Zhang Mingqiao, Zhang Xiaohui, Huang Qian, Liang Liang, Long Jian
Department of Endocrinology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
BMC Endocr Disord. 2025 Jul 14;25(1):177. doi: 10.1186/s12902-025-01981-6.
To assess the association between the apparent diffusion coefficient (ADC) of extraocular muscles (EOMs) and the efficacy of glucocorticoid (GC) therapy in patients with active and moderate-severe thyroid eye disease (TED).
Eighteen active and moderate-to-severe bilateral TED patients (responsive group, n = 8 patients (16 eyes); unresponsive group, n = 10 patients (20 eyes)) who underwent orbital long variable echo‑trains (Resolve)-diffusion tensor imaging (DTI) before GC therapy were retrospectively enrolled. The ADC values of each EOM were collected. The correlation between the ADC of EOMs and the efficacy of GC therapy was analyzed.
Age was significantly younger in the responsive group compared with the unresponsive group (52.13 ± 5.18 years vs. 58.80 ± 9.33 years, P value = 0.02).There were no statistical differences in sex, smoking, TED duration, visual acuity, intraocular pressure, exophthalmos, clinical activity score, the levels of free triiodothyronine, free tetraiodothyronine thyroid-stimulating hormone, and thyroid-stimulating hormone receptor antibody between the responsive group and the unresponsive group. Apparent diffusion coefficient in the responsive group were significantly lower than that in the unresponsive group in superior rectus muscle (1351.17 ± 232.12 vs. 1624.36 ± 193.70, P value = 0.001) and medial rectus muscle (1420.69 ± 192.05 vs. 1697.00 ± 199.89, P value = 0.001). After age, sex and CAS adjustment, ADC of the superior rectus muscle and medial rectus muscle were independent predictors of the response to GC treatment by binary logistic regression analysis. The cut-off value of ADC was 1582.00 × 10 mm/s in superior rectus muscle with a sensitivity of 88% and a specificity of 65% respectively [ area under the curve (AUC) = 0.81]. The cut-off value of ADC was 1541.39 × 10 mm/s in medial rectus muscle with a sensitivity of 75% and a specificity of 80% (AUC = 0.84). There were no significant difference in the predictive efficacy between the two ADC cut-off values.
Apparent diffusion coefficient values of EOMs from resolve DTI can be used as an indicator to predict the efficacy of GC therapy. Moderate-to-severe active TED patients with low ADC values at baseline in superior rectus muscle or medial rectus muscle may respond well to GC therapy.
评估眼外肌（EOM）的表观扩散系数（ADC）与糖皮质激素（GC）治疗活动期中度至重度甲状腺眼病（TED）患者疗效之间的关联。
回顾性纳入18例活动期中度至重度双侧TED患者（反应组，n = 8例患者（16只眼）；无反应组，n = 10例患者（20只眼）），这些患者在GC治疗前接受了眼眶长可变回波链（Resolve）-扩散张量成像（DTI）检查。收集每条EOM的ADC值。分析EOM的ADC与GC治疗疗效之间的相关性。
反应组的年龄明显低于无反应组（52.13±5.18岁 vs. 58.80±9.33岁，P值 = 0.02）。反应组和无反应组在性别、吸烟情况、TED病程、视力、眼压、眼球突出度、临床活动评分、游离三碘甲状腺原氨酸、游离甲状腺素、促甲状腺激素及促甲状腺激素受体抗体水平方面无统计学差异。反应组上直肌的表观扩散系数显著低于无反应组（1351.17±232.12 vs. 1624.36±193.70，P值 = 0.001），内直肌也显著低于无反应组（1420.69±192.05 vs. 1697.00±199.89，P值 = 0.001）。在对年龄、性别和临床活动评分进行校正后，通过二元逻辑回归分析，上直肌和内直肌的ADC是GC治疗反应的独立预测因素。上直肌ADC的截断值为1582.00×10⁻³mm²/s，敏感性为88%，特异性为65%[曲线下面积（AUC）= 0.81]。内直肌ADC的截断值为1541.39×10⁻³mm²/s，敏感性为75%，特异性为80%（AUC = 0.84）。两个ADC截断值的预测效能无显著差异。
Resolve DTI获得的EOM的表观扩散系数值可作为预测GC治疗疗效的指标。上直肌或内直肌基线ADC值较低的中度至重度活动期TED患者可能对GC治疗反应良好。
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