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Perros P, Žarković M, Pearce SH, Razvi S, Kolli H, Dickinson AJ. Inter-observer Variability of Clinical Activity Score: Assessments in Patients With Thyroid Eye Disease. Am J Ophthalmol 2023; 252:94-100. [PMID: 37028695 DOI: 10.1016/j.ajo.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Thyroid eye disease (TED) can be difficult to manage. The range of available treatments is expanding rapidly; however, cost is a concern and some patients do not respond. The Clinical Activity Score (CAS) was devised as a measure of disease activity and a potential predictor of response to anti-inflammatory treatment. Despite the widespread use of the CAS, inter-observer variability has not been investigated. The aim of the study was to determine the inter-observer variability of the CAS in patients with TED. DESIGN Prospective reliability analysis. METHODS Nine patients with a spectrum of clinical features of TED were assessed by 6 experienced observers on the same day. Agreement among the observers was analyzed using the Krippendorff alpha. RESULTS The Krippendorff alpha for the total CAS was 0.532 (95% CI = 0.199-0.665), whereas alpha values for the individual components of the CAS varied between 0.171 (CI = 0.000-0.334) for lid redness and 0.671 (CI = 0.294-1.000) for spontaneous pain. Assuming that a CAS value ≥3 implies suitability of the patient for anti-inflammatory treatment, the calculated Krippendorff alpha for agreement among assessors on whether treatment should be given or not given was 0.332 (95% CI = 0.0011-0.5862). CONCLUSIONS This study has shown unreliable inter-observer variability in total CAS and most individual CAS components, thus highlighting the need for improving the performance of the CAS or seeking other methods to assess activity.
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Affiliation(s)
- Petros Perros
- From the Department of Endocrinology (P.P., S.H.P., S.R.), Royal Victoria Infirmary, Newcastle upon Tyne, UK; Translational and Clinical Research Institute (P.P., S.H.P., SR), Newcastle University, Newcastle upon Tyne, UK.
| | - Miloš Žarković
- Clinic of Endocrinology, Diabetes and Metabolic Disorders (M.Ž.), University Clinical Centre of Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Simon H Pearce
- From the Department of Endocrinology (P.P., S.H.P., S.R.), Royal Victoria Infirmary, Newcastle upon Tyne, UK; Translational and Clinical Research Institute (P.P., S.H.P., SR), Newcastle University, Newcastle upon Tyne, UK
| | - Salman Razvi
- From the Department of Endocrinology (P.P., S.H.P., S.R.), Royal Victoria Infirmary, Newcastle upon Tyne, UK; Translational and Clinical Research Institute (P.P., S.H.P., SR), Newcastle University, Newcastle upon Tyne, UK
| | - Hema Kolli
- Newcastle Eye Centre (H.K., A.J.D.), Newcastle upon Tyne, UK
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Gamma camera imaging of benign thyroid diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00147-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lee HJ, Ehlerding EB, Cai W. Antibody-Based Tracers for PET/SPECT Imaging of Chronic Inflammatory Diseases. Chembiochem 2019; 20:422-436. [PMID: 30240550 PMCID: PMC6377337 DOI: 10.1002/cbic.201800429] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Indexed: 12/18/2022]
Abstract
Chronic inflammatory diseases are often progressive, resulting not only in physical damage to patients but also social and economic burdens, making early diagnosis of them critical. Nuclear medicine techniques can enhance the detection of inflammation by providing functional as well as anatomical information when combined with other modalities such as magnetic resonance imaging, computed tomography or ultrasonography. Although small molecules and peptides were mainly used for the treatment and imaging of chronic inflammatory diseases in the past, antibodies and their fragments have also been emerging for chronic inflammatory diseases as they show high specificity to their targets and can have various biological half-lives depending on how they are engineered. In addition, imaging with antibodies or their fragments can visualize the in vivo biodistribution of the probes or help monitor therapeutic responses, thereby providing physicians with a greater understanding of drug behavior in vivo and another means of monitoring their patients. In this review, we introduce various targets and radiolabeled antibody-based probes for the molecular imaging of chronic inflammatory diseases in preclinical and clinical studies. Targets can be classified into three different categories: 1) cell-adhesion molecules, 2) surface markers on immune cells, and 3) cytokines or enzymes. The limitations and future directions of using radiolabeled antibodies for imaging inflammatory diseases are also discussed.
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Affiliation(s)
- Hye Jin Lee
- Pharmaceutical Sciences Department, University of Wisconsin – Madison, Madison WI 53705, USA
| | - Emily B. Ehlerding
- Medical Physics Department, University of Wisconsin – Madison, Madison WI 53705, USA
| | - Weibo Cai
- Pharmaceutical Sciences Department, University of Wisconsin – Madison, Madison WI 53705, USA
- Medical Physics Department, University of Wisconsin – Madison, Madison WI 53705, USA
- Department of Radiology and Carbone Cancer Center, University of Wisconsin – Madison, Madison WI 53705, USA
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de Lacerda AM, de Souza SAL, Gutfilen B, Barbosa da Fonseca LM, Lobo Lopes FPP, Tonomura E, Vaisman M, Teixeira PDFDS. Technetium-99m-anti-tumour necrosis factor alpha scintigraphy as promising predictor of response to corticotherapy in chronic active Graves' ophthalmopathy. Clin Physiol Funct Imaging 2018; 39:135-142. [DOI: 10.1111/cpf.12548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/13/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Adriano Machado de Lacerda
- Faculdade de Medicina; Pós-graduacão em Endocrinologia; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | | | - Bianca Gutfilen
- Departamento de Radiologia; Faculdade de Medicina; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | | | | | - Elise Tonomura
- Departamento de Radiologia; Faculdade de Medicina; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - Mário Vaisman
- Faculdade de Medicina; Pós-graduacão em Endocrinologia; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
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Pacilio M, Lauri C, Prosperi D, Petitti A, Signore A. New SPECT and PET Radiopharmaceuticals for Imaging Inflammatory Diseases: A Meta-analysis of the Last 10 Years. Semin Nucl Med 2018; 48:261-276. [PMID: 29626943 DOI: 10.1053/j.semnuclmed.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Modern molecular nuclear medicine is rapidly developing in the field of imaging of chronic inflammatory diseases, and many new radiopharmaceuticals have been recently described and tested in animals and man. These can detect early pathophysiological changes before the development of anatomical changes and, often, before clinical onset of symptoms. This field includes new radiopharmaceuticals for SPECT and PET use to define new strategies for imaging immune cells as well as tissue modifications induced by the inflammatory process. In this review, we present the results of a meta-analysis based on radiopharmaceuticals (for SPECT or PET) that are not commercially available and that have been used, at least once, in humans in the last 10 years.
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Affiliation(s)
- Marta Pacilio
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, Italy
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, Italy.; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Daniela Prosperi
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, Italy
| | - Agnese Petitti
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, Italy
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, "Sapienza" University of Rome, Italy.; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, The Netherlands.
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Abdel Razek AA, El-Hadidy M, Moawad ME, El-Metwaly N, El-Said AA. Performance of apparent diffusion coefficient of medial and lateral rectus muscles in Graves' orbitopathy. Neuroradiol J 2017; 30:230-234. [PMID: 28379055 DOI: 10.1177/1971400917691993] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective The purpose of this study was to determine the performance of the apparent diffusion coefficient in the detection of involvement of the medial and lateral rectus muscles in patients with Graves' orbitopathy. Methods and materials This prospective study was conducted on 33 consecutive patients (16 males, 17 females with a mean age of 36 years) with Graves' orbitopathy and 18 age- and sex-matched volunteers. The patients and volunteers underwent diffusion-weighted magnetic resonance imaging of the orbit in the axial plane using echo-planar imaging. The apparent diffusion coefficient of the medial and lateral rectus muscles was calculated. Results The medial rectus muscle was more affected than the lateral rectus muscle. The mean apparent diffusion coefficient value of the medial and lateral rectus muscles was 1.81 ± 0.19 and 1.72 ± 0.07 × 10-3 mm2/s in patients with Graves' orbitopathy and 1.59 ± 0.06 and 1.51 ± 0.06 × 10-3 mm2/s in volunteers, respectively. There was a significant difference in apparent diffusion coefficient values of the medial and lateral rectus muscles between patients with Graves' orbitopathy and volunteers ( p = 0.001). The classification performance as measured with area under the receiver operator characteristic curve was 0.89 (95% confidence interval: 0.732-0.904). The best performing threshold of the apparent diffusion coefficient value of the medial rectus muscle was 1.69 × 10-3 mm2/s and associated efficiency was 86%, sensitivity was 97%, and specificity was 97%. Conclusion We concluded that the apparent diffusion coefficient of the medial rectus muscle can be used for diagnosis of Graves' orbitopathy.
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Affiliation(s)
| | - Mohamed El-Hadidy
- 2 Department of Internal medicine, Mansoura Faculty of Medicine, Egypt
| | - Mohamed E Moawad
- 2 Department of Internal medicine, Mansoura Faculty of Medicine, Egypt
| | - Nader El-Metwaly
- 3 Department of Ophthalmology , Mansoura Faculty of Medicine, Egypt
| | - Amr A El-Said
- 2 Department of Internal medicine, Mansoura Faculty of Medicine, Egypt
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Piantanida E, Lai A, Sassi L, Gallo D, Spreafico E, Tanda ML, Bartalena L. Outcome Prediction of Treatment of Graves' Hyperthyroidism with Antithyroid Drugs. Horm Metab Res 2015. [PMID: 26197855 DOI: 10.1055/s-0035-1555759] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Graves' disease is the most common cause of hyperthyroidism in iodine-replete areas and is ultimately due to antibodies interacting with the TSH receptor on thyroid follicular cells [TSH-receptor antibody (TRAb)]. Antithyroid drugs (ATDs) belonging to the family of thionamides are the first-line treatment in Europe. ATD treatment is commonly continued for 18-24 months. Its major limitation is the high rate of relapses after drug withdrawal. Factors particularly bound to subsequent relapses are the large thyroid volume, smoking habit, persistence of TRAb in the circulation at the end of treatment, and the post-partum period. Under these conditions, consideration should be given to a definitive therapy for hyperthyroidism (radioiodine treatment, thyroidectomy), particularly if the patient is at risk of cardiovascular complications that might be exacerbated by persistence or recurrence of hyperthyroidism.
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Affiliation(s)
- E Piantanida
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - A Lai
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - L Sassi
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - D Gallo
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - E Spreafico
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - M L Tanda
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
| | - L Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
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