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Li Z, Luo Y, Huang Q, Chen Z, Song D, Pan D, Hu S, Jiang W, Cai Q, Feng X, Zhang Q, Weng C, Zhong Q, Zhao T, Li C, Zhang T, Shen J. A Randomized Clinical Trial of Intravenous Methylprednisolone With 2 Protocols in Patients With Graves Orbitopathy. J Clin Endocrinol Metab 2023; 109:36-45. [PMID: 37579198 DOI: 10.1210/clinem/dgad476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/16/2023]
Abstract
CONTEXT Intravenous glucocorticoid (IVGC) is an accessible and affordable treatment for Graves orbitopathy (GO); the 4.5-g protocol is well studied, but many details of treatment protocols need to be clarified. OBJECTIVE To compare the efficacy and safety of weekly and monthly protocol of IVGC in GO. METHODS A prospective, randomized, observer-masked, single-center clinical trial, followed up to week 24, at the third affiliated hospital of Southern Medical University; 58 patients with active and moderate to severe GO, aged 18-60 years old, who had not received relevant treatment were included. The intervention was weekly protocol or monthly protocol of IVGC; both received a cumulative dose of methylprednisolone 4.5 g and had a duration of 12 weeks. The overall effective rate, improvement of quality of life (QOL) and signal intensity ratio (SIR) were measured. RESULTS There was no significant difference in the effective rate between the 2 groups at week 12 and week 24 (86.21% vs 72.41%, P = .195; 86.21% vs 82.61%, P = .441), there was no significant difference in the improvement of clinical activity score, exophthalmos, soft tissue involvement, diplopia, and QOL. At week 24, the mean SIR and maximum SIR of the 2 groups were lower than those before treatment, and there were no statistically significant difference between the 2 groups. There was no significant difference in the incidence of adverse events between the 2 groups (31.03% vs 27.59%, P = .773). CONCLUSION The efficacy and safety of the 2 protocols are comparable; the monthly protocol could be used as an alternative to the weekly protocol.
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Affiliation(s)
- Zhangfang Li
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Quandi Huang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Dandan Song
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Daoyan Pan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Shidi Hu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Wei Jiang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qiuyue Cai
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoting Feng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chanyan Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Zhong
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Tongfeng Zhao
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chenzhong Li
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Tong Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
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Zhang H, Lu T, Liu Y, Jiang M, Wang Y, Song X, Fan X, Zhou H. Application of Quantitative MRI in Thyroid Eye Disease: Imaging Techniques and Clinical Practices. J Magn Reson Imaging 2023. [PMID: 37974477 DOI: 10.1002/jmri.29114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
Thyroid eye disease (TED) is a complex autoimmune disorder that impairs various orbital structures, leading to cosmetic damage and vision loss. Magnetic resonance imaging (MRI) is a fundamental diagnostic tool utilized in clinical settings of TED, for its accurate demonstration of orbital lesions and indication of disease conditions. The application of quantitative MRI has brought a new prospect to the management and research of TED, offering more detailed information on morphological and functional changes in the orbit. Therefore, many researchers concentrated on the implementation of different quantitative MRI techniques on TED for the exploration of clinical practices. Despite the abundance of studies utilizing quantitative MRI in TED, there remain considerable barriers and disputes on the best exploitation of this tool. This could possibly be attributed to the complexity of TED and the fast development of MRI techniques. It is necessary that clinical and radiological aspects of quantitative MRI in TED be better integrated into comprehensive insights. Hence, this review traces back 30 years of publications regarding quantitative MRI utilized in TED and elucidates this promising application in the facets of imaging techniques and clinical practices. We believe that a deeper understanding of the application of quantitative MRI in TED will enhance the efficacy of the multidisciplinary management of TED. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Haiyang Zhang
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ting Lu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yuting Liu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yishi Wang
- MR Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Xuefei Song
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Huifang Zhou
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Li Z, Luo Y, Feng X, Zhang Q, Zhong Q, Weng C, Chen Z, Shen J. Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy. J Magn Reson Imaging 2023; 58:1279-1289. [PMID: 36780178 DOI: 10.1002/jmri.28642] [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: 11/04/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Assessment of the activity of Graves' ophthalmopathy (GO) is difficult. Existing methods need improvement. PURPOSE Investigate the application of multiparametric magnetic resonance imaging (MRI) in GO. STUDY TYPE Retrospective. POPULATION A total of 235 GO patients (age: 38.8 ± 13.4 years; 90 male; 96 active patients). FIELD STRENGTH/SEQUENCE Short-tau inversion recovery (STIR) fast spin echo, multiecho spin echo T2 mapping and 3D T1-weighted fast field echo sequences at 3.0 T. ASSESSMENT Two physicians assessed the mean and maximum signal intensity ratio of extraocular muscles to white matter (SIR), T2 relaxation time (T2RT), extraocular muscle area (EMA), fat fraction (FF), retrobulbar fat volume (RFV), and extraocular muscle volume (EMV). Clinical activity score (CAS) ≧ 3 was in active stage. STATISTICAL TESTS The optimal cut-off point of diagnostic efficacy was selected using receiver operating characteristic (ROC) curve analysis and evaluated using area under the curve (AUC), compared using Student's t test, analysis of variance or Kruskal-Wallis H test. The correlation used Pearson correlation analysis. The discriminant equation used a binary logistic regression analysis. P < 0.05 was considered statistically significant. RESULTS The SIRmean, SIRmax, T2RTmean, T2RTmax, EMA, and EMV in active GO patients were significantly higher than those in inactive and were positively correlated with CAS (r = 0.276, 0.228, 0.438, 0.388, 0.502, and 0333, respectively). The FFmax of active patients was significantly lower than that of inactive patients and was negatively correlated with CAS (r = -0.44). Logistic regression analysis indicated that T2RTmean was independently associated with GO active periods and had good diagnostic performance (area under ROC curve = 0.736, sensitivity 70.7%, specificity 69.3%). T2RTmean ≧ 74.295 could be a diagnostic cut-off for judging GO activity (sensitivity 55.3%). CONCLUSION SIR, T2RT, EMV, and FF can quantitatively assess the activity and severity of GO and can potentially provide a basis for clinical judgment and selection of treatment options. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Zhangfang Li
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
| | - Xiaoting Feng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Zhang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Zhong
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Chanyan Weng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zhi Chen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jie Shen
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China
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Čivrný J, Karhanová M, Hübnerová P, Schovánek J, Heřman M. MRI in the assessment of thyroid-associated orbitopathy activity. Clin Radiol 2022; 77:925-934. [PMID: 36116966 DOI: 10.1016/j.crad.2022.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022]
Abstract
Management of patients with thyroid-associated orbitopathy (also called Graves' disease) is dependent on the assessment of the disease activity. Evaluation of disease activity is based on ophthalmological examination. Magnetic resonance imaging (MRI) is an auxiliary method that may help quantify the activity and is also helpful in obtaining anatomical information concerning muscle thickness, exophthalmos, or optic neuropathy. We present a review of MRI techniques of the orbits with emphasis on the evaluation of disease activity. The most convincing seems to be the group of T2-weighted techniques such as conventional T2 weighting, T2 relaxometry, and T2 mapping. Dynamic contrast-enhanced MRI is another promising method.
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Affiliation(s)
- J Čivrný
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic.
| | - M Karhanová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - P Hübnerová
- Department of Ophthalmology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - J Schovánek
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, Palacky University and University Hospital, Olomouc, Czech Republic
| | - M Heřman
- Department of Radiology, Palacky University and University Hospital, Olomouc, Czech Republic
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Ma R, Geng Y, Gan L, Peng Z, Cheng J, Guo J, Qian J. Quantitative T1 mapping MRI for the assessment of extraocular muscle fibrosis in thyroid-associated ophthalmopathy. Endocrine 2022; 75:456-464. [PMID: 34549377 DOI: 10.1007/s12020-021-02873-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to investigate the performance of T1 mapping and its histological correlation with extraocular muscle fibrosis in thyroid-associated ophthalmopathy (TAO). METHODS We prospectively recruited 12 cases of active TAO, 12 cases of inactive TAO, and 15 cases of control subjects. All participants underwent magnetic resonance imaging (MRI) scan with pre-/postcontrast T1 mapping and short-time inversion-recovery (STIR) sequence. The images were analyzed to obtain precontrast T1, extracellular-volume (ECV) fraction on T1 mapping, and signal-intensity ratio (SIR) on STIR for each rectus. Muscle biopsy was performed at lateral rectus to quantify-collagen volume fraction, glycosaminoglycan (GAG)-volume fraction, and extracellular space component. The relationship between MRI and histopathology was examined with Pearson correlation coefficient. RESULTS The active TAO group was characterized with GAG accumulation, while the inactive TAO group presented with substantial fibrosis. The MRI parameters achieved acceptable interobserver and intraobserver agreement. The precontrast T1 and ECV remarkably increased in the TAO groups than the control group, and ECV positively correlated with collagen-volume fraction (r = 0.913) and extracellular-space component (r = 0.886) in the inactive TAO group. The SIR statistically increased in the active TAO group, and SIR positively correlated with GAG-volume fraction in all three groups. The performance of ECV (cutoff > 48.1%) to screen out extraocular muscle fibrosis in inactive TAO was 60.9% sensitivity and 93.3% specificity. CONCLUSIONS The ECV parameter on T1 mapping MRI is a reliable tool to quantify extraocular muscle fibrosis, providing insights into noninvasive evaluation of pathological changes in TAO orbit. TRIAL REGISTRATION NUMBER ChiCTR2000040394; Date of registration: 28 November 2020.
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Affiliation(s)
- Ruiqi Ma
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Yue Geng
- Department of Radiology, Fudan Eye & ENT Hospital, Shanghai, China
| | - Lu Gan
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Zhiyu Peng
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
| | - Jinwei Cheng
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China
| | - Jie Guo
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China.
| | - Jiang Qian
- Department of Ophthalmology, Fudan Eye & ENT Hospital, Shanghai, China.
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Ge Q, Zhang X, Wang L, Fan Y, Huang Q, Yao N, Long J, Liu C. Quantitative evaluation of activity of thyroid-associated Ophthalmopathy using short-tau inversion recovery (STIR) sequence. BMC Endocr Disord 2021; 21:226. [PMID: 34774035 PMCID: PMC8590769 DOI: 10.1186/s12902-021-00895-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Quantitatively staging TAO using MRI remains limited. Our study aims to identify the cut-off signal intensity value for staging TAO using STIR sequence scan. METHODS Between June 2018 and July 2020, a number of 51 patients with TAO (102 eyes) and 19 volunteer controls (38 eyes) were recruited. The clinical and biochemical parameters were measured in each patient. Disease activity was diagnosed based on the Clinical Activity Score (CAS). The signal intensities of extraocular muscles were scanned using short-tau inversion recovery (STIR) sequences from MRI. RESULTS Compared to the inactive TAO patients and the controls, the signal intensity ratios (SIRs) of the superior rectus, inferior rectus, medial rectus, lateral rectus on STIR images were significantly increased in the active TAO patients. After adjustment for age and smokers, the SIRs of four extraocular muscles showed strong associations with CAS. By receiver operator characteristic (ROC) curve analysis, all four muscle SIRs demonstrated good efficiency for predicting disease activity [area under curve (AUC) 0.75-0.83, all P < 0.01]. The identified cut-off SIR values were further validated in a new group of TAO patients (30 eyes) enrolled between September 2020 and January 2021. The cut-off SIR value of > 2.9 in the inferior rectus showed optimal diagnostic value for staging the active TAO. CONCLUSIONS the signal intensity of extraocular muscles on STIR sequence was a good predictor for TAO activity. A cut-off SIR value of > 2.9 in the inferior rectus could be applied to evaluate the active stage of TAO.
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Affiliation(s)
- Qian Ge
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, NO.1, Friendship road, Yuzhong District, Chongqing, 400016, China
| | - Xiaohui Zhang
- Department of Medical imaging, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lu Wang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, NO.1, Friendship road, Yuzhong District, Chongqing, 400016, China
| | - Yao Fan
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, NO.1, Friendship road, Yuzhong District, Chongqing, 400016, China
| | - Qian Huang
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, NO.1, Friendship road, Yuzhong District, Chongqing, 400016, China
| | - Ning Yao
- Chongqing center for disease control and prevention, Chongqing, 400042, China
| | - Jian Long
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, NO.1, Friendship road, Yuzhong District, Chongqing, 400016, China.
| | - Chun Liu
- Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, NO.1, Friendship road, Yuzhong District, Chongqing, 400016, China.
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Siomkajło M, Mizera Ł, Szymczak D, Kolačkov K, Grzegrzółka J, Bolanowski M, Daroszewski J. Effect of systemic steroid therapy in Graves' orbitopathy on regulatory T cells and Th17/Treg ratio. J Endocrinol Invest 2021; 44:2475-2484. [PMID: 33866536 DOI: 10.1007/s40618-021-01565-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/29/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Glucocorticoids are a mainstay treatment for Graves' orbitopathy, yet their exact mechanisms of action remain unclear. We aimed to determine whether the therapeutic effects of systemic steroid therapy in Graves' orbitopathy are mediated by changes in regulatory T lymphocytes (Tregs) and T helper 17 lymphocytes (Th17). METHODS We assessed Treg and Th17 levels in the peripheral blood of 32 patients with active, moderate-to-severe Graves' orbitopathy who received 12 weekly pulses of methylprednisolone, and determined their association with disease severity, disease activity, and treatment outcomes. The acute orbitopathy phase was confirmed based on clinical evaluation and magnetic resonance imaging, and assessed using the clinical activity score (CAS). The severity of the disease was classified according to ETA/EUGOGO guidelines, and quantified based on the total eye score. Treatment response was determined based on specific criteria (e.g., changes in CAS score, diplopia grade, visual acuity, etc.). Treg and Th17 cells were identified using flow cytometry. RESULTS Methylprednisolone treatment improved the activity of the disease and altered the Th17/Treg balance (i.e., the percentage of Tregs decreased while the number of Th17 cells remained unchanged). There was no association between the Treg/Th17 ratio and the activity and severity of the disease or the treatment response. CONCLUSIONS Therapeutic effects of steroid therapy in Graves' orbitopathy are not mediated by Treg and Th17 alterations in the peripheral blood. The decrease in peripheral Treg percentage is likely a consequence of the non-specific effects of steroids and does not impact clinical outcome.
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Affiliation(s)
- M Siomkajło
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland.
| | - Ł Mizera
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - D Szymczak
- Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - K Kolačkov
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - J Grzegrzółka
- Department of Human Morphology and Embryology, Wroclaw Medical University, T. Chalubinskiego 6a, 50-368, Wroclaw, Poland
| | - M Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
| | - J Daroszewski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, L. Pasteur 4, 50-367, Wroclaw, Poland
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Liu H, Yang X, Wang Y, Wang P, Chen Y. 68Ga-FAPI PET/CT Imaging of Graves Ophthalmopathy in a Patient With Esophageal Cancer. Clin Nucl Med 2021; 46:938-939. [PMID: 34028423 DOI: 10.1097/rlu.0000000000003703] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT 68Ga-FAPI PET/CT has been used in the assessment of a variety of malignancies. In addition, FAPI uptake in nonmalignant diseases has also been reported. Herein, we present a case of Graves ophthalmopathy detected by 68Ga-FAPI PET/CT.
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Affiliation(s)
- Huipan Liu
- From the Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province; and Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, China
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Reginelli A, Vacca G, Belfiore M, Sangiovanni A, Nardone V, Vanzulli A, Grassi R, Cappabianca S. Pitfalls and differential diagnosis on adrenal lesions: current concepts in CT/MR imaging: a narrative review. Gland Surg 2021; 9:2331-2342. [PMID: 33447584 DOI: 10.21037/gs-20-559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of this pictorial essay is to review the imaging findings of adrenal lesions. Adrenal lesions could be divided into functioning or non-functioning masses, primary or metastatic, and benign or malignant. Imaging techniques have undergone significant advances in recent years. The most significant objective of adrenal imaging is represented by the detection and, when possible, characterization of adrenal lesions in order to direct patient management correctly. The detection and management of adrenal lesions is based on cross-sectional imaging obtained with non-contrast CT (tumour density), contrast-enhanced CT including delayed washout (either absolute percentage washout or relative percentage one) and finally with MR chemical shift analysis (loss of signal intensity between in-phase and out-of-phase images including both qualitative and quantitative estimates of signal loss). The small incidental adrenal nodules are benign, in most of cases; some tumors such as lipid-rich adenoma and myelolipoma have characteristic features that can be diagnosed accurately in CT. On contrary, if the presenting contrast-enhanced CT shows an adrenal mass with uncertain or malignant morphologic features, particularly in patients with a known history of malignancy, further evaluations should be considered. The most significative implications for radiologists are represented by how to assess risk of malignancy on imaging and what follow-up to indicate if an adrenal incidentaloma is not surgically removed.
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Affiliation(s)
- Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giovanna Vacca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mariapaola Belfiore
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Angelo Sangiovanni
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Angelo Vanzulli
- Department of Radiology, University "La Statale" of Milan, Milan, Italy
| | - Roberto Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Salvatore Cappabianca
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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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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11
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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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12
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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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13
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Xie C, He C, Gao J, Jia S. Efficacy and safety of tripterygium glycosides in the treatment of hyperthyroidism: A systemic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22282. [PMID: 32957384 PMCID: PMC7505354 DOI: 10.1097/md.0000000000022282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hyperthyroidism is a condition in which the thyroid gland is overreactive and produces excess amounts of thyroid hormone. Tripterygium glycosides, traditional Chinese medicine has been widely used in the treatment of rheumatoid arthritis, nephrotic syndrome, hyperthyroidism and other diseases due to its anti-inflammatory and immunosuppressive effects. Evidence-based research is becoming popular especially with the application of Chinese traditional medicine. This paper systematically reviews and evaluates existing clinical data on the efficacy and safety of Tripterygium glycosides in the treatment of hyperthyroidism. MATERIALS AND METHODS PubMed, Cochrane library and EMBase, Chinese biomedical literature database (CBM), Chinese journal full-text database (CNKI), Wan fang digital periodical full-text database and China Science and Technology Journal Database (VIP) were searched based on the defined inclusion and exclusion criteria. Data extraction, research quality assessment and meta-analysis were conducted with RevMan5.3 software. Trial sequential analysis (TSA) was used to evaluate information size and treatment benefits. RESULTS Seventeen randomized controlled clinical trials with 1536 participants were included in the systematic review. In the meta-analysis, there were two subgroups: Tripterygium glycosides combined with thiamazole and prednisone group; Tripterygium glycosides combined with thiamazole group. The study results revealed that the degree of exophthalmos, FT3, FT4, BGP, and AKP decreased while TSH, SOD, GSH-PX increased after the addition of Tripterygium glycosides. This study results suggested that Tripterygium glycosides combined with western medicine are an effective therapy for hyperthyroidism. CONCLUSION This study indicates that Tripterygium glycosides enhances the effect of thiamazole and prednisone in the treatment of hyperthyroidism and without increasing the risk of adverse events.
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Affiliation(s)
| | | | - Jun Gao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
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14
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AlSemari MA, Perrotta M, Russo C, Alkatan HM, Maktabi A, Elkhamary S, Crescenzo RMD, Mascolo M, Elefante A, Rombetto L, Capasso R, Strianese D. Orbital myeloid sarcoma (chloroma): Report of 2 cases and literature review. Am J Ophthalmol Case Rep 2020. [PMID: 32775766 DOI: 10.1016/j.ajoc.2020.100806.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022] Open
Abstract
Purpose Myeloid sarcoma (MS) of the orbit is an uncommon condition in occurring in children, generally coupled to myeloproliferative neoplasms. Observations We describe two rare cases of orbital MS in young boys with aggressive local symptoms but without evidence of acute myeloid leukemia (AML), both patients underwent orbitotomy for gross-tumor resection and biopsy. At follow up, there was no evidence of recurrence nor evolution of the myeloproliferative neoplasms clinically and by radiological and laboratory work-up. We also provide a detailed description of the magnetic resonance imaging presentation, with an extensive pathological analysis correlation. Conclusions and importance A comprehensive revision of the literature on isolated orbital MS was carried out with particular emphasis on clues for differential diagnosis and treatment options, stressing the need to consider MS even in the absence of sign and symptoms of an underlying myeloproliferative disorders.
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Affiliation(s)
| | - Marianna Perrotta
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Camilla Russo
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Hind M Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - A Maktabi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - S Elkhamary
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rosa Maria Di Crescenzo
- Department of Advanced Biomedical Sciences - Pathology Unit, University "Federico II", Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences - Pathology Unit, University "Federico II", Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Luca Rombetto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II", Naples, Italy
| | - Raffaella Capasso
- Department of Medicine and Health Sciences "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Diego Strianese
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Institute of Ophthalmology, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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15
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Orbital myeloid sarcoma (chloroma): Report of 2 cases and literature review. Am J Ophthalmol Case Rep 2020; 19:100806. [PMID: 32775766 PMCID: PMC7397738 DOI: 10.1016/j.ajoc.2020.100806] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose Myeloid sarcoma (MS) of the orbit is an uncommon condition in occurring in children, generally coupled to myeloproliferative neoplasms. Observations We describe two rare cases of orbital MS in young boys with aggressive local symptoms but without evidence of acute myeloid leukemia (AML), both patients underwent orbitotomy for gross-tumor resection and biopsy. At follow up, there was no evidence of recurrence nor evolution of the myeloproliferative neoplasms clinically and by radiological and laboratory work-up. We also provide a detailed description of the magnetic resonance imaging presentation, with an extensive pathological analysis correlation. Conclusions and importance A comprehensive revision of the literature on isolated orbital MS was carried out with particular emphasis on clues for differential diagnosis and treatment options, stressing the need to consider MS even in the absence of sign and symptoms of an underlying myeloproliferative disorders.
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16
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Russo C, Strianese D, Perrotta M, Iuliano A, Bernardo R, Romeo V, Ugga L, Brunetti L, Tranfa F, Elefante A. Multi-parametric magnetic resonance imaging characterization of orbital lesions: a triple blind study. Semin Ophthalmol 2020; 35:95-102. [PMID: 32298217 DOI: 10.1080/08820538.2020.1742358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Multi-parametric MRI used for preoperative assessment of orbital lesions does not routinely include DCE-MRI, since its accuracy in differential diagnosis of orbital mass is still under debate. Aim of this study is to characterize orbital lesions by multi-parametric MRI, analysing the incremental predictive value of DCE-MRI in differential diagnosis of orbital lesions.Methods: In this prospective triple-blind study, 43 consecutive patients with unilateral orbital lesion underwent conventional multimodal MRI and DCE-MRI before biopsy in a tertiary referral centre. Pre-operative MRI examination including conventional unenhanced MRI protocol, DWI with ADC maps, static CE 3D-T1 w and dynamic CE T1 w sequences, was performed within 1 week from surgery (anterior/lateral orbitotomy depending on location of the lesion, to carry out incisional/excisional biopsy).Results: Comparison between conventional T1 w/T2 w, DWI, CE 3D-T1 w and DCE-MRI groups showed a statistically significant difference in scores distribution (p < .001). Statistically significant difference was found between conventional T1 w/T2 w and DWI (p < .005), as well as between DWI and CE 3D-T1 w (p < .001). Conversely, no significant difference was found between CE 3D-T1 w and DCE (p < .005).Conclusions and Relevance: This study confirmed the positive effect of DWI and CE 3D-T1 w on orbital lesions diagnosis when added to conventional T1 w/T2 w sequences, whereas no substantial impact on diagnostic performance was observed with the further addition of DCE-MRI. DCE does not strongly influence diagnostic performance and inter-rater agreement in characterizing orbital lesions; therefore, it should be recommended in selected patients whose assessment of flow dynamics is particularly useful for management.Abbreviations: US = ultrasonography; MRI = magnetic resonance imaging; CT = computed tomography; STIR = Short-TI Inversion Recovery; DWI = diffusion weighted imaging; DCE-MRI = dynamic contrast-enhanced MRI; SE = Spin-Echo; TSE = Turbo Spin-Echo; THRIVE = T1-weighted high resolution Isotropic Volume Examination (dynamic contrast-enhanced ultrafast spoiled gradient echo); ROI = regions of interest; IRR = inter-rater reliability; TIC = time-intensity curve.
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Affiliation(s)
- Camilla Russo
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Diego Strianese
- Orbital Unit, CME Department, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Neuroscience, Odontostomatological and Reproductive Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Marianna Perrotta
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Adriana Iuliano
- Department of Neuroscience, Odontostomatological and Reproductive Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Roberta Bernardo
- Department of Neuroscience, Odontostomatological and Reproductive Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Lisa Brunetti
- Neuroradiology Unit, Università Vita-Salute San Raffaele, Milano, Italy
| | - Fausto Tranfa
- Department of Neuroscience, Odontostomatological and Reproductive Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Università Degli Studi Di Napoli "Federico II", Napoli, Italy
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Upper Eyelid Isolated Arterio-Venous Malformation Treated With Embolization in a Patient With Keloid-Prone Skin. Ophthalmic Plast Reconstr Surg 2020; 36:e116-e119. [PMID: 32205780 DOI: 10.1097/iop.0000000000001620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ocular adnexal aterio-venous malformations (AVMs) are rare congenital disabling anomalies, which may enlarge causing disfiguring deformity and rarely severe hemorrhage. These lesions are generally treated by preliminary endovascular embolization to shrink the arterio-venous malformation, followed by surgical gross total resection. The authors report a case of eyelid arterio-venous malformation in a 12-year-old girl, which progressively increased in size in few months. The patient complained mild itching, blurring of the vision, and mild tenderness. Magnetic resonance imaging showed an expansive mass with multiple arterial vessels at the left superior eyelid and left forehead. The diagnosis of arterio-venous malformation was then confirmed by digital subtraction angiography. Primary surgical excision was excluded because of the high risk of intrasurgical bleeding. Embolization through superselective cannulation of the left external carotid feeder vessels was performed resulting in flow exclusion up to the 80% of the nidus. Subsequent surgical resection was not recommended due to clinical evidence of keloid-prone skin.
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18
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The role of ultrasonography in differential diagnosis of orbital lesions. J Ultrasound 2020; 24:35-40. [PMID: 32166724 DOI: 10.1007/s40477-020-00443-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/22/2020] [Indexed: 10/24/2022] Open
Abstract
AIMS The aim of this study is to assess the value of ultrasound in the differential diagnosis of orbital lesions. METHODS One hundred and thirty-eight patients with clinical features of an orbital mass were examined by orbital ultrasound prior to undergoing surgery, from January 2000 to January 2017. All patients underwent excisional or incisional orbital biopsy. The results of orbital ultrasonography were compared with the final histological diagnosis. RESULTS Orbital lesions were localized by ultrasonography in 133/138 cases (96.4%); the false-negative rate of orbital echography was 3.6% (5/138). The nature of the orbital lesions was correctly determined by ultrasonography in 54.3% of the cases (75/138) preoperatively (true positives). In 58/138 (42%) patients, there was no correspondence between the ultrasound diagnosis and the histological diagnosis (false positives). The sensitivity of orbital ultrasonography for the detection of an orbital mass was 93.75% (CI 87.87-99.63%), while the specificity yielded no meaningful result (CI 0.00-60.24%). Moreover, the specificity of orbital ultrasonography to identify a malignant tumor falls within a CI of 0-62.72%. CONCLUSIONS Orbital ultrasonography is a rapid and noninvasive test that is highly sensitive in displaying an orbital mass; however, the specificity in the differential diagnosis of orbital lesions is not meaningful, particularly if malignancy is suspected. The assessment of orbital diseases requires multiple diagnostic approaches to balance the strengths and weaknesses of each method.
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19
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Chen L, Chen W, Chen HH, Wu Q, Xu XQ, Hu H, Wu FY. Radiological Staging of Thyroid-Associated Ophthalmopathy: Comparison of T1 Mapping with Conventional MRI. Int J Endocrinol 2020; 2020:2575710. [PMID: 33144856 PMCID: PMC7599391 DOI: 10.1155/2020/2575710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Accurate staging of patients with thyroid-associated ophthalmopathy (TAO) is crucial for clinical decision. Full cognition of pathologic changes and staging TAO using conventional T2-weighted imaging is still limited. PURPOSE To investigate the feasibility of using T1 mapping to evaluate changes of extraocular muscles (EOMs) in TAO patients, as well as to compare T1 mapping and conventional T2-weighted imaging in staging TAO. MATERIALS AND METHODS Forty TAO patients were retrospectively enrolled. "Hot spot" and "cold spot" T1 relaxation times (T1RTHS and T1RTCS) of EOMs, as well as conventionally applied highest signal intensity ratio (SIR) of EOMs, were measured and compared between active and inactive groups. RESULTS T1RTCS and SIR were significantly higher in active TAOs than in the inactive ones (P < 0.001), while T1RTHS was not (P=0.093). Meanwhile, T1RTCS and SIR were positively correlated with clinical activity score (r = 0.489, 0.540; P < 0.001). TIRTCS and SIR showed no significant area under curve for staging TAO (0.830 vs. 0.852; P=0.748). T1RTCS ≥ 1000 alone showed optimal staging specificity (90.0%), while integration of T1RTCS ≥ 1000 and SIR ≥ 2.9 demonstrated optimal staging efficiency and sensitivity (area under curve, 0.900; sensitivity, 86.0%). CONCLUSIONS Our findings suggest that the T1-mapping technique holds the potency to be utilized in TAO. The derived T1RTCS of EOMs, which may be associated with fat infiltration, could be a useful biomarker to stage the disease, serving added efficiency, sensitivity, and specificity to single usage of conventional SIR.
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Affiliation(s)
- Lu Chen
- Department of Radiology, 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
| | - Huan-Huan Chen
- Department of Endocrinology, 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
| | - Xiao-Quan Xu
- 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
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Zhou M, Shen L, Jiao Q, Ye L, Zhou Y, Zhu W, Wang W, Wang S. ROLE OF MAGNETIC RESONANCE IMAGING IN THE ASSESSMENT OF ACTIVE THYROID-ASSOCIATED OPHTHALMOPATHY PATIENTS WITH LONG DISEASE DURATION. Endocr Pract 2019; 25:1268-1278. [PMID: 31412229 DOI: 10.4158/ep-2019-0133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: In thyroid-associated ophthalmopathy (TAO), long disease duration is negatively correlated with the response to immunosuppression treatment. The current treatment decision-making process does not involve magnetic resonance imaging (MRI); thus, we investigated the predictive value of MRI parameters for the immunosuppressive response in active moderate to severe TAO patients with different disease durations. Methods: We retrospectively analyzed the baseline MRI parameters of active TAO patients treated with guideline-recommended weekly glucocorticoid therapy in our center. Data were stratified by the quartile of disease duration. The signal intensity ratio (SIR) of T2-weighted images was used to describe the activity of extraocular muscles (EOMs). Results: Compared to the lowest quartile of disease duration, SIR values of EOMs were significantly lower in quartile 3 (Q3) and quartile 4 (Q4). Meanwhile, the clinical activity score (CAS) curve did not change in parallel and was not correlated with the SIR curve. In the highest quartile of disease duration, nonresponders had significantly lower SIR values of the most inflamed muscle (P = .03) and the medial rectus (P = .004) than did the responders, while no such significance was observed in patients within the lower 3 quartiles. A multivariable predictive model (including CAS, TAO duration, and SIR value) was established in each quartile. The fit of the model was better than CAS with regard to prognostic prediction and showed a high positive predictive value (Model 1: 86.67%; Model 2: 92.86%) and negative predictive value (Model 1: 88.89%; Model 2: 90%) in the top quartile. Conclusion: The anterior manifestation assessed by CAS is not always consistent with retro-orbital activity in long-term TAO patients. CAS is sufficient to reflect disease activity in short-term TAO patients. The supplementation of CAS with orbital MRI would be valuable in selecting appropriate active patients with a long disease duration. Abbreviations: AUC = area under the curve; CAS = clinical activity score; EOM = extraocular muscle; FT3 = free triiodothyronine; FT4 = free thyroxine; GC = glucocorticoid; ivGC = intravenous glucocorticoids; MRI = magnetic resonance imaging; NPV = negative predictive value; PPV = positive predictive value; SIR = signal intensity ratio; TAO = thyroid-associated ophthalmopathy; TRAb = thyroid-stimulating hormone receptor antibody; TSH = thyroid-stimulating hormone.
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Triamcinolone for the Treatment of Graves Ophthalmopathy Tested With Short Tau Inversion Recovery Magnetic Resonance. Ophthalmic Plast Reconstr Surg 2019; 35:22-24. [DOI: 10.1097/iop.0000000000001125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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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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Higashiyama T, Ohji M. Treatment with bimatoprost for exophthalmos in patients with inactive thyroid-associated ophthalmopathy. Clin Ophthalmol 2018; 12:2415-2421. [PMID: 30568419 PMCID: PMC6267500 DOI: 10.2147/opth.s187164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was performed to observe changes prospectively in exophthalmos and orbital fat in patients with inactive thyroid-associated ophthalmopathy (TAO) treated with bimatoprost. Methods In this 12-month single-treatment pilot observational study, 13 patients with inactive-phase TAO were administered bimatoprost to treat exophthalmos due to TAO. Exophthalmos values and orbital tissue volumes were measured on MRI by technicians in a masked fashion. Results Nine orbits of nine patients (eight women, one man) were treated with bimatoprost for 12 months. Mean exophthalmos values before and after treatment were 21.7±2.2 and 21.7±2.0 mm, respectively. The mean value after 12 months of treatment was not significantly different from before treatment (P=0.82). Mean orbital fat volume before and after 12 months of treatment was 17.2±2.5 and 17.0±3.0 cm3, respectively. The corresponding total extraocular muscle volume was 4.0±0.7 and 3.8±0.9 cm3, respectively. Mean volume in each tissue type after 12 months of treatment was not significantly different from before treatment (orbital fat, P=0.70; extraocular muscles, P=0.32). Conclusion Topical bimatoprost treatment did not reduce exophthalmos or orbital fat in this cohort of patients with inactive TAO.
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Affiliation(s)
- Tomoaki Higashiyama
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan,
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan,
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Lingam RK, Mundada P, Lee V. 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. Orbit 2018; 37:325-330. [PMID: 29319381 DOI: 10.1080/01676830.2017.1423343] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Ravi Kumar Lingam
- a Department of Radiology , Northwick Park & Central Middlesex Hospital, London Northwest University Healthcare NHS Trust , London , United Kingdom
| | - Pravin Mundada
- b Department of Radiology , Raffles Hospital , Singapore
| | - Vickie Lee
- c Eye Department , Central Middlesex Hospital , London , United Kingdom
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Quantitative Analysis of Inflammation in Orbital Fat of Thyroid-associated Ophthalmopathy Using MRI Signal Intensity. Sci Rep 2017; 7:16874. [PMID: 29203853 PMCID: PMC5715090 DOI: 10.1038/s41598-017-17257-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 11/22/2017] [Indexed: 11/19/2022] Open
Abstract
We quantitatively analyzed inflammation in orbital fat from cases of thyroid-associated ophthalmopathy (TAO) using short-tau inversion recovery (STIR) sequences from magnetic resonance imaging. The signal intensity ratios (SIRs) of orbital fat as well as the superior rectus (SR), inferior rectus (IR), lateral rectus (LR), medial rectus (MR), and superior oblique (SO) muscles on STIR images were measured in 70 eyes from 70 treatment-naive TAO patients (active TAO group, 19 patients; inactive TAO group, 51 patients) and 20 eyes from 20 controls. The mean SIR in the active TAO group was significantly higher than that in the inactive TAO group and controls (P < 0.001). The SIR of orbital fat in all TAO patients was significantly (P < 0.001) positively correlated with that of the extraocular muscles: SR (r = 0.64), IR (r = 0.55), LR (r = 0.58), MR (r = 0.71), and SO (r = 0.65). The SIR of orbital fat had a significant positive correlation with the CAS (r = 0.53, P < 0.001). The measurements of SIRs in orbital fat may be useful in evaluating the activity in tissues of TAO patients.
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Ugga L, Stilo S, Napolitano P, Guadagno E, Iuliano A, Del Basso de Caro ML, Elefante A. Orbitofrontal cholesterol granuloma: case report and review of the literature. Quant Imaging Med Surg 2017; 7:373-377. [PMID: 28812004 DOI: 10.21037/qims.2017.04.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, "Federico II" University, Naples, Italy
| | - Salvatore Stilo
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, "Federico II" University, Naples, Italy
| | - Pasquale Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, "Federico II" University, Naples, Italy
| | - Adriana Iuliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, "Federico II" University, Naples, Italy
| | | | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, "Federico II" University, Naples, Italy
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Hu H, Xu XQ, Wu FY, Chen HH, Su GY, Shen J, Hong XN, Shi HB. Diagnosis and stage of Graves' ophthalmopathy: Efficacy of quantitative measurements of the lacrimal gland based on 3-T magnetic resonance imaging. Exp Ther Med 2016; 12:725-729. [PMID: 27446267 PMCID: PMC4950689 DOI: 10.3892/etm.2016.3389] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/29/2016] [Indexed: 12/11/2022] Open
Abstract
The aim of the present study was to determine the efficacy of quantitative measurements of the lacrimal gland based on 3-T magnetic resonance (MR) imaging in the diagnosis and staging of Graves' ophthalmopathy (GO). The study retrospectively enrolled 33 patients with GO (the GO group) and 24 healthy volunteers [the healthy control (HC) group] with orbit MR imaging performed using a 3-T MR scanner. Quantitative parameters of the lacrimal gland, including axial length, axial width, axial area, coronal length, coronal width, coronal area, volume and signal intensity ratio (SIR) of the lacrimal gland to the ipsilateral temporal muscle were measured. The difference of quantitative parameters between the GO and HC groups, or between active and inactive GO groups were evaluated using a Student's t-test. Receiver operating characteristic analyses were used to evaluate the diagnostic value of the significant parameters in discriminating patients with GO from healthy controls, or discriminating active from inactive GO. All the quantitative measurements of the GO patients were significantly larger than those of the healthy controls (P<0.05), with the exception of the coronal length (P=0.150). Axial and coronal width had the best efficacy in discriminating patients with GO from healthy controls. Only SIR was found to be different between the active and inactive GO groups (P=0.001). Setting a SIR of 2.57 as the threshold value, the optimal efficacy was achieved (area under the curve, 0.711; sensitivity, 57.7%; specificity, 77.5%) in discriminating between active and inactive GO. Quantitative measurements of the lacrimal gland based on 3-T MR imaging may assist in the diagnosis and stage of GO.
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Affiliation(s)
- Hao Hu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Fei-Yun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Huan-Huan Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Guo-Yi Su
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jie Shen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xun-Ning Hong
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Using Nonechoplanar Diffusion-weighted MRI to Assess Treatment Response in Active Graves Orbitopathy: A Novel Approach with 2 Case Reports. Ophthalmic Plast Reconstr Surg 2016; 32:e67-70. [DOI: 10.1097/iop.0000000000000248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Higashiyama T, Nishida Y, Ohji M. Relationship between magnetic resonance imaging signal intensity and volume of extraocular muscles in thyroid-associated ophthalmopathy with methylprednisolone pulse therapy. Clin Ophthalmol 2016; 10:721-9. [PMID: 27143850 PMCID: PMC4844430 DOI: 10.2147/opth.s105096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To characterize the relationship between inflammation and swelling of extraocular muscles in thyroid-associated ophthalmopathy before and after methylprednisolone pulse therapy. Methods The signal intensities and volumes of the superior rectus (SR), inferior rectus (IR), lateral rectus (LR), medial rectus (MR), and superior oblique (SO) muscles were measured with magnetic resonance imaging in 25 eyes of 25 patients with thyroid-associated ophthalmopathy in the acute inflammatory phase before and after methylprednisolone pulse therapy. The signal intensity ratios (SIRs) of muscles and brain white matter were calculated. Result The mean SIRs before treatment were 2.28±0.74 in SR, 2.66±0.57 in IR, 2.03±0.42 in LR, 2.45±0.49 in MR, and 1.98±0.48 in SO muscles. The mean SIRs after treatment were 1.82±0.62, 1.84±0.52, 1.70±0.35, 1.95±0.46, and 1.60±0.36, respectively. The mean volumes (cm3) before treatment were 1.35±0.67 in SR, 1.21±0.39 in IR, 0.66±0.13 in LR, 0.94±0.31 in MR, and 0.58±0.14 in SO muscles. Those after treatment were 1.12±0.45, 0.91±0.31, 0.61±0.12, 0.85±0.28, and 0.49±0.11, respectively. The SIRs showed significantly positive correlations with volumes both before and after treatment in SR muscles (before, r=0.77; after, r=0.69), IR muscles (before, r=0.65; after, r=0.60), MR muscles (before, r=0.69; after, r=0.73), and SO muscles (before, r=0.52; after, r=0.50) (P<0.01 for all correlations). Conclusion Swelling reflected the inflammation in extraocular muscles of thyroid-associated ophthalmopathy both before and after treatment.
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Affiliation(s)
- Tomoaki Higashiyama
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiro Nishida
- Clinical Medical Education Center, Shiga University of Medical Science, Shiga, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
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Higashiyama T, Nishida Y, Morino K, Ugi S, Nishio Y, Maegawa H, Ohji M. Use of MRI signal intensity of extraocular muscles to evaluate methylprednisolone pulse therapy in thyroid-associated ophthalmopathy. Jpn J Ophthalmol 2014; 59:124-30. [PMID: 25448468 DOI: 10.1007/s10384-014-0365-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 10/14/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To quantitatively evaluate the efficacy of methylprednisolone pulse therapy for extraocular muscle inflammation in thyroid-associated ophthalmopathy (TAO) using the short-tau inversion-recovery (STIR) technique of magnetic resonance imaging (MRI). METHODS The signal intensities of the superior rectus (SR), inferior rectus (IR), lateral rectus (LR), medial rectus (MR), and superior oblique (SO) muscles were measured using the STIR images from 34 eyes of 17 patients with TAO before and after methylprednisolone pulse therapy and 19 eyes of 19 controls. The signal intensity ratio (SIR) of the signal intensity in muscles to that in brain white matter was calculated. RESULTS The mean SIRs of the controls were 1.08 ± 0.26 in the SR, 1.32 ± 0.29 in the IR, 1.34 ± 0.19 in the LR, 1.47 ± 0.25 in the MR, and 1.28 ± 0.22 in the SO muscles. SIRs exceeding 2.0 were out of the normal range. The SIRs of the patients with TAO before treatment were 2.19 ± 0.64, 2.44 ± 0.58, 1.96 ± 0.43, 2.24 ± 0.47, and 1.91 ± 0.42, respectively, which was significantly (P < 0.001) higher than those of the controls; after treatment, the mean SIRs were 1.82 ± 0.57, 1.81 ± 0.49, 1.64 ± 0.35, 1.88 ± 0.43, and 1.54 ± 0.33, respectively, significantly (P < 0.001) lower in all muscles than those before treatment. However, the SIRs of some muscles remained over 2.0. Moreover, all cases that had deterioration of TAO had one or more muscles with a SIR exceeding 2.5 after treatment. CONCLUSION Extraocular muscle inflammation in TAO improved with treatment. However, inflammation in some muscles persisted after treatment, and a high SIR in the muscle after treatment suggested the risk of deterioration of TAO.
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Affiliation(s)
- Tomoaki Higashiyama
- Department of Ophthalmology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan,
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