MR T2 relaxation time for the assessment of retrobulbar inflammation in Graves' ophthalmopathy.
Utech C I,Khatibnia U,Winter P F,Wulle K G
Thyroid : official journal of the American Thyroid Association
The results of 39 patients with severe Graves' ophthalmopathy (GO), who were monitored by magnetic resonance imaging (MRI) and tonography before and after combined immunosuppressive treatment with cyclosporine and corticosteroids, are presented. A correlation was found between the decrease in T2 relaxation time of the superior, medial, and inferior rectus muscle (p < 0.01) and the response to the immunosuppressive treatment. Muscle thickness and intraocular pressure showed less improvement (p < 0.05). The infiltrative eye signs improved partially in correlation with the T2 relaxation time. By distinguishing inflammation of the extraorbital muscles from fibrosis, the T2 relaxation time can help to select patients that benefit from immunosuppressive treatment as well as to monitor the therapeutic effect.
10.1089/thy.1995.5.185
[Prediction for effectiveness of steroid pulse therapy by MRI in Graves' ophthalmopathy].
Sato M,Hiromatsu Y,Tanaka K,Nonaka K,Kojima K,Nishimura H,Nishida H
Nihon Naibunpi Gakkai zasshi
Fifteen patients with Graves' ophthalmopathy (GO) were treated with intravenous methylprednisolone (steroid pulse therapy, 1g daily for 3 days a week, 2-4 times) and followed up by ophthalmological assessment and magnetic resonance imaging (MRI). The signal intensity of enlarged eye muscle and retrobulbar fat was examined with MRI at 0.5T with short inversion time inversion recovery (STIR) sequences. The signal intensity of eye muscle and retrobulbar fat tissue in STIR was evaluated as the ratio to cerebral substantia alba (signal intensity ratio). The thickness of enlarged eye muscle was measured by T1-weighted coronal images. The signal intensity ratios of enlarged eye muscle of GO patients were significantly higher than those of eight normal subjects. Although the signal intensity ratios of muscle and retrobulbar fat before therapy were not related to the severity of clinical findings of GO assessed by ophthalmopathy index, the initial signal intensity ratios of eye muscle and retrobulbar fat of ten patients with improved clinical findings of GO after steroid pulse therapy tended to be higher than those of five patients without improvement by the therapy. After the therapy the signal intensity ratios of muscle and retrobulbar fat were significantly decreased in ten patients with favorable response. Our data suggested that high signal intensity in STIR may reflect edema caused by acute inflammation associated with GO. In conclusion, MRI may be a useful tool for determining the indication and prognosis of steroid pulse therapy. We strongly recommend measuring the signal intensity of eye muscle as well as muscle thickness in MRI to evaluate the activity of GO.
Quantitative Assessment of Optic Nerve With Diffusion Tensor Imaging in Patients With Thyroid Orbitopathy.
Özkan Berna,Anik Yonca,Katre Büşra,Altintaş Özgül,Gençtürk Mehmet,Yüksel Nurşen
Ophthalmic plastic and reconstructive surgery
PURPOSE:To detect abnormalities of the optic nerve in patients with thyroid orbitopathy using diffusion tensor MRI. METHODS:Twenty-eight patients with Graves orbitopathy prospectively underwent diffusion tensor imaging scanning. A full ophthalmic examination including visual acuity, intraocular pressure, fundoscopy, and visual field analysis was performed. Clinical activity scores were also calculated. Fractional anisotropy (FA) and mean diffusivity values of the patients were compared with age and sex-matched healthy control subjects. RESULTS:The mean FA values were decreased and mean diffusivity values were increased significantly in patients with Graves orbitopathy compared with the control subjects (p < 0.001). There was a strong reverse correlation between the FA levels and the visual fields in 4 quadrants of the optic nerve. In addition, there was a strong correlation between the degree of proptosis and the FA values in both eyes. The mean diffusivity levels were also correlated with changes in the visual field and the degree of proptosis. CONCLUSION:FA and mean diffusivity levels measured with the diffusion tensor imaging of the thyroid orbitopathy patients were affected. The changes in diffusion tensor imaging were also correlated with the ophthalmologic tests of the patients.
10.1097/IOP.0000000000000359
Severe thyroid-associated orbitopathy in Hashimoto's thyroiditis. Report of 2 cases.
Yoshihara Ai,Yoshimura Noh Jaeduk,Nakachi Ayako,Ohye Hidemi,Sato Shiori,Sekiya Kenichi,Kosuga Yuka,Suzuki Miho,Matsumoto Masako,Kunii Yo,Watanabe Natsuko,Mukasa Koji,Inoue Yoichi,Ito Kunihiko,Ito Koichi
Endocrine journal
Thyroid-associated orbitopathy (TAO) is characterized by immune-mediated inflammation of the extraocular muscles surrounding orbital connective tissue and adipose tissue. Severe orbitopathy related to autoimmune thyroid disease often occurs in patients with Grave's disease, but it is rare in patients with Hashimoto's thyroiditis. The pathogenesis of TAO is unclear. Several studies have noted a strong correlation between the levels of antibodies to thyrotropin receptor antibody (TRAb) and TAO in Graves' disease. Mild upper eyelid retraction has been reported to be common in Hashimoto's thyroiditis patients, however severe orbitopathy is rare. We report two cases of severe TAO in patients with Hashimoto's thyroiditis who required systemic glucocorticoid therapy and orbital irradiation to treat the TAO. The activity of the TAO was high in both patients, because their clinical activity scores (CAS) for the orbitopathy were high, and magnetic resonance imaging (MRI) showed enlargement of the extraocular muscles and an increase in T2 signal intensity and prolonged T2 relaxation time which indicate an active stage of inflammation. We tested the presence of TRAb by three different assays and were negative in both patients. Since the eye muscle damage cannot be due to TSH receptor antibodies, other pathogenetic mechanisms may be responsible for the orbitopathy in patients with Hashimoto's thyroiditis.
[Short-tau inversion-recovery (STIR) sequence magnetic resonance imaging evaluation of orbital structures in Graves' orbitopathy].
Rodríguez-González N,Pérez-Rico C,López-Para Giménez R,Arévalo-Serrano J,Del Amo García B,Calzada Domingo L,Flores Ruiz L,Blanco R
Archivos de la Sociedad Espanola de Oftalmologia
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.
10.1016/j.oftal.2011.06.010
T2-relaxation mapping and fat fraction assessment to objectively quantify clinical activity in thyroid eye disease: an initial feasibility study.
Das Tilak,Roos Jonathan C P,Patterson Andrew J,Graves Martin J,Murthy Rachna
Eye (London, England)
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.
10.1038/s41433-018-0304-z
Fractional anisotropy and diffusivity changes in thyroid-associated orbitopathy.
Han Ji Sung,Seo Hyung Suk,Lee Young Hen,Lee Hwa,Suh Sang-Il,Jeong Eun-Kee,Sapkota Nabraj,Kim Ki Joon
Neuroradiology
INTRODUCTION:To investigate the extraocular muscle (EOM) changes in thyroid-associated orbitopathy (TAO) on DTI and the correlations between DTI parameters and clinical features. METHODS:Twenty TAO patients and 20 age- and sex-matched controls provided informed consent and were enrolled. Ten-directional DTI was acquired in orbit. Fractional anisotropy (FA), mean, axial, and radial diffusivities were obtained at medial and lateral EOMs in both orbits. EOM thickness was measured in patients using axial CT images. FA and diffusivities were compared between patients and controls. The relationships between DTI values and muscle thickness and exophthalmos were evaluated. DTI values compared between patients in active and inactive phases by clinical activity score of TAO. DTI values were also compared between acute and chronic stages by the duration of disease. RESULTS:In medial EOM, FA was significantly lower in patients (p < 0.001) and negatively correlated with muscle thickness (r = -0.604, p < 0.001). Radial diffusivity was significantly higher in patients (p = 0.010) and correlated with muscle thickness (r = 0.349, p = 0.027). In lateral EOM, DTI values did not differ between patients and controls. In the acute stage, the diffusivities of the medial rectus EOM were increased compared with the chronic stage. DTI values of the medial and lateral rectus EOM did not differ significantly between active and inactive phases. CONCLUSION:DTI can be used to diagnose TAO with FA and radial diffusivity change in EOM. Diffusivities can be used to differentiate acute and chronic stage of TAO. However, DTI values showed limitation in reflecting TAO activity according to the CAS.
10.1007/s00234-016-1764-0
Dixon-T2WI magnetic resonance imaging at 3 tesla outperforms conventional imaging for thyroid eye disease.
Ollitrault Alexis,Charbonneau Frédérique,Herdan Marie-Laure,Bergès Olivier,Zuber Kevin,Giovansili Lama,Launay Pauline,Savatovsky Julien,Lecler Augustin
European radiology
OBJECTIVES:To determine the diagnostic performances of a single Dixon-T2-weighted imaging (WI) sequence compared to a conventional protocol including T1-, T2-, and fat-suppressed T2-weighted MRI at 3 T when assessing thyroid eye disease (TED). MATERIALS AND METHODS:This IRB-approved prospective single-center study enrolled participants presenting with confirmed TED from April 2015 to October 2019. They underwent an MRI, including a conventional protocol and a Dixon-T2WI sequence. Two neuroradiologists, blinded to all data, read both datasets independently and randomly. They assessed the presence of extraocular muscle (EOM) inflammation, enlargement, fatty degeneration, or fibrosis as well as the presence of artifacts. The Wilcoxon signed-rank test was used. RESULTS:Two hundred six participants were enrolled (135/206 [66%] women, 71/206 [34%] men, age 52.3 ± 13.2 years). Dixon-T2WI was significantly more likely to detect at least one inflamed EOM as compared to the conventional set (248/412 [60%] versus 228/412 [55%] eyes; (p = 0.02). Dixon-T2WI was more sensitive and specific than the conventional set for assessing muscular inflammation (100% versus 94.7% and 71.2% versus 68.5%, respectively). Dixon-T2WI was significantly less likely to show major or minor artifacts as compared to fat-suppressed T2WI (20/412 [5%] versus 109/412 [27%] eyes, p < 0.001, and 175/412 [42%] versus 257/412 [62%] eyes, p < 0.001). Confidence was significantly higher with Dixon-T2WI than with the conventional set (2.35 versus 2.24, p = 0.003). CONCLUSION:Dixon-T2WI showed higher sensitivity and specificity and showed fewer artifacts than a conventional protocol when assessing thyroid eye disease, in addition to higher self-reported confidence. KEY POINTS:• Dixon-T2WI has better sensitivity and specificity than a conventional protocol for assessing inflamed extraocular muscles in patients with thyroid eye disease. • Dixon-T2WI shows significantly fewer artifacts than fat-suppressed T2WI. • Dixon-T2WI is faster and is associated with significantly higher self-reported reader confidence as compared to a conventional protocol when assessing inflammatory extraocular muscles.
10.1007/s00330-020-07540-y
Signal intensity, clinical activity and cross-sectional areas on MRI scans in thyroid eye disease.
Mayer E J,Fox D L,Herdman G,Hsuan J,Kabala J,Goddard P,Potts M J,Lee R W J
European journal of radiology
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.
10.1016/j.ejrad.2005.03.027
Magnetic resonance imaging with diffusion-weighted imaging in the evaluation of thyroid-associated orbitopathy: getting below the tip of the iceberg.
Politi Letterio Salvatore,Godi Claudia,Cammarata Gabriella,Ambrosi Alessandro,Iadanza Antonella,Lanzi Roberto,Falini Andrea,Bianchi Marzoli Stefania
European radiology
OBJECTIVES:To compare extraocular muscles (EOMs) T2, post-contrast T1 (T1Gad) signal intensity ratios (SIRs) and normalized-apparent diffusion coefficient (n-ADC) values in patients with thyroid-associated orbitopathy (TAO) at different phases of activity and severity and correlate MRI modifications to clinical evolution during follow-up. METHODS:A total of 74 TAO patients were classified as active or inactive on the basis of the clinical activity score (CAS). Severity of EOM impairment was evaluated by assigning a functional score to each rectus. T2, T1Gad SIRs and n-ADC of EOMs were compared in patients with active inflammation, those with inactive disease and 26 healthy controls, and correlated with clinical scores. MRI parameter variation was correlated with clinical modifications during follow-up. RESULTS:All MRI parameters in TAO EOMs were significantly higher than in healthy subjects and correlated with muscle dysfunction and CAS. EOMs of active patients showed higher T2 and T1Gad SIRs than those with inactive disease. The T2 SIR and n-ADC of normally functioning TAO EOMs were higher than those of healthy controls. SIRs decreased in clinically improved and clinically stable EOMs after therapy. CONCLUSIONS:T2 SIR, T1Gad SIR and n-ADC are objective measures of activity and severity of EOMs in TAO patients. MRI shows clinically silent muscle involvement and modifications. KEY POINTS:• MRI and DWI measures are objective, quantitative parameters of TAO activity and severity • MRI and DWI measures significantly correlate with clinical scores in TAO patients • MRI and DWI can identify clinically silent inflammation of deep orbital structures • MRI and DWI can depict subclinical modifications during follow-up • MRI and DWI may aid clinicians in choosing the most appropriate treatment.
10.1007/s00330-014-3103-3
Can contrast enhanced MRI predict the response of Graves' ophthalmopathy to orbital radiotherapy?
Ott M,Breiter N,Albrecht C F,Pradier O,Hess C F,Schmidberger H
The British journal of radiology
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.
10.1259/bjr.75.894.750514
Magnetic Resonance evaluation of disease activity in Graves' ophthalmopathy: T2-time and signal intensity of extraocular muscles.
Majos Agata,Pajak Michał,Grzelak Piotr,Stefańczyk Ludomir
Medical science monitor : international medical journal of experimental and clinical research
BACKGROUND:It is accepted that T2-weighted imaging can demonstrate the extent of an inflammatory process in Graves' ophthalmopathy (GO). This aim of this study was a comparative evaluation of the most commonly used indicators of extraocular muscle pathophysiology, i.e. signal intensity (SI) and T2-time (T2-t) in correlation with muscle volume (MV), and to determine the need to make the above indicators objective with regards to clinical practice. MATERIAL/METHODS:MRI examinations in a 1.5 T scanner of 40 orbits formed the study group. Quantitative assessment of the muscles was carried out using a numerical segmentation imaging technique (NSI). SI and T2-t were measured for each muscle. A standardization algorithm was applied based on T2-t and IS from the ipsilateral white matter of the frontal lobes. RESULTS:The correlation between T2-t and MV for the medial rectus and inferior rectus muscles (IRM) was at a comparatively high level (R: 0.49 and 0.47), with a value as high as R=0.58 for the superior rectus muscle. Correlation between SI and volume for these muscles was found to be at R-levels of 0.37, 0.48, and 0.46. Correction of the T2-t and SI values with use of a standardization algorithm in most cases did not change the above correlations, except for IRM. CONCLUSIONS:The parameter with the higher correlation to the symptoms of GO is T2 The value of SI as an indicator of disease intensity in GO that can be used without the use of multiple echo sequences was confirmed. It is necessary to make the above parameters objective relative to white matter when calculating IS for the inferior rectus muscle.
Novel use of non-echo-planar diffusion weighted MRI in monitoring disease activity and treatment response in active Grave's orbitopathy: An initial observational cohort study.
Lingam Ravi Kumar,Mundada Pravin,Lee Vickie
Orbit (Amsterdam, Netherlands)
AIM:To examine the novel use of non-echo-planar diffusion weighted MRI (DWI) in depicting activity and treatment response in active Grave's orbitopathy (GO) by assessing, with inter-observer agreement, for a correlation between its apparent diffusion coefficients (ADCs) and conventional Short tau Inversion Recovery (STIR) MRI signal-intensity ratios (SIRs). METHOD AND MATERIALS:A total of 23 actively inflamed muscles and 30 muscle response episodes were analysed in patients with active GO who underwent medical treatment. The MRI orbit scans included STIR sequences and non-echo-planar DWI were evaluated. Two observers independently assessed the images qualitatively for the presence of activity in the extraocular muscles (EOMs) and recorded the STIR signal-intensity (SI), SIR (SI ratio of EOM/temporalis muscle), and ADC values of any actively inflamed muscle on the pre-treatment scans and their corresponding values on the subsequent post-treatment scans. Inter-observer agreement was examined. RESULTS:There was a significant positive correlation (0.57, p < 0.001) between ADC and both SIR and STIR SI of the actively inflamed EOM. There was also a significant positive correlation (0.75, p < 0.001) between SIR and ADC values depicting change in muscle activity associated with treatment response. There was good inter-observer agreement. CONCLUSION:Our preliminary results indicate that quantitative evaluation with non-echo-planar DWI ADC values correlates well with conventional STIR SIR in detecting active GO and monitoring its treatment response, with good inter-observer agreement.
10.1080/01676830.2017.1423343
[Management of Graves' ophthalmopathy by using orbital magnetic resonance imaging].
Hiromatsu Yuji,Eguchi Hiroyuki,Tani Junichi
Nihon rinsho. Japanese journal of clinical medicine
Orbital magnetic resonance imaging (MRI) can visualize the inflamed lesions of Graves' ophthalmopathy(GO). Parasagittal, transverse and coronal sections of T1-weighted, T2-weighted and short inversion time inversion recovery(STIR) images correlate clinical manifestations with the location of the inflamed lesions. In addition, the measurement of T2 relaxation time or signal intensity ratio of the enlarged muscles in T2-weighted fat suppression images or STIR images provide a precise quantitative evaluation of disease activity and may predict the outcome of immunosuppressive therapy for GO. Thus, MRI is useful for decision-making regarding immunosuppressive therapy and prompt surgery for GO. Therefore, we recommend MRI as a useful tool for the management of GO in specialized clinics.
Evaluation of rectus extraocular muscles using dynamic contrast-enhanced MR imaging in patients with Graves' ophthalmopathy for assessment of disease activity.
Jiang Hong,Wang Zhenchang,Xian Junfang,Li Jing,Chen Qinghua,Ai Likun
Acta radiologica (Stockholm, Sweden : 1987)
BACKGROUND:It is important to assess the activity of Graves' ophthalmopathy (GO) for planning optimal treatment strategy. Dynamic contrast-enhanced MR imaging (DCE-MRI) is a technique for assessment of microcirculation status. The correlation between disease activity and the microcirculation characteristics of extraocular muscles (EOMs) has been demonstrated in GO. PURPOSE:To investigate the changes of rectus EOMs in patients with active vs. inactive GO using DCE-MRI, and to evaluate the value of DCE-MRI in assessing the activity of GO. MATERIAL AND METHODS:Rectus EOMs of 20 healthy controls, 18 patients with active GO, and 16 patients with inactive GO were studied. The signal intensity (SI) of rectus EOMs on T(2)W images was evaluated. Regions of interest were placed on each rectus on DCE-MRI images. The DCE-MRI parameters including time to peak enhancement (Tpeak), enhancement ratio (ER), and wash-out ratio (WR) were calculated. RESULTS:There were significant differences in SI and T(peak), ER and WR values among the three groups (P = 0.000). However, there was no significant difference in SI between the active and inactive groups (P = 0.07). T(peak) values of each rectus were significantly increased in inactive group compared with the active group (P < 0.05). ER and WR values of the inferior rectus and WR values of the superior rectus in inactive group were significantly lower than those in active group (P < 0.05). There was significant correlation between clinical activity score (CAS) and minimum T(peak) (minT(peak)), maximum ER (maxER) and maximum WR (maxWR) (P < 0.001). The cut-off values of minT(peak), maxER and maxWR were 156.98s, 1.31 and 13.50% respectively, giving positive predictive values of 68.00%, 88.90%, and 94.44% for the assessment of disease activity. CONCLUSION:DCE-MRI could demonstrate the microcirculatory changes of rectus EOMs in both active and inactive GO, and this MRI method is a useful tool in differentiating active from inactive GO.
10.1258/ar.2011.110431
Graves' ophthalmopathy: the role of diffusion-weighted imaging in detecting involvement of extraocular muscles in early period of disease.
Kilicarslan R,Alkan A,Ilhan M M,Yetis H,Aralasmak A,Tasan E
The British journal of radiology
OBJECTIVE:To evaluate involvement of the extraocular muscle (EOM) using diffusion-weighted imaging (DWI), to determine whether there is correlation with conventional orbital MRI and apparent diffusion coefficient (ADC) values in patients with Graves' ophthalmopathy (GO). METHODS:35 patients known clinically with GO and 21 healthy controls were studied. Patients were assessed with clinical activity scores. All subjects underwent conventional MRI and DWI study. Involvement of the EOM was evaluated. The patients were classified as involved or uninvolved on orbital MRI and their ADC values in DWI compared. RESULTS:There was significant difference in the mean ADC value of all the EOMs in patients vs controls. The ADC values of all the EOMs were higher in patients. There were significant differences in ADC values between uninvolved muscles on conventional MRI and controls for the MR, SR and LR. There was no significant difference in ADC value between the two groups when considering the IR. ADC values of medial, lateral and superior rectus muscles were increased. CONCLUSION:Increased ADC values of the EOM in patients with GO suggest that EOM damage begins at a very early stage before being detected on routine orbital MRI. The routine MRI with DWI sequence will be a useful adjunct in the selection of a group of patients most likely to benefit from early treatment. ADVANCES IN KNOWLEDGE:This study can help to evaluate the involvement of GO in early period with MRI added DWI.
10.1259/bjr.20140677
Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity.
European radiology
BACKGROUND:Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities. METHODS:Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular evaluation, and orbital MRI examination. RESULTS:No difference was found between the hormonal parameters, thyroid ultrasound-derived parameters, and thyroid-stimulating hormone (TSH) receptor (TSH-R) antibodies (TRAb) levels in group B and those in group A. The LG herniation (LGH) measurement evaluated by MRI was significantly higher in group B for both right (10.1 (7.3-17) vs. 7 (0-3.4) mm; p = 0.004) and left (8.5 (6.6-13) vs. 5.8 (0-12) mm; p = 0.026) eye than group A. A positive correlation was found between TRAb and LGH herniation (Rho 0.462, p = 0.009). CONCLUSIONS:Measurement of LGH seems to be a good marker of the disease and GO activity. KEY POINTS:• Lacrimal gland herniation is a simple index related to disease activity • Lacrimal gland herniation is correlated to TRAb levels • Lacrimal gland evaluation could be useful to differentiate active from inactive Graves ophthalmopathy in an early stage of disease.
10.1007/s00330-019-06570-5
Utility of multi-parametric quantitative magnetic resonance imaging of the lacrimal gland for diagnosing and staging Graves' ophthalmopathy.
Wu Dide,Zhu Hongzhang,Hong Shubin,Li Bin,Zou Mengsha,Ma Xiaoyi,Zhao Xiaojuan,Wan Pengxia,Yang Zhiyun,Li Yanbing,Xiao Haipeng
European journal of radiology
PURPOSE:To explore radiological changes of the lacrimal gland (LG) in Graves' ophthalmopathy (GO) based on multi-parametric quantitative MRI and its clinical utility in LG diagnosis and activity in GO. METHODS:We enrolled 99 consecutive patients with GO (198 eyes) and 12 Graves' Disease (GD) patients (24 eyes) from July 2018 to June 2020. Clinical, laboratory, and MRI data were collected at the first visit. Based on clinical activity scores, eyes with GO were subdivided into active and inactive groups. T2-relaxation time (T2) and the absolute reduction in T1-relaxation time (ΔT1) were determined. After MRI and processing, we performed descriptive data analysis and group comparisons. Novel logistic regression predictive models were developed for diagnosing and staging GO. Diagnostic performance of MRI parameters and models was assessed by receiver operating characteristic curve analysis. RESULTS:LG in GO group had significantly higher T2 and ΔT1 values than the GD group [106.25(95.30,120.21) vs. 83.35(78.15,91.45), P<0.001, and 662.62(539.33,810.95) vs. 547.35(458.62,585.57), P = 0.002, respectively]. The GO group had higher T2 of LG indicating higher disease activity [110.93(102.54,127.67) vs. 93.29(87.06,101.96), P < 0.001]. Combining T2 and ΔT1 values of LG, Model I had higher diagnostic value for distinguishing GO from GD (AUC=0.94, 95 %CI: 0.89,0.99, P<0.001). Meanwhile, T2 of LG had higher diagnostic value for grading GO activity (AUC = 0.84, 95 %CI: 0.76,0.92, P<0.001). CONCLUSIONS:Multi-parametric quantitative MRI parameters of the LG in GO were significantly altered. Novel models combining LG T2 and ΔT1 values showed excellent predictive performances in diagnosing GO. Furthermore, T2 of LG showed practical utility for staging GO.
10.1016/j.ejrad.2021.109815