多参数定量磁共振成像在 Graves 眼病评估中的应用。
Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves' Ophthalmopathy.
机构信息
Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China.
Department of Endocrinology and Metabolism, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, China.
出版信息
J Magn Reson Imaging. 2023 Oct;58(4):1279-1289. doi: 10.1002/jmri.28642. Epub 2023 Feb 13.
BACKGROUND
Assessment of the activity of Graves' ophthalmopathy (GO) is difficult. Existing methods need improvement.
PURPOSE
Investigate the application of multiparametric magnetic resonance imaging (MRI) in GO.
STUDY TYPE
Retrospective.
POPULATION
A total of 235 GO patients (age: 38.8 ± 13.4 years; 90 male; 96 active patients).
FIELD STRENGTH/SEQUENCE: Short-tau inversion recovery (STIR) fast spin echo, multiecho spin echo T2 mapping and 3D T1-weighted fast field echo sequences at 3.0 T.
ASSESSMENT
Two physicians assessed the mean and maximum signal intensity ratio of extraocular muscles to white matter (SIR), T2 relaxation time (T2RT), extraocular muscle area (EMA), fat fraction (FF), retrobulbar fat volume (RFV), and extraocular muscle volume (EMV). Clinical activity score (CAS) ≧ 3 was in active stage.
STATISTICAL TESTS
The optimal cut-off point of diagnostic efficacy was selected using receiver operating characteristic (ROC) curve analysis and evaluated using area under the curve (AUC), compared using Student's t test, analysis of variance or Kruskal-Wallis H test. The correlation used Pearson correlation analysis. The discriminant equation used a binary logistic regression analysis. P < 0.05 was considered statistically significant.
RESULTS
The SIRmean, SIRmax, T2RTmean, T2RTmax, EMA, and EMV in active GO patients were significantly higher than those in inactive and were positively correlated with CAS (r = 0.276, 0.228, 0.438, 0.388, 0.502, and 0333, respectively). The FFmax of active patients was significantly lower than that of inactive patients and was negatively correlated with CAS (r = -0.44). Logistic regression analysis indicated that T2RTmean was independently associated with GO active periods and had good diagnostic performance (area under ROC curve = 0.736, sensitivity 70.7%, specificity 69.3%). T2RTmean ≧ 74.295 could be a diagnostic cut-off for judging GO activity (sensitivity 55.3%).
CONCLUSION
SIR, T2RT, EMV, and FF can quantitatively assess the activity and severity of GO and can potentially provide a basis for clinical judgment and selection of treatment options.
EVIDENCE LEVEL
TECHNICAL EFFICACY
Stage 2.
背景
Graves 眼病（GO）活动的评估具有挑战性。现有的方法需要改进。
目的
探讨多参数磁共振成像（MRI）在 GO 中的应用。
研究类型
回顾性。
人群
共有 235 名 GO 患者（年龄：38.8±13.4 岁；90 名男性；96 名活动期患者）。
磁场强度/序列：3.0T 短回波时间反转恢复（STIR）快速自旋回波、多回波自旋回波 T2 映射和 3D T1 加权快速场回波序列。
评估
两名医生评估眼外肌与脑白质的平均信号强度比（SIR）、T2 弛豫时间（T2RT）、眼外肌面积（EMA）、脂肪分数（FF）、球后脂肪体积（RFV）和眼外肌体积（EMV）。临床活动评分（CAS）≧3 为活动期。
统计检验
使用受试者工作特征（ROC）曲线分析选择诊断效能的最佳截断点，并使用曲线下面积（AUC）进行评估，使用学生 t 检验、方差分析或 Kruskal-Wallis H 检验进行比较。使用 Pearson 相关分析相关性。使用二元逻辑回归分析判别方程。P<0.05 被认为具有统计学意义。
结果
活动期 GO 患者的 SIRmean、SIRmax、T2RTmean、T2RTmax、EMA 和 EMV 显著高于非活动期，与 CAS 呈正相关（r=0.276、0.228、0.438、0.388、0.502 和 0.333）。活动期患者的 FFmax 显著低于非活动期，与 CAS 呈负相关（r=-0.44）。逻辑回归分析表明，T2RTmean 与 GO 活动期独立相关，具有良好的诊断性能（ROC 曲线下面积=0.736，灵敏度 70.7%，特异性 69.3%）。T2RTmean≧74.295 可作为判断 GO 活动的诊断截断值（敏感性 55.3%）。
结论
SIR、T2RT、EMA 和 FF 可定量评估 GO 的活动和严重程度，可能为临床判断和治疗方案选择提供依据。
证据水平
4。
技术功效
2 级。
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