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

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Abstract

Objective

We aimed to investigate the ability of readout-segmented echo-planar imaging (rs-EPI)-based diffusion tensor imaging (DTI) in assessing the microstructural change of extraocular muscles (EOMs) and optic nerves in patients with thyroid-associated orbitopathy (TAO) as well as in evaluating disease activity.

Materials and Methods

We enrolled 35 TAO patients and 22 healthy controls (HCs) who underwent pre-treatment rs-EPI-based DTI. Mean, axial, and radial diffusivity (MD, AD, and RD) and fractional anisotropy (FA) of the medial and lateral EOMs and optic nerve for each orbit were calculated and compared between TAO and HC groups and between active and inactive TAO groups. Factors such as age, sex, disease duration, mediation, and smoking history between groups were also compared. Logistic regression analysis was used to evaluate the predictive value of significant variables for disease activity.

Results

Disease duration was significantly shorter in active TAOs than in inactive ones ( p < 0.001). TAO patients showed significantly lower FA and higher MD, AD, and RD than HCs for both medial and lateral EOMs ( p < 0.001), but not the AD value of lateral EOMs ( p = 0.619). Active patients had significantly higher FA, MD, and AD than inactive patients for medial EOMs ( p < 0.005), whereas only FA differed significantly in the lateral EOMs ( p = 0.018). The MD, AD, and RD of optic nerves were significantly lower in TAO patients than HCs ( p < 0.05), except for FA ( p = 0.129). Multivariate analysis showed that the MD of medial EOMs and disease duration were significant predictors for disease activity. The combination of these two parameters showed optimal diagnostic efficiency for disease activity (area under the curve, 0.855; sensitivity, 68.4%; specificity, 96.9%).

Conclusion

rs-EPI-based DTI is promising in assessing microstructural changes of EOMs and optic nerves and can help to indicate the disease activity of TAO, especially through the MD of medial EOMs.

Related collections

Most cited references 33

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Diagnostic criteria for Graves' ophthalmopathy.

G B Bartley, C A Gorman (1995)

To propose criteria for the diagnosis of Graves' ophthalmopathy. We reviewed the evolution of nomenclature describing Graves' ophthalmopathy. and the diagnostic schema used in key published reports. A laboratory test or clinical finding pathognomonic for Graves' ophthalmopathy currently is not available or recognized. Extant diagnostic criteria may exclude appropriate cases. Graves' ophthalmopathy is considered to be present if eyelid retraction occurs in association with objective evidence of thyroid dysfunction or abnormal regulation, exophthalmos, optic nerve dysfunction, or extraocular muscle involvement. The ophthalmic signs may be unilateral or bilateral, and confounding causes must be excluded. If eyelid retraction is absent, then Graves' ophthalmopathy may be diagnosed only if exophthalmos, optic nerve involvement, or restrictive extraocular myopathy is associated with thyroid dysfunction or abnormal regulation and if no other cause for the ophthalmic feature is apparent.

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Management of Graves' ophthalmopathy: reality and perspectives.

L. Bartalena, Claudio Marcocci, A Pinchera (2000)

Graves' ophthalmopathy is an debilitating disease impairing the quality of life of affected individuals. Despite recent progress in the understanding of its pathogenesis, treatment is often not satisfactory. In mild cases, local therapeutic measures (artificial tears and ointments, sunglasses, nocturnal taping of the eyes, prisms) can control symptoms and signs. In severe forms of the disease (3-5%), aggressive measures are required. If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment. If the disease is severe but inactive, orbital decompression is preferred. Novel treatments such as somatostatin analogs or intravenous immunoglobulins are under evaluation. Rehabilitative (extraocular muscle or eyelid) surgery is often needed after treatment and inactivation of eye disease. Correction of both hyper- and hypothyroidism is crucial for the ophthalmopathy. Antithyroid drugs and thyroidectomy do not influence the course of the ophthalmopathy, whereas radioiodine treatment may cause the progression of preexisting ophthalmopathy, especially in smokers. The exacerbation, however, is prevented by glucocorticoids. In addition, thyroid ablation may prove beneficial for the ophthalmopathy in view of the pathogenetic model relating eye disease to autoimmune reactions directed against antigens shared by the thyroid and the orbit.

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Diffusion anisotropy measurement of brain white matter is affected by voxel size: underestimation occurs in areas with crossing fibers.

H Oouchi, K. C. Yamada, K Sakai … (2016)

Voxel size/shape of diffusion tensor imaging (DTI) may directly affect the measurement of fractional anisotropy (FA) in regions where there are crossing fibers. The purpose of this article was to investigate the effect of voxel size/shape on measured FA by using isotropic and nonisotropic voxels. Ten healthy adult volunteers had MR imaging by using a 1.5 T clinical imager. DTI was performed with 2 different voxel sizes: a 2-mm-section isotropic voxel (2 x 2 x 2 mm(3)) and a 6-mm-section nonisotropic voxel (2 x 2 x 6 mm(3)). Images were obtained by using a single-shot echo-planar imaging technique with motion-probing gradients in 15 orientations and a b-value of 1000 s/mm(2). FA and the apparent diffusion coefficient (ADC) were measured at different sites of the brain. When smaller isotropic voxels were used, the FA was greater in areas with crossing fibers, including the superior longitudinal fasciculus, the thalamus, and the red nucleus; the FA was not significantly different in areas without crossing fibers, such as the corpus callosum, the posterior limb of the internal capsule, and the corticospinal tract at the level of the centrum semiovale (P>.05). The ADC values were not affected by voxel size/shape at any of the areas of the brain that were measured. FA values that are measured in regions containing crossing fibers are underestimated when using nonisotropic DTI.

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Author and article information

Journal

Journal ID (nlm-ta): Korean J Radiol

Journal ID (iso-abbrev): Korean J Radiol

Journal ID (publisher-id): KJR

Title: Korean Journal of Radiology

Publisher: The Korean Society of Radiology

ISSN (Print): 1229-6929

ISSN (Electronic): 2005-8330

Publication date (Print): March 2020

Publication date (Electronic): 11 February 2020

Volume: 21

Issue: 3

Pages: 332-340

Affiliations

[1 ]Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

[2 ]Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Author notes

Corresponding author: Tao Yang, MD, PhD, Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou district, Nanjing, China. Tel: (86) 13851991429, Fax: (86) 25-83724440, njmu_yt@ 123456sina.com

^*These authors contributed equally to this work.

Author information

Huan-Huan Chen https://orcid.org/0000-0003-0201-2059

Hao Hu https://orcid.org/0000-0002-7983-7377

Wen Chen https://orcid.org/0000-0002-4380-8013

Dai Cui https://orcid.org/0000-0003-0356-3362

Xiao-Quan Xu https://orcid.org/0000-0001-5493-5256

Fei-Yun Wu https://orcid.org/0000-0002-3479-369X

Tao Yang https://orcid.org/0000-0003-1883-4129

Article

DOI: 10.3348/kjr.2019.0053

PMC ID: 7039723

PubMed ID: 32090526

SO-VID: 3ab4b5fa-5e07-46f6-8e05-b5acc0b23eb6

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 January 2019

Date accepted : 07 November 2019

Funding

Funded by: National Natural Science Foundation of China, CrossRef https://doi.org/10.13039/501100001809;

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

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Abstract

Objective

Materials and Methods

Results

Conclusion

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 33

Diagnostic criteria for Graves' ophthalmopathy.

Management of Graves' ophthalmopathy: reality and perspectives.

Diffusion anisotropy measurement of brain white matter is affected by voxel size: underestimation occurs in areas with crossing fibers.

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