATD and non-ATD groups, respectively. ATDs were significantly associated with increased DED (aHR: 1.81, 95% CI: 1.73-1.89, p < 0.0001). This association was generally consistent across the subgroups of age, sex, different comorbidity levels, and use of systemic corticosteroids or not. Furthermore, patients with ATD had a higher risk of corneal surface damage compared with non-ATD subjects (aHR: 1.31, 95% CI: 1.19-1.44, p < 0.0001), including recurrent corneal erosions (aHR: 2.00, 95% CI: 1.66-2.41, p < 0.0001) and corneal scars (aHR: 1.26, 95% CI: 1.01-1.59, p = 0.0432). Other independent factors for corneal surface damage were age, sex, diabetes mellitus, Charlson Comorbidity Index scores, and use of systemic corticosteroids. Our results suggested that ATDs were associated with higher risks of DED and corneal surface damage. Considering the high prevalence of ATD, prophylactic and therapeutic strategies should be further developed to prevent irreversible vision loss in this susceptible population.
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Affiliation(s)
- Eric W Lai
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Ying-Hsuan Tai
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Hsiang-Ling Wu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ying-Xiu Dai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Dermatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu 31064, Taiwan
| | - Yih-Giun Cherng
- Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Shih-Chung Lai
- Department of Ophthalmology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
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Babić Leko M, Pleić N, Lešin M, Gunjača I, Torlak V, Škunca Herman J, Vatavuk Z, Punda A, Polašek O, Hayward C, Zemunik T. Association between Thyroid Function and Ocular Parameters. BIOLOGY 2022; 11:1847. [PMID: 36552356 PMCID: PMC9776046 DOI: 10.3390/biology11121847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
During development, thyroid hormones play an important role in eye development, while in adults, some pathological thyroid conditions can affect the normal functioning of the eyes. Thyroid eye disease is the most well-known eye pathology caused by a pathological thyroid condition. Few studies have investigated the association between ocular parameters and thyroid function. Thus, in this study, we aimed to examine whether thyroid activity affects ocular parameters. This cross-sectional study included 4633 healthy adults recruited within the 10,001 Dalmatians project of the Croatian Biobank. The plasma levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin (Tg), thyroglobulin antibodies (TgAb), and thyroid peroxidase antibodies (TPOAb) were measured by an immunoassay. We determined 20 ocular parameters for each participant (10 for each eye, including corneal radius, corneal thickness, anterior chamber depth, anterior chamber angle, lens thickness, posterior chamber length, axial length, intraocular lens power (IOL), spherical power, and cylinder power). Patients with hyperthyroidism had thicker corneas compared to euthyroid individuals. Corneal thickness was also negatively associated with plasma TSH levels. Intra-ocular lens power was higher in patients with clinical hypothyroidism, while spherical power was higher in euthyroid individuals with positive antibodies compared to euthyroid individuals. Intra-ocular lens power negatively correlated with fT4 levels, while spherical power positively correlated with TgAb, TPOAb, and Tg levels and negatively correlated with TSH levels. The anterior chamber angle was positively associated with plasma TSH levels and TPOAb levels and negatively associated with plasma fT4 levels. These findings suggest an interesting interplay between ophthalmic measures and thyroid status, detectable even in the general adult population.
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Affiliation(s)
- Mirjana Babić Leko
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Nikolina Pleić
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Mladen Lešin
- Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia
| | - Ivana Gunjača
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Vesela Torlak
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia
| | - Jelena Škunca Herman
- Department of Ophthalmology, Clinical Hospital Sisters of Mercy, 10000 Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology, Clinical Hospital Sisters of Mercy, 10000 Zagreb, Croatia
| | - Ante Punda
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia
| | - Ozren Polašek
- Department of Public Health, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
- Algebra University College, 10000 Zagreb, Croatia
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Tatijana Zemunik
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
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Takahashi Y, Vaidya A, Kakizaki H. Changes in Dry Eye Status after Steroid Pulse and Orbital Radiation Therapies in Active Thyroid Eye Disease. J Clin Med 2022; 11:jcm11133604. [PMID: 35806890 PMCID: PMC9267447 DOI: 10.3390/jcm11133604] [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: 05/02/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 02/01/2023] Open
Abstract
This prospective, observational study examined changes in dry eye status after steroid pulse and orbital radiation therapies in 16 patients (32 eyes) with active thyroid eye disease (TED). TED status was evaluated through clinical activity score (CAS), margin reflex distance (MRD)-1 and 2, presence or absence of Graefe’s sign/lid lag, and Hertel exophthalmometric value. Dry eye status was quantified through presence or absence of superior limbic keratoconjunctivitis, corneal fluorescein staining (AD score), tear break-up time, Schirmer test I results, tear meniscus height, and dry eye-related quality of life score. Meibomian gland dysfunction (MGD) was evaluated through Marx line score, eyelid abnormalities (MGD score), meibum expression score, and meibomian gland loss score. Those items were measured before and 6 months after treatment, and the results were statistically compared. Consequently, CAS significantly improved, and MRD-1 significantly decreased after treatment (p < 0.050). Although a part of MGD status improved (p < 0.050), all items regarding dry eye status did not change significantly after treatment (p > 0.050). Steroid pulse and orbital radiation therapies did not largely alter most items regarding dry eye and MGD status.
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Affiliation(s)
- Yasuhiro Takahashi
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Japan; (A.V.); (H.K.)
- Correspondence: ; Tel.: +81-561-62-3311 (ext. 12314)
| | - Aric Vaidya
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Japan; (A.V.); (H.K.)
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Kirtipur Eye Hospital, Kathmandu 44600, Nepal
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Japan; (A.V.); (H.K.)
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Ocular surface disease in thyroid eye disease: A narrative review. Ocul Surf 2022; 24:67-73. [PMID: 35167950 PMCID: PMC9058200 DOI: 10.1016/j.jtos.2022.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 01/03/2023]
Abstract
Ocular surface disease (OSD) in the setting of thyroid eye disease (TED) is traditionally thought of as a natural consequence of anatomical changes such as proptosis and corneal exposure. However, a growing body of research suggests that ocular surface inflammation and multi-factorial changes to the homeostasis of the ocular surface contribute substantially to the OSD seen in TED patients. In this paper we review the existing literature which highlights the work and existing theories underlying this new paradigm shift.
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