Zhou Jiang, Liu Jun, Lu Jin-Ling, Pu Xiong-Ying, Chen Huan-Huan, Liu Hu, Xu Xiao-Quan, Wu Fei-Yun, Hu Hao
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Rd, Gulou District, Nanjing, China.
Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Jpn J Radiol. 2025 Apr;43(4):603-611. doi: 10.1007/s11604-024-01710-4. Epub 2024 Nov 25.
So far, there is no gold standard to diagnosis dysthyroid optic neuropathy (DON). Diffusion kurtosis imaging (DKI) has the potential to provide imaging biomarkers for the timely and accurate diagnosis of DON. This study aimed to explore the white matter (WM) alterations in thyroid-associated ophthalmopathy (TAO) patients with and without DON using DKI with tract-based spatial statistics method.
Fifty-three TAO patients (21 DON and 32 non-DON) and 30 healthy controls (HCs) were recruited in this cross-sectional study. DKI data were analyzed and compared among groups. The correlations between diffusion parameters and clinical variables were assessed. Receiver-operating characteristic curve analysis was used to evaluate the feasibility of using DKI parameters to distinguish DON and non-DON.
Compared with HCs, both DON and non-DON groups exhibited significantly decreased radial kurtosis (RK), mean kurtosis (MK), axial kurtosis (AK), kurtosis fractional anisotropy, and fractional anisotropy values in several WM tracts. No significant differences were observed in mean diffusivity values among groups. Meanwhile, DON patients exhibited lower RK, MK, and AK values than non-DON patients mainly in the visual system. Significant correlations were observed between RK values of posterior thalamic radiation (PTR) and best-corrected visual acuity. For distinguishing DON, the RK values of PTR exhibited decent diagnostic performance.
Microstructural abnormalities in WM, especially in the visual system, could provide novel insights into the potential neural mechanisms of the disease, thereby contributing to the timely diagnosis of DON and the development of neuroprotective therapy.
到目前为止，甲状腺功能异常性视神经病变（DON）尚无金标准诊断方法。扩散峰度成像（DKI）有潜力为DON的及时准确诊断提供影像生物标志物。本研究旨在采用基于纤维束的空间统计方法，利用DKI探讨伴有和不伴有DON的甲状腺相关眼病（TAO）患者的白质（WM）改变。
本横断面研究纳入了53例TAO患者（21例DON患者和32例非DON患者）以及30名健康对照者（HCs）。对DKI数据进行分析并在各组间进行比较。评估扩散参数与临床变量之间的相关性。采用受试者工作特征曲线分析来评估使用DKI参数区分DON和非DON的可行性。
与HCs相比，DON组和非DON组在几条WM纤维束中均表现出径向峰度（RK）、平均峰度（MK）、轴向峰度（AK）、峰度分数各向异性和分数各向异性值显著降低。各组间平均扩散率值未观察到显著差异。同时，DON患者主要在视觉系统中的RK、MK和AK值低于非DON患者。丘脑后辐射（PTR）的RK值与最佳矫正视力之间存在显著相关性。对于区分DON，PTR的RK值表现出良好的诊断性能。
WM的微观结构异常，尤其是视觉系统中的异常，可为该疾病的潜在神经机制提供新的见解，从而有助于DON的及时诊断和神经保护治疗的发展。
