García-Rojas Leonardo, Adame-Ocampo Gloria, Mendoza-Vázquez Guillermo, Alexánderson Erick, Tovilla-Canales José Luis
Instituto de Oftalmología Fundación "Conde de Valenciana" I,A,P,, Mexico City, Mexico.
BMC Res Notes. 2013 Sep 4;6:353. doi: 10.1186/1756-0500-6-353.
We aimed to describe orbital positron emission tomography/computed tomography (PET/CT) imaging findings, both structural and metabolic, in different clinical stages of Graves ophthalmopathy (GO). This prospective, observational, cross-sectional study examined 32 eyes of 16 patients with GO.
Patients were assessed with a complete ophthalmological evaluation and assigned a VISA classification for GO. All patients underwent serum thyroid hormone measurement, antibody profile, and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT) of the orbits. The 18-FDG uptake on PET images was expressed in terms of maximum standard uptake value (SUVmax). CT images were analyzed, and orbital structures were measured in millimeters. Vision, inflammation, strabismus, and overall appearance were assessed according to the VISA classification system, thyroid hormone levels, antibody values, 18-FDG uptake, and thickness of orbital structures.
Altogether, 32 eyes of 16 patients (10 women, 6 men; mean age 44.31 ± 13 years, range 20-71 years) were included. Three patients were hypothyroid, seven were euthyroid, and six were hyperthyroid. CT measurements of extraocular muscle diameter were elevated (P < 0.05), and muscle 18-FDG uptake values were increased. Eyes with a clinical VISA inflammation score of ≤ 4 had an average extraocular muscle SUVmax of 3.09, and those with a score of ≥ 5 had an average SUVmax of 3.92 (P = 0.09), showing no clear correlation between clinically observed inflammation and 18-FDG uptake. 18-FDG uptake values also did not show a correlation with extraocular muscle diameter as measured by CT (R2 = 0.0755, P > 0.05).
We demonstrated a lack of correlation between 18-FDG extraocular muscle uptake and either clinical inflammation score or muscle diameter. Although 18-FDG uptake has been used as an inflammation marker in other pathologies, inflammation in GO may be clinically detected in PET/CT-negative cases, and cases with negative clinical findings may show inflammation on PET/CT. Clinical evaluation is mandatory but may be insufficient and inaccurate for classifying GO. A larger and homogeneous sample size and further research is needed to define the role of PET/CT in detecting, grading, and follow-up of GO to optimize treatment of the inflammatory stage respect clinical methods currently used.
我们旨在描述格雷夫斯眼病（GO）不同临床阶段的眼眶正电子发射断层扫描/计算机断层扫描（PET/CT）成像结果，包括结构和代谢方面。这项前瞻性、观察性横断面研究检查了16例GO患者的32只眼睛。
对患者进行全面的眼科评估，并为其GO分配VISA分类。所有患者均接受血清甲状腺激素测量、抗体谱分析以及眼眶的18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18-FDG PET/CT）。PET图像上的18-FDG摄取以最大标准摄取值（SUVmax）表示。分析CT图像，并以毫米为单位测量眼眶结构。根据VISA分类系统、甲状腺激素水平、抗体值、18-FDG摄取和眼眶结构厚度评估视力、炎症、斜视和整体外观。
共纳入16例患者的32只眼睛（10名女性，6名男性；平均年龄44.31±13岁，范围20-71岁）。3例患者甲状腺功能减退，7例甲状腺功能正常，6例甲状腺功能亢进。眼外肌直径的CT测量值升高（P<0.05），肌肉18-FDG摄取值增加。临床VISA炎症评分为≤4的眼睛，眼外肌平均SUVmax为3.09，评分≥5的眼睛平均SUVmax为3.92（P=0.09），表明临床观察到的炎症与18-FDG摄取之间无明显相关性。18-FDG摄取值也与CT测量所得的眼外肌直径无相关性（R2=0.0755，P>0.05）。
我们证明了18-FDG眼外肌摄取与临床炎症评分或肌肉直径之间缺乏相关性。尽管18-FDG摄取在其他病理情况下已被用作炎症标志物，但GO中的炎症在PET/CT阴性的病例中可能在临床上被检测到，而临床检查结果为阴性的病例在PET/CT上可能显示炎症。临床评估是必要的，但对于GO的分类可能不足且不准确。需要更大且同质的样本量以及进一步的研究来确定PET/CT在GO的检测、分级和随访中的作用，以优化炎症阶段的治疗，使其优于目前使用的临床方法。
