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.
Korean J Radiol. 2024 Dec;25(12):1070-1082. doi: 10.3348/kjr.2024.0335. Epub 2024 Oct 29.
To assess the role of dynamic contrast-enhanced (DCE)-MRI of the extraocular muscles (EOMs) for determining the activity of thyroid-associated ophthalmopathy (TAO) and treatment response to glucocorticoids (GCs).
We prospectively enrolled 65 patients with TAO (41 active, 82 eyes; 24 inactive, 48 eyes). Twenty-two active patients completed the GC treatment and follow-up assessment, including 15 patients (30 eyes) and 7 patients (14 eyes), defined as responsive and unresponsive, respectively. Model-free (time to peak [TTP], area under the curve [AUC], and Slope) and model-based (K, K, and V) parameters of EOMs in embedded simplified histogram analyses were calculated and compared between groups. Multivariable logistic regression analysis was used to identify the independent predictors. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the diagnostic performance.
Active patients exhibited significantly higher TTP at the 10th percentile (-10th), TTP-mean, and TTP at the 90th percentile (-90th); AUC-10th, AUC-mean, AUC-90th, and AUC-max; K-10th and K-mean; and V-10th, V-mean, V-90th, and V-max than inactive patients ( < 0.05). Responsive patients exhibited significantly lower TTP-min; higher K-mean and K-max; and higher K-10th, K-mean, and K-max than unresponsive patients ( < 0.05). TTP-mean and V-mean were independent variables for determining disease activity ( = 0.017 and 0.022, respectively). A combination of the two parameters could determine active TAO with moderate performance (AUROC = 0.687). TTP-min and K-mean were independent predictors of the response to GCs ( = 0.023 and 0.004, respectively), uniting which could determine the response to GCs with decent performance (AUROC = 0.821).
DCE-MRI-derived model-free and model-based parameters of EOMs can assist in the evaluation of TAO. In particular, TTP-mean and V-mean could be useful for determining the activity of TAO, whereas TTP-min and K-mean could be promising biomarkers for determining the response to GCs.
评估眼眶外肌（EOM）动态对比增强（DCE）MRI 用于确定甲状腺相关眼病（TAO）活动度和糖皮质激素（GCs）治疗反应的作用。
我们前瞻性纳入 65 例 TAO 患者（活动期 41 例，82 眼；非活动期 24 例，48 眼）。22 例活动期患者完成 GC 治疗和随访评估，包括 15 例（30 眼）和 7 例（14 眼）患者，分别定义为有反应和无反应。通过嵌入式简化直方图分析计算并比较 EOM 的无模型（达峰时间 [TTP]、曲线下面积 [AUC]和斜率）和基于模型（Ktrans、Ve 和 Kep）参数。采用多变量逻辑回归分析识别独立预测因子。采用受试者工作特征曲线（AUROC）评估诊断性能。
活动期患者第 10 百分位数（-10th）、平均 TTP（TTP-mean）和第 90 百分位数（-90th）TTP、AUC-10th、AUC-mean、AUC-90th 和 AUC-max、K-10th 和 K-mean 以及 V-10th、V-mean、V-90th 和 V-max 均显著高于非活动期患者（<0.05）。有反应患者 TTP-min 显著降低，K-mean 和 K-max 显著升高，K-10th、K-mean 和 K-max 也显著高于无反应患者（<0.05）。TTP-mean 和 V-mean 是确定疾病活动度的独立变量（=0.017 和 0.022）。联合使用这两个参数可用于确定活动 TAO，诊断性能中等（AUROC=0.687）。TTP-min 和 K-mean 是 GC 治疗反应的独立预测因子（=0.023 和 0.004），联合使用可用于确定 GC 治疗反应，诊断性能良好（AUROC=0.821）。
EOM 的 DCE-MRI 衍生无模型和基于模型参数可辅助 TAO 的评估。特别是 TTP-mean 和 V-mean 可用于确定 TAO 的活动度，而 TTP-min 和 K-mean 可能是预测 GC 治疗反应的有前途的生物标志物。
