1
|
Luccas R, Riguetto CM, Alves M, Zantut-Wittmann DE, Reis F. Computed tomography and magnetic resonance imaging approaches to Graves' ophthalmopathy: a narrative review. Front Endocrinol (Lausanne) 2024; 14:1277961. [PMID: 38260158 PMCID: PMC10801040 DOI: 10.3389/fendo.2023.1277961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Graves' ophthalmopathy (GO) affects up to 50% of patients with Graves' disease (GD) ranging from mild ocular irritation to vision loss. The initial diagnosis is based on clinical findings and laboratory tests. Orbital imaging, such as magnetic resonance imaging (MRI) and computed tomography (CT), is an important tool to assess orbital changes, being also useful for understanding disease progression and surgical planning. In this narrative review, we included 92 studies published from 1979 to 2020 that used either MRI and/or CT to diagnose and investigate GO, proposing new methods and techniques. Most of the methods used still need to be corroborated and validated, and, despite the different methods and approaches for thyroid eye disease (TED) evaluation, there is still a lack of standardization of measurements and outcome reports; therefore, additional studies should be performed to include these methods in clinical practice, facilitating the diagnosis and approach for the treatment of TED.
Collapse
Affiliation(s)
- Rafael Luccas
- Graduate Program of Neuroscience, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - Cinthia Minatel Riguetto
- Division of Endocrinology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
- Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | | | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| |
Collapse
|
2
|
Zhang H, Fan J, Qu J, Han Q, Zhou H, Song X. Predictive markers for anti-inflammatory treatment response in thyroid eye disease. Front Endocrinol (Lausanne) 2023; 14:1292519. [PMID: 38111706 PMCID: PMC10726127 DOI: 10.3389/fendo.2023.1292519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023] Open
Abstract
Anti-inflammatory treatment is the primary and vital therapeutic approach for active, moderate-to-severe thyroid eye disease (TED). Accurate pretreatment prediction of treatment response is of paramount importance for the prognosis of patients. However, relying solely on the clinical activity score asa determinant of activity has led to unsatisfactory treatment outcomes. In recent years, significant advancements have been made in identifying predictive markers for anti-inflammatory treatment response in TED, clinical markers, body fluid biomarkers and imaging biomarkers. Several clinical studies have developed prediction models based on these markers. However, there is still a lack of comprehensive elucidation or comparison between the different markers. Therefore, this review aims to provide a detailed analysis of the definition, characteristics, and application of predictive markers for anti-inflammatory treatment response in TED. Through detailed literature search, 26 articles applying anti-inflammatory treatment effect prediction with a total of 1948 TED patients were used for analysis and discussion. By gaining a better understanding of the current research on predictive markers, we can accelerate and guide the exploration of treatment prediction strategies, leading us towards an era of precise therapy for TED.
Collapse
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
| | - Jingyuan 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
| | - Jialu Qu
- 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
| | - Qinghe Han
- Department of Radiology, The Second Hospital of Jilin University, Changchun, Jilin, 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
| | - 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
| |
Collapse
|
3
|
Vaishnav YJ, Mawn LA. Magnetic Resonance Imaging in the Management of Thyroid Eye Disease: A Systematic Review. Ophthalmic Plast Reconstr Surg 2023; 39:S81-S91. [PMID: 38054988 DOI: 10.1097/iop.0000000000002511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
PURPOSE MRI may potentially detect active thyroid eye disease prior to elevation of clinical activity score. We aimed to systematically review the existing literature pertaining to MRI thyroid eye disease and to assess the role of MRI in the diagnosis of thyroid eye disease. METHODS A Population, Intervention, Comparison, Outcome/Preferred Reporting Items for Systematic Reviews and Meta-Analyses selection criteria was applied to identify studies for inclusion published between the years 2000 and 2023. RESULTS Twenty-four articles were identified for inclusion in the systematic review. All included studies utilized MRI as the imaging modality. MRI sequences used included T2-weighted imaging in 87.5%, T1-weighted imaging in 54.2%, diffusion-weighted imaging in 20.8%, and short tau inversion recovery in 16.7%. The most common parameters quantified were signal intensity ratio in 10 studies (41.7%) and T2-relaxation time in 8 studies (33.3%). Signal intensity ratio and T2-relaxation time were shown to correlate with clinical activity score and identify the phase of the disease. CONCLUSIONS MRI has untapped potential for further elucidating the highly complex biological processes in thyroid eye disease. As we move away from clinical activity score as a predictor of response to biologic therapy, MRI may prove more important than ever in the risk-benefit analysis around the use of immunomodulators.
Collapse
Affiliation(s)
- Yash J Vaishnav
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee, U.S.A
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| |
Collapse
|
4
|
Zhu H, Zou M, Wu D, Li B, Su Y, Li Y, Hong S, Yang Z. Quantitative assessment of extraocular muscles in Graves' ophthalmopathy using T1 mapping. Eur Radiol 2023; 33:9074-9083. [PMID: 37466707 DOI: 10.1007/s00330-023-09931-3] [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: 09/08/2022] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To evaluate the performance of T1 mapping in the characterization of extraocular muscles (EOMs) of Graves' ophthalmopathy (GO) patients and investigate its feasibility in assessing the response to glucocorticoid therapy in active GO patients. METHODS A total of 133 participants (78 active GO, 23 inactive GO, 18 Graves' disease (GD) patients, and 14 healthy volunteers) were consecutively enrolled from July 2018 to December 2020. Native T1 (nT1) and postcontrast T1 (cT1) values of EOMs were measured and compared. The variations in T1 mapping metrics of EOMs were compared pre/post glucocorticoid treatment in 23 follow-up active GO patients. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. RESULTS The nT1 of EOMs in GO patients was higher than that in GD patients and healthy volunteers. The nT1 of superior rectus (SR) in active GO was higher than that in inactive GO patients, and it could be used as a potential marker of GO activity (OR: 1.003; 95% CI: 1.001, 1.004), with a diagnostic sensitivity of 86.3% and specificity of 43.7%. Meanwhile, the cT1 of SR, inferior rectus (IR), and medial rectus (MR) in inactive GO patients were higher than those in active GO patients. The nT1 of EOMs achieved sufficient diagnostic performance in evaluating the response to glucocorticoid therapy for follow-up active GO patients (AUC, 0.797; sensitivity, 71.9%; specificity, 85.7%). CONCLUSIONS T1 mapping could quantitatively assess the activity of GO and the response to glucocorticoid therapy in active GO patients and may even potentially reflect the fibrosis of EOMs. CLINICAL RELEVANCE STATEMENT T1 values can reflect the pathological status of the extraocular muscle. T1 mapping could help to quantitatively assess the clinical activity of GO and the response to glucocorticoid therapy in active GO patients. KEY POINTS • Graves' ophthalmopathy patients had greater nT1 of extraocular muscles than Graves' disease patients and healthy volunteers, and nT1 of the superior rectus could be a potential marker of Graves' ophthalmopathy activity. • The cT1 of extraocular muscles in inactive Graves' ophthalmopathy patients was higher than that in active Graves' ophthalmopathy patients, and it might be associated with muscle fibrosis. • nT1 of extraocular muscles could offer sufficient diagnostic performance in evaluating the response to glucocorticoid therapy for follow-up active Graves' ophthalmopathy patients.
Collapse
Affiliation(s)
- Hongzhang Zhu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengsha Zou
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dide Wu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yihua Su
- Department of Ophthalmology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shubin Hong
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Zhiyun Yang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Boutzios G, Chatzi S, Goules AV, Mina A, Charonis GC, Vlachoyiannopoulos PG, Tzioufas AG. Tocilizumab improves clinical outcome in patients with active corticosteroid-resistant moderate-to-severe Graves' orbitopathy: an observational study. Front Endocrinol (Lausanne) 2023; 14:1186105. [PMID: 37424868 PMCID: PMC10327634 DOI: 10.3389/fendo.2023.1186105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Background Graves' orbitopathy (GO) is an autoimmune disorder affecting the orbital fat and muscles. A significant role of IL-6 in the pathogenesis of GO has been described and tocilizumab (TCZ), an IL-6 inhibitor targeting IL-6R has been given in some patients. The aim of our case study was to evaluate the therapeutic outcome of TCZ in non-responders to first line treatments with corticosteroids. Methods We conducted an observational study of patients with moderate to severe GO. Twelve patients received TCZ in intravenous infusions at a dose of 8mg/kg every 28 days for 4 months and followed up for additionally 6 weeks. The primary outcome was improvement in CAS by at least 2 points, 6 weeks after the last dose of TCZ. Secondary outcomes included CAS <3 (inactive disease) 6 weeks after TCZ last dose, reduced TSI levels, proptosis reduction by > 2mm and diplopia response. Results The primary outcome, was achieved in all patients 6 weeks after treatment course. Furthermore all patients had inactive disease 6 weeks after treatment cessation. Treatment with TCZ reduced significantly median CAS by 3 units (p=0.002), TSI levels by 11.02 IU/L (p=0.006), Hertel score on the right eye by 2.3 mm (p=0.003), Hertel score on the left eye by 1.6 mm (p=0.002), while diplopia persisted in fewer patients (25%) after treatment with TCZ (not statistically significant, p=0.250). After treatment with TCZ, there was a radiological improvement in 75% of patients, while 16.7% showed no response, and in 8.3% of patients deterioration was established. Conclusion Tocilizumab appears to be a safe and cost effective therapeutic option for patients with active, corticosteroid-resistant, moderate to severe Graves' orbitopathy.
Collapse
|
7
|
Imaging of the medial rectus muscle predicts the development of optic neuropathy in thyroid eye disease. Sci Rep 2022; 12:6259. [PMID: 35428798 PMCID: PMC9012828 DOI: 10.1038/s41598-022-10043-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
Goal of the study was to evaluate bony orbit remodeling and extraocular muscle (EOM) volume in thyroid eye disease (TED) and their role as predicting factors for development of dysthyroid optic neuropathy (DON). Orbital computed tomography of 92 patients with TED with (76 orbits) or without DON (98 orbits) were retrospectively evaluated. Orbits (n = 40) of subjects without TED served as controls. Measurements of the bony orbit as well as EOM volume were incorporated into a generalized linear mixed model to predict DON. The angle of the medial orbital wall was significantly smaller (p < 0.001) in patients with TED (− 2.3 ± 3.6°) compared to patients with TED + DON (1.0 ± 4.1°). Both groups differed significantly from controls (− 4.2 ± 2.7°). Bowing of the medial orbital wall correlated positively with muscle volume (r = 0.564; p < 0.001). Total EOM volume was significantly larger in TED + DON (7.6 ± 2.5cm3) compared to TED only (5.6 ± 3.0cm3; p < 0.001) or controls (2.6 ± 0.5cm3). Multivariate analysis revealed the medial rectus muscle volume (TED: 1.06 ± 0.48cm3 vs. TED + DON: 2.16 ± 0.84cm3) as the strongest predictor, achieving a specifity of 86.7% and a sensitivity of 73.7% in diagnosing DON in univariate analysis. Though characterized by a wide range of variability, increased medial rectus muscle volume is the strongest predictor for DON in our patient cohort with TED when analyzing a single muscle.
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Song C, Luo Y, Yu G, Chen H, Shen J. Current insights of applying MRI in Graves' ophthalmopathy. Front Endocrinol (Lausanne) 2022; 13:991588. [PMID: 36267571 PMCID: PMC9577927 DOI: 10.3389/fendo.2022.991588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Graves' ophthalmopathy (GO) is an autoimmune disease related to Grave's disease (GD). The therapeutic strategies for GO patients are based on precise assessment of the activity and severity of the disease. However, the current assessment systems require development to accommodate updates in treatment protocols. As an important adjunct examination, magnetic resonance imaging (MRI) can help physicians evaluate GO more accurately. With the continuous updating of MRI technology and the deepening understanding of GO, the assessment of this disease by MRI has gone through a stage from qualitative to precise quantification, making it possible for clinicians to monitor the microstructural changes behind the eyeball and better integrate clinical manifestations with pathology. In this review, we use orbital structures as a classification to combine pathological changes with MRI features. We also review some MRI techniques applied to GO clinical practice, such as disease classification and regions of interest selection.
Collapse
Affiliation(s)
- Cheng Song
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yaosheng Luo
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Genfeng Yu
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haixiong Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Radiology, Shunde Hospital of Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
- *Correspondence: Jie Shen, ; Haixiong Chen,
| | - Jie Shen
- Department of Endocrinology and Metabolism, Shunde Hospital of Southern Medical University (The First People’s Hospital of Shunde), Foshan, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Jie Shen, ; Haixiong Chen,
| |
Collapse
|
10
|
Edama M, Matsuzawa K, Yokota H, Hirabayashi R, Sekine C, Maruyama S, Sato N. Elbow valgus stability of the transverse bundle of the ulnar collateral ligament. BMC Musculoskelet Disord 2021; 22:873. [PMID: 34641828 PMCID: PMC8513277 DOI: 10.1186/s12891-021-04760-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background The purpose of this study was to clarify elbow valgus stability of the transverse bundle (TB). We hypothesized that the transverse bundle is involved in elbow valgus stability. Methods Twelve elbows of six Japanese Thiel-embalmed cadavers were evaluated. The skin, subcutaneous tissue and origin of forearm flexors were removed from about 5 cm proximal to the elbow to about 5 cm distal to the elbow, and the ulnar collateral ligament was dissected (intact state). The cut state was defined as the state when the TB was cut in the middle. The joint space of the humeroulnar joint (JS) was measured in the intact state and then in the cut state. With the elbow flexed to 30°, elbow valgus stress was gradually increased to 30, 60 N using the Telos Stress Device, and the JS was measured by ultrasonography under each load condition. Paired t-testing was performed to compare the JS between the intact and cut states under each load. Results No significant difference in JS was identified between the intact and cut state at start limb position. The JS was significantly higher in the cut state than in the intact state at both 30 N and 60 N. Conclusion The findings from this study suggested that the TB may be involved in elbow valgus stability.
Collapse
Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan.
| | - Kanta Matsuzawa
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Chie Sekine
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Sae Maruyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Noboru Sato
- Division of Gross Anatomy and Morphogenesis, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
11
|
Johnson BT, Jameyfield E, Aakalu VK. Optic neuropathy and diplopia from thyroid eye disease: update on pathophysiology and treatment. Curr Opin Neurol 2021; 34:116-121. [PMID: 33278144 PMCID: PMC7853658 DOI: 10.1097/wco.0000000000000894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Thyroid eye disease (TED) is a disfiguring disease that can lead to neuro-ophthalmic manifestations including diplopia and optic neuropathy. The aim of this review is to shed light on the diagnosis of TED based on clinical examination findings and diagnostic imaging. We will also discuss gold standard as well as newly emerging therapies for TED. RECENT FINDINGS We discussed diagnostic criteria for TED and differentiating TED from other causes of binocular diplopia. We also reviewed the pathophysiology and differential diagnoses for dysthyroid optic neuropathy as well as recent developments on controversial causes. New imaging techniques are available for evaluation and prognosis of TED comorbidities. Most of the recent developments in TED have been focused on new treatment modalities that have thus far had promising results. We reviewed recently approved and novel potential therapies that are helpful in treating both diplopia and dysthyroid optic neuropathy. SUMMARY TED is a complicated disorder with many clinical manifestations as well as treatment modalities. Our aim of this review was to outline new developments in the diagnosis and management of TED.
Collapse
Affiliation(s)
- Brooke T Johnson
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary UIC
| | - Evan Jameyfield
- Department of Neurology, PGY2, University of Illinois at Chicago
| | - Vinay K Aakalu
- Department of Ophthalmology and Visual Sciences, Illinois Center for Thyroid Eye Disease, Illinois Eye and Ear Infirmary UIC, Chicago, Illinois, USA
| |
Collapse
|
12
|
Hu H, Xu XQ, Chen L, Chen W, Wu Q, Chen HH, Zhu H, Shi HB, Wu FY. Predicting the response to glucocorticoid therapy in thyroid-associated ophthalmopathy: mobilizing structural MRI-based quantitative measurements of orbital tissues. Endocrine 2020; 70:372-379. [PMID: 32504380 DOI: 10.1007/s12020-020-02367-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE We aimed to evaluate the performance of structural magnetic resonance imaging (MRI)-based quantitative measurements at extraocular muscle (EOM), orbital fat (OF), and especially lacrimal gland (LG) in predicting response to glucocorticoid (GC) in patients with active and moderate-severe thyroid-associated ophthalmopathy (TAO). METHODS Forty-seven active and moderate-severe TAOs (responsive group, 29 patients and 58 eyes; unresponsive group, 18 patients and 36 eyes) were enrolled. Pretreatment MRI-based parameters of EOM, OF, and LG, and clinical factors were retrospectively collected and compared between two groups. Logistic regression and receiver operating characteristic curve analyses were used to assess the predictive value of identified independent variables. RESULTS Responsive group showed significantly higher minimum signal intensity ratio of EOM (EOM-SIRmin) (p < 0.001), higher EOM-SIRmean (p = 0.034), higher LG herniation (LGH) (p = 0.019), lower OF thickness (OFT) (p = 0.017), higher LGH/OFT ratio (p = 0.001), and shorter disease duration (p = 0.004) than unresponsive group. Multivariate analysis showed that EOM-SIRmin, LGH/OFT ratio, and disease duration were independent predictors for responsive TAOs (all p < 0.05). Integration of three independent predictors demonstrated optimal predictive efficiency (area under curve, 0.829). Combining EOM-SIRmin ≥1.43 and LGH/OFT ratio ≥1.65, optimal predictive specificity (94.4%) could be obtained, while optimal predictive sensitivity (82.8%) was achieved when integrating disease duration ≤3.5 and LGH/OFT ratio ≥1.65. CONCLUSIONS Structural MRI-based quantitative measurements at EOM, OF, and LG, specially EOM-SIRmin and LGH/OFT ratio, together with disease duration, may serve as promising markers to predict response to GC in patients with active and moderate-severe TAO.
Collapse
Affiliation(s)
- Hao Hu
- 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
| | - 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
| | - Qian Wu
- 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
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- 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.
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|