Clinical and Radiological Findings in Patients with Newly Diagnosed Graves’ Ophthalmopathy

Abstract

Background. Graves’ ophthalmopathy is the most common extrathyroidal manifestation of Graves’ disease. The objective of this study was to investigate the clinical ophthalmological and MRI findings in newly diagnosed Graves’ ophthalmopathy. Methods. This study included 36 newly diagnosed Graves’ disease patients and 23 control participants. Patients and control participants underwent detailed ophthalmologic examination. In addition, all subjects underwent orbital MRI examination; and sizes, cross-sectional areas, and signal intensities of extraocular muscles were also measured. Results. Based on MRI measurements, the mean exophthalmos in the left eye was significantly higher in the patient group when compared to those of controls (2.04 ± 0.29 vs. 1.85 ± 0.15 cm, p = 0.003). The mean long diameter of inferior oblique muscle in both the right and left eyes were significantly shorter in patients when compared to those of controls ( p = 0.001, p = 0.002, resp.); however, the mean long diameter of superior oblique in the left eye was longer in patients than those of controls ( p = 0.001). Patients had significantly higher superior oblique muscle signal intensity than those of controls in the right eye ( p = 0.01). There was no significant difference for the other parameters between the patient and control groups. Conclusion. Our findings suggest that there is no obvious change in MRI examination despite clinical ophthalmological findings in patients with newly diagnosed Graves’ ophthalmopathy. Unnecessary MRI examination should be avoided in this patient group due to unsatisfactory cost-effectiveness.

Computed tomography and magnetic resonance imaging approaches to Graves’ ophthalmopathy: a narrative review

“…Studies seeking to evaluate diagnostic methods and disease grading would better consider disease stage to evidence which method is more sensitive for each distinct stage, as shown by Chen et al. ( 65 – 69 ). In this MRI study, all findings suggested that the methods used can help to identify the disease activity and staging, providing a better perspective on treatment options.…”

Application of Quantitative MRI in Thyroid Eye Disease: Imaging Techniques and Clinical Practices

“…The arrow shows the length from the foremost part of the cornea to the orbital apex on axial T1WI sequence. Reproduced with permission from Cevik et al 12 Copyright 2021 International Journal of Endocrinology. ( b ) Quantitative measurement of EOMs diameters on T1WI for TED diagnosis.…”

“…Arrow a shows long diameter and arrow b shows short diameter on coronal T1WI sequence. Reproduced with permission from Cevik et al 12 Copyright 2021 International Journal of Endocrinology. ( c , d ) The patient with active TED had prominent T1CE hyperintensity of EOMs (medial, superior and inferior recti muscles) than the patient with inactive TED.…”

Current insights of applying MRI in Graves’ ophthalmopathy

“…For this, the axial slice that most obviously depicts the EOMs and optic nerve is selected, and from which the perpendicular distance between the interzygomatic line and the surface of the cornea is measured (Figure 3A) (52). However, depending on the selection of either the anterior or the posterior corneal surface, there can be a difference of 1-2 mm for the exophthalmos determined by MRI and by Hertel ophthalmometry (15,16). In summary, in the absence of guidance from an experienced ophthalmologist, m e a s u r i n g e x o p h t h a l m o s w i t h M R I i s a g o o d diagnostic option.…”