Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, 200011, China.
Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
Endocrine. 2022 Nov;78(2):321-328. doi: 10.1007/s12020-022-03167-9. Epub 2022 Aug 23.
To explore radiological changes of the lacrimal gland (LG) in Graves' ophthalmopathy (GO) and whether a combination of MRI parameters and clinical indicators would be more effective in predicting individual clinical manifestation of GO compared to clinical activity scores (CAS) assessment.
A total of 28 patients with GO (56 eyes) and 14 healthy controls (HCs) (28 eyes) were enrolled between July 2020 and July 2021. Patients were classified into the active GO group (CAS ≥ 3) and the inactive GO group (CAS < 3). MRI data and clinical data of LG were collected. The diagnostic performance of MRI parameters and models was assessed by receiver operating characteristic curve analysis. Logistic regression predictive models for staging GO were compared.
LG in GO groups had significantly higher K, Ve, IAUC, ADC, and T2-mapping values (p = 0.006, p < 0.001, p < 0.001, p = 0.048, and p = 0.001, respectively), and significant lower Kep and Vp values (p < 0.001 and p < 0.001 respectively). There were statistically significant differences in T2-mapping value (p < 0.001), the proportion of mild or no obvious redness of conjunctiva (p < 0.001), and the proportion of swelling of caruncle or plica (p < 0.001) between inactive and active groups. In MRI based logistic regression model, the T2-mapping value was an independent risk factor (AUC = 0.832). When combining MRI and clinical indicators, T2-mapping value and age resulted in independent risk factors (AUC = 0.928). Swelling of eyelids, redness of the conjunctiva, swelling of the conjunctiva, swelling of caruncle or plica, and spontaneous retrobulbar pain could be replaced by other objective indicators (AUC = 0.937, 0.852, 0.876, 0.896, and 0.891, respectively).
There were significant differences in MRI quantitative parameters of LG between HCs and GO patients. The combination of the T2-mapping value of LG and clinical indicators improved the stage prediction of Graves' ophthalmopathy compared to CAS, thus providing a new idea for enhancing the objectification level of GO data collection.
探讨格雷夫斯眼病（GO）患者泪腺（LG）的影像学变化，以及 MRI 参数与临床指标相结合是否比临床活动评分（CAS）评估更能有效预测 GO 的个体临床表现。
2020 年 7 月至 2021 年 7 月期间，共纳入 28 例 GO 患者（56 只眼）和 14 例健康对照者（HCs）（28 只眼）。患者分为活动期 GO 组（CAS≥3）和非活动期 GO 组（CAS<3）。收集 LG 的 MRI 数据和临床资料。采用受试者工作特征曲线分析评估 MRI 参数和模型的诊断性能。比较 GO 分期的 Logistic 回归预测模型。
GO 组的 LG 的 K、Ve、IAUC、ADC 和 T2 映射值明显更高（p=0.006、p<0.001、p<0.001、p=0.048 和 p=0.001），而 Kep 和 Vp 值明显更低（p<0.001 和 p<0.001）。在 T2 映射值（p<0.001）、结膜轻度或无明显发红比例（p<0.001）和穹隆或半月皱襞肿胀比例（p<0.001）方面，非活动期和活动期之间存在统计学差异。在 MRI 基础的 Logistic 回归模型中，T2 映射值是一个独立的危险因素（AUC=0.832）。当结合 MRI 和临床指标时，T2 映射值和年龄是独立的危险因素（AUC=0.928）。眼睑肿胀、结膜充血、结膜肿胀、穹隆或半月皱襞肿胀以及自发性球后疼痛可被其他客观指标替代（AUC=0.937、0.852、0.876、0.896 和 0.891）。
HCs 和 GO 患者的 LG MRI 定量参数存在显著差异。LG 的 T2 映射值与临床指标的结合提高了 Graves 眼病的分期预测能力，相较于 CAS，这为增强 GO 数据采集的客观性提供了新的思路。
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