Diagnosis and stage of Graves' ophthalmopathy: Efficacy of quantitative measurements of the lacrimal gland based on 3-T magnetic resonance imaging

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.

Teprotumumab (Tepezza): from the discovery and development of medicines to USFDA approval for active thyroid eye disease (TED) treatment

“…Few findings discussed the importance of the lacrimal gland in TAO. In patients with TAO, computed tomography and isotope scans are used to test lacrimal glands, but they are correlated with exposure to radiation [5,6,[61][62][63][64][65][66]. Imaging of diffusion-weighted magnetic resonance (MR) offers the characterization of soft tissues and their biological effects since it represents the spontaneous motion of water protons that are disrupted by tissue-located intracellular organelles and macromolecules [7,8].…”

Thyroid-Associated Orbitopathy: Evaluating Microstructural Changes of Extraocular Muscles and Optic Nerves Using Readout-Segmented Echo-Planar Imaging-Based Diffusion Tensor Imaging

“…Signal intensity on T2-weighted images and contrast-enhanced images can assist in staging and deciding treatment (8). However, the overall accuracy for disease staging is still limited from 55.6% to 71.2% (6)(7)(8)(9).…”

Usefulness of readout-segmented EPI-based diffusion tensor imaging of lacrimal gland for detection and disease staging in thyroid-associated ophthalmopathy

“…Patients with TAO commonly complain about biliousness of ocular surface, including photophobia, excess tearing, grittiness, and foreign-body sensations [3,4]. Besides the traditionally documented pathogeneses regarding anatomical changes of widened vertical palpebral fissure and increased exophthalmos that accelerate the evaporation of tears, decreased secretion of tears due to lacrimal gland (LG) involvement has been considered as another crucial factor [3][4][5][6]. A strong correlation between thyroid antibodies and lacrimal dysfunction has also been declared, indicating the target role of LG in disease process of TAO [3,7].…”