Zhou Jiang, Yuan Quan, Pu Xiong-Ying, Lu Jin-Ling, Liu Hu, Chen Huan-Huan, Xu Xiao-Quan, Hu Hao, Wu Fei-Yun
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Radiology, The People's Hospital of Danyang, Zhenjiang, China.
Korean J Radiol. 2025 Jul;26(7):704-715. doi: 10.3348/kjr.2024.1188. Epub 2025 Jun 13.
To evaluate the ability of magnetization transfer imaging (MTI) to diagnose dysthyroid optic neuropathy (DON) and to establish the added value of MTI to conventional T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI).
One hundred and forty-nine patients with thyroid-associated ophthalmopathy were included and divided into training (46 eyes with DON and 148 eyes without DON) and validation (20 eyes with DON and 64 eyes without DON) cohorts. The orbital magnetic resonance imaging (MRI) protocols included coronal MTI, fat-suppressed T2WI, and DWI. The minimum, mean, and maximum values of the magnetization transfer ratio (MTR), signal intensity ratio (SIR), apparent diffusion coefficient (ADC) of each optic nerve (ON), and modified muscle index (mMI) of each orbit were calculated and compared between the groups. Multi-variable logistic regression analysis was performed to identify the independent imaging predictors of DON. The performance of each imaging predictor and their combinations using a binary logistic regression model for diagnosing DON was evaluated using receiver operating characteristic (ROC) curve analysis.
Eyes with DON exhibited significantly lower MTRs and ADCs of the ON, increased SIRs of the ON, and increased mMI. The MTR of the ON, ADC of the ON, and mMI were independent predictors of DON. The multi-variable model incorporating these three variables yielded an area under the ROC curve (AUC) of 0.946 and showed significantly higher diagnostic performance than MTR (AUC = 0.831), ADC (AUC = 0.738), or mMI (AUC = 0.862) alone in the training cohort (all < 0.001). In the validation cohort, the multi-variable model achieved satisfactory diagnostic performance (AUC = 0.926).
MTI may be a useful non-invasive technique for diagnosing DON. MTR can provide additional value to conventional DWI in distinguishing patients with DON from those without DON.
评估磁化传递成像（MTI）诊断甲状腺功能异常性视神经病变（DON）的能力，并确定MTI相对于传统T2加权成像（T2WI）和扩散加权成像（DWI）的附加价值。
纳入149例甲状腺相关性眼病患者，分为训练组（46只患DON的眼和148只未患DON的眼）和验证组（20只患DON的眼和64只未患DON的眼）。眼眶磁共振成像（MRI）检查方案包括冠状位MTI、脂肪抑制T2WI和DWI。计算并比较各组每条视神经（ON）的磁化传递率（MTR）、信号强度比（SIR）、表观扩散系数（ADC）的最小值、平均值和最大值，以及每个眼眶的改良肌肉指数（mMI）。进行多变量逻辑回归分析以确定DON的独立影像预测指标。使用二元逻辑回归模型，通过受试者工作特征（ROC）曲线分析评估每个影像预测指标及其组合诊断DON的性能。
患DON的眼表现出视神经的MTR和ADC显著降低，视神经的SIR升高，以及mMI升高。视神经的MTR、视神经的ADC和mMI是DON的独立预测指标。纳入这三个变量的多变量模型在ROC曲线下的面积（AUC）为0.946，在训练组中显示出比单独的MTR（AUC = 0.831）、ADC（AUC = 0.738）或mMI（AUC = 0.862）显著更高的诊断性能（均P < 0.001）。在验证组中，多变量模型取得了令人满意的诊断性能（AUC = 0.926）。
MTI可能是一种用于诊断DON的有用的非侵入性技术。MTR在区分患DON的患者和未患DON的患者方面可为传统DWI提供附加价值。
