Retrobulbar <sup>99m</sup>Tc-Diethylenetriamine-Pentaacetic-Acid Uptake May Predict the Effectiveness of Immunosuppressive Therapy in Graves' Ophthalmopathy

Ujhelyi, Bernadett; Erdei, Annamária; Galuska, László; Varga, József; Szabados, Lajos; Balázs, Erzsébet; Bodor, Miklós; Cseke, B.; Karányi, Zsolt; Leövey, A; Mezősi, Emese; Burman, Kenneth D.; Berta, András; Nagy, Endre

doi:10.1089/thy.2008.0298

Cited by 16 publications

(18 citation statements)

References 19 publications

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“…The visual image evaluation and orbital uptake fraction calculation with DTPA provide qualitative (image) and quantitative (numerical) information, respectively, on disease activity. High orbital DTPA uptake predicts the effectiveness of immunosuppressive therapy in GO [13,14]. In this twoyear long case-control study we tested if the development of GO in GD patients is predictable by DTPA SPECT.…”

Section: Discussionmentioning

confidence: 99%

Early Stage Graves’ Disease is Uniformly Accompanied by Orbital Immune Activity even in Patients who Fail to Develop Orbithopathy during Follow-up

Berta

Bodor

Galuska

et al. 2018

Exp Clin Endocrinol Diabetes

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Section: Discussionmentioning

confidence: 99%

Early Stage Graves’ Disease is Uniformly Accompanied by Orbital Immune Activity even in Patients who Fail to Develop Orbithopathy during Follow-up

Berta

Bodor

Galuska

et al. 2018

Exp Clin Endocrinol Diabetes

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“…The clinical usefulness of DTPA SPECT has been proven by several clinical studies from our institution [17]. Although factors of the initiation and perpetuation of the autoimmune process in GO remain unclear [18], quantitative data of orbital inflammation in GO are essential for appropriate treatment choices [19]. In disease activity measurement and prognosis estimation, the UA has been shown a useful parameter in GO by independent authors [20].…”

Section: Dtpa Uptake Values Other Diagnostic Methods and Treatment mentioning

confidence: 99%

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

Galuska

Barna²,

Varga

et al. 2018

Nucl. Med. Rev.

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The pathogenesis of Graves' orbitopathy (GO) is not completely understood. Coexistent hyperfunction of the thyroid gland is frequent; however, GO may also coexist with hypo-or euthyrodism. The course of GO is largely independent of thyroid function, although elevated serum TSH is known to negatively interfere with GO course. GO is severe in 10% of the cases; sight threatening complications may also develop. A successful therapy of GO requires the assesment of both the severity and activity of orbital inflammation. Based on relevant studies and our own experiences, the possible management choices are reviewed here. For this purpose, we compare the clinical value of imaging techniques for detecting the activity of the disease. During the last 15 years, we used 99m Tc-DTPA retrobulbar SPECT routinely in more than 1400 patients to facilitate the right therapeutic decision. This diagnostic utility simplified management decisions compared to previously applied alternative techniques. We recommended the routine use of 99m Tc-DTPA retrobulbar SPECT for the evaluation and follow-up of GO.

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“…This protocol was clinically tested by Galuska et al, who was able to visualize the active retrobulbar inflammation in GO patient by Tc-99m DTPA SPECT [83]. Moreover, Ujhelyi et al found that the mean retrobulbar Tc-99m DTPA uptake is useful to estimate GO activity and may predict the effectiveness of immunosuppressive therapy with corticosteroids in GO patients [84]. Especially, patients included in this study with Tc-99m DTPA uptake score above 12.28MBq/cm 3 were more likely to respond to corticosteroid treatment.…”

Section: Radionuclide-based Imaging Evaluation Of Graves' Ophthalmopathymentioning

confidence: 99%

“…Subsequently, SPECT imaging of the orbits using Tc-99mlabeled DTPA have been proposed by several reports [102][103]. This method has been accepted for evaluation of GO disease activity allowing a rapid imaging at an acceptable cost, and in addition, the successful management of GO has been associated with the decrease in orbital uptake of radiotracer [84]. In addition, to improve the sensitivity of detection of active GO phase, and therefore the prediction of the response to immunosuppressive therapy, over clinical activity score (CAS) alone, the combination of Tc-99m DTPA SPECT imaging and CAS estimation was proposed by Galuska et al [104].…”

Section: Predicting Therapeutic Efficacy and Disease Activity Based Omentioning

confidence: 99%

Graves’ Ophthalmopathy Imaging Evaluation

Kawa¹,

Machalińska²,

Wilk³

et al. 2014

Thyroid Disorders - Focus on Hyperthyroidism

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Graves ophthalmopathy GO , known as Graves orbitopathy or thyroid eye disease TED , is an autoimmune disorder and the main extrathyroidal expression of Graves' disease GD . GO occurs mainly, but not exclusively, in patients with Graves disease up to % of GD patients have clinically apparent ophthalmopathy . The major clinical risk factor for developing thyroid eye disease is smoking. Moreover, radioactive iodine used to treat hyperthyroidism can worsen GO. There is an age-specific and gender-related distribution of GO, and the annual incidence is . % for women and . % for men but this largely reflects the increased incidence of GD in women [ ]. In addition to GD, thyroid eye disease can also be seen in chronic autoimmune thyroiditis, albeit is far less common and occurs in % of these patients [ ]. "lthough the link between GD and GO is still not totally clear, the close association between onset of GD and the development of GO suggests that both disorders would have common pathogenic mechanisms [ ]. The ocular involvement of GD is explained by the expression of receptor for thyroid-stimulating hormone TSH-R present not only in the thyroid follicular cells but also in adipocytes, and fibroblasts located in the orbit, and lymphocytes infiltrating orbit tissues [ ]. Likewise, the signs and symptoms of GO occur due to inflammatory reaction and subsequent fibrosis of the orbital components, including orbital connective tissue, and the extraocular muscles [ ]. Inflammatory cell infiltration of extraocular muscles is associated with increased secretion of glycosaminoglycans and osmotic retention of water. The muscles become enlarged, sometimes up to eight times their normal size, and may compress the optic nerve. Subsequent degeneration of muscle fibers eventually leads to fibrosis, which exerts a tethering effect on the involved muscle resulting in the muscle dysfunction and ophthalmoplegia. Infiltration of interstitial tissues, orbital fat and lacrimal glands with lymphocytes, plasma cells, macrophages and mast cells along with accumulation of glycosaminoglycans and

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Retrobulbar ^99mTc-Diethylenetriamine-Pentaacetic-Acid Uptake May Predict the Effectiveness of Immunosuppressive Therapy in Graves' Ophthalmopathy

Cited by 16 publications

References 19 publications

Early Stage Graves’ Disease is Uniformly Accompanied by Orbital Immune Activity even in Patients who Fail to Develop Orbithopathy during Follow-up

Early Stage Graves’ Disease is Uniformly Accompanied by Orbital Immune Activity even in Patients who Fail to Develop Orbithopathy during Follow-up

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

Graves’ Ophthalmopathy Imaging Evaluation

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Retrobulbar 99mTc-Diethylenetriamine-Pentaacetic-Acid Uptake May Predict the Effectiveness of Immunosuppressive Therapy in Graves' Ophthalmopathy

Cited by 16 publications

References 19 publications

Early Stage Graves’ Disease is Uniformly Accompanied by Orbital Immune Activity even in Patients who Fail to Develop Orbithopathy during Follow-up

Early Stage Graves’ Disease is Uniformly Accompanied by Orbital Immune Activity even in Patients who Fail to Develop Orbithopathy during Follow-up

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

Graves’ Ophthalmopathy Imaging Evaluation

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Retrobulbar ^99mTc-Diethylenetriamine-Pentaacetic-Acid Uptake May Predict the Effectiveness of Immunosuppressive Therapy in Graves' Ophthalmopathy