Hu Hao, Chen Lu, Zhou Jiang, Chen Wen, Chen Huan-Huan, Zhang Jiu-Lou, Hsu Yi-Cheng, Xu Xiao-Quan, Wu Fei-Yun
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Eur J Radiol. 2022 Jun;151:110295. doi: 10.1016/j.ejrad.2022.110295. Epub 2022 Apr 6.
To investigate the feasibility of using magnetization transfer (MT) magnetic resonance imaging for evaluating patients with thyroid-associated ophthalmopathy (TAO), and determine its added value for differentiating active from inactive TAO and predicting clinical activity score (CAS), compared with conventional fat-saturated T2-weighted and diffusion-weighted imaging.
Orbital MT, fat-saturated T2-weighted, and diffusion-weighted imaging of 60 prospectively enrolled consecutive patients with TAO was analyzed. Simplified histogram parameters (mean, max, min) of magnetization transfer ratio (MTR), signal intensity ratio (SIR), and apparent diffusion coefficient (ADC) at extraocular muscles were calculated for each orbit and compared between the active and inactive groups.
Intraclass correlation coefficients of MTRs and SIRs were similar (0.802-0.963 vs 0.812-0.974, respectively), followed by those of ADCs (0.714-0.855). Patients with active TAO showed significantly lower MTRs and higher SIRs and ADCs than those with inactive TAO (P < 0.05). MTR achieved the highest area under the curve (AUC) of 0.868 for differentiating active from inactive group, followed by SIR (AUC, 0.836). MTR also demonstrated a higher and negative correlation with CAS (r = -0.614, P < 0.001) than MTR and MTR (r = -0.495, P < 0.001; r = -0.243, P = 0.007; respectively). Support vector machine-based analysis revealed that uniting MTRs could prosper concurrently added performance for disease activity differentiation and CAS prediction, compared with merely combining SIRs and ADCs (AUC, 0.933 vs 0.901; r = 0.703 vs. 0.673).
MT imaging could potentially be used as a noninvasive method for differentiating the activity of TAO and predicting CAS, thereby offering added value to conventional SIR and ADC.
探讨利用磁化传递（MT）磁共振成像评估甲状腺相关眼病（TAO）患者的可行性，并确定其与传统脂肪饱和T2加权成像和扩散加权成像相比，在区分TAO活动期与非活动期以及预测临床活动评分（CAS）方面的附加价值。
对60例前瞻性连续纳入的TAO患者进行眼眶MT、脂肪饱和T2加权和扩散加权成像分析。计算每个眼眶眼外肌的磁化传递率（MTR）、信号强度比（SIR）和表观扩散系数（ADC）的简化直方图参数（均值、最大值、最小值），并在活动组和非活动组之间进行比较。
MTR和SIR的组内相关系数相似（分别为0.802 - 0.963和0.812 - 0.974），其次是ADC的组内相关系数（0.714 - 0.855）。活动期TAO患者的MTR显著低于非活动期患者，而SIR和ADC显著高于非活动期患者（P < 0.05）。MTR在区分活动组与非活动组时曲线下面积（AUC）最高，为0.868，其次是SIR（AUC为0.836）。MTR与CAS的相关性也高于SIR和ADC（r = -0.614，P < 0.001；r = -0.495，P < 0.001；r = -0.243，P = 0.007）。基于支持向量机的分析显示，与仅结合SIR和ADC相比，联合MTR在疾病活动度区分和CAS预测方面能同时提高性能（AUC为0.933对0.901；r = 0.703对0.673）。
MT成像可能作为一种无创方法用于区分TAO的活动度并预测CAS，从而为传统的SIR和ADC提供附加价值。
