18-Fluorodeoxyglucose Uptake by Positron Emission Tomography in Extraocular Muscles of Patients with and without Graves' Ophthalmology

García-Rojas, Leonardo; Adame-Ocampo, Gloria; Alexánderson, Erick; Tovilla-Canales, José Luis

doi:10.1155/2013/529187

Cited by 13 publications

(15 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests that 18-FDG may detect those cases in which clinical assessment is confusing and VISA is not precise. As previously published by our group [20], patients with GO do have increased FDG uptake compared with patients without GO.…”

Section: Discussionsupporting

confidence: 78%

Orbital positron emission tomography/computed tomography (PET/CT) imaging findings in graves ophthalmopathy

García-Rojas¹,

Adame-Ocampo

Mendoza-Vázquez

et al. 2013

BMC Res Notes

Self Cite

View full text Add to dashboard Cite

BackgroundWe aimed to describe orbital positron emission tomography/computed tomography (PET/CT) imaging findings, both structural and metabolic, in different clinical stages of Graves ophthalmopathy (GO). This prospective, observational, cross-sectional study examined 32 eyes of 16 patients with GO.MethodsPatients were assessed with a complete ophthalmological evaluation and assigned a VISA classification for GO. All patients underwent serum thyroid hormone measurement, antibody profile, and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT) of the orbits. The 18-FDG uptake on PET images was expressed in terms of maximum standard uptake value (SUVmax). CT images were analyzed, and orbital structures were measured in millimeters. Vision, inflammation, strabismus, and overall appearance were assessed according to the VISA classification system, thyroid hormone levels, antibody values, 18-FDG uptake, and thickness of orbital structures.ResultsAltogether, 32 eyes of 16 patients (10 women, 6 men; mean age 44.31 ± 13 years, range 20–71 years) were included. Three patients were hypothyroid, seven were euthyroid, and six were hyperthyroid. CT measurements of extraocular muscle diameter were elevated (P < 0.05), and muscle 18-FDG uptake values were increased. Eyes with a clinical VISA inflammation score of ≤ 4 had an average extraocular muscle SUVmax of 3.09, and those with a score of ≥ 5 had an average SUVmax of 3.92 (P = 0.09), showing no clear correlation between clinically observed inflammation and 18-FDG uptake. 18-FDG uptake values also did not show a correlation with extraocular muscle diameter as measured by CT (R2 = 0.0755, P > 0.05).ConclusionsWe demonstrated a lack of correlation between 18-FDG extraocular muscle uptake and either clinical inflammation score or muscle diameter. Although 18-FDG uptake has been used as an inflammation marker in other pathologies, inflammation in GO may be clinically detected in PET/CT-negative cases, and cases with negative clinical findings may show inflammation on PET/CT. Clinical evaluation is mandatory but may be insufficient and inaccurate for classifying GO. A larger and homogeneous sample size and further research is needed to define the role of PET/CT in detecting, grading, and follow-up of GO to optimize treatment of the inflammatory stage respect clinical methods currently used.

show abstract

Section: Discussionsupporting

confidence: 78%

Orbital positron emission tomography/computed tomography (PET/CT) imaging findings in graves ophthalmopathy

García-Rojas¹,

Adame-Ocampo

Mendoza-Vázquez

et al. 2013

BMC Res Notes

Self Cite

View full text Add to dashboard Cite

show abstract

“…Biopsy of the orbital tissue may be useful to differentiate EGO from other inflammatory or infiltrating diseases, but the diagnosis of EGO can often be made on clinical and radiological grounds alone. 18-Fluorodeoxyglucose positron emission tomography scans have been used in some series in the diagnosis of cases where clinical doubt exists ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Thyroid antibody-negative euthyroid Graves’ ophthalmopathy

Tabasum

Khan

Taylor

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

View full text Add to dashboard Cite

SummaryTSH receptor antibodies (TRAbs) are the pathological hallmark of Graves’ disease, present in nearly all patients with the disease. Euthyroid Graves’ ophthalmopathy (EGO) is a well-recognized clinical entity, but its occurrence in patients with negative TRAbs is a potential source of diagnostic confusion. A 66-year-old female presented to our endocrinology clinic with right eye pain and diplopia in the absence of thyroid dysfunction. TRAbs were negative, as measured with a highly sensitive third-generation thyrotropin-binding inhibitory immunoglobulin (TBII) ELISA assay. CT and MRI scans of the orbit showed asymmetrical thickening of the inferior rectus muscles but no other inflammatory or malignant orbital pathology. Graves’ ophthalmopathy (GO) was diagnosed on the basis of the clinical and radiological features, and she underwent surgical recession of the inferior rectus muscle with complete resolution of the diplopia and orbital pain. She remained euthyroid over the course of follow-up but ultimately developed overt clinical and biochemical hyperthyroidism, 24 months after the initial presentation. By this time, she had developed positive TRAb as well as thyroid peroxidase antibodies. She responded to treatment with thionamides and remains euthyroid. This case highlights the potential for negative thyroid-specific autoantibodies in the presentation of EGO and underscores the variable temporal relationship between the clinical expression of thyroid dysfunction and orbital disease in the natural evolution of Graves’ disease.Learning pointsEuthyroid Graves’ ophthalmopathy can present initially with negative thyroid-specific autoantibodies.Patients with suggestive symptoms of ophthalmopathy should be carefully evaluated for GO with imaging studies even when thyroid function and autoantibodies are normal.Patients with EGO can develop thyroid dysfunction within 4 years of follow-up underpinning the need for long-term follow-up and continued patient and physician vigilance in patients who have been treated for EGO.

show abstract

“…One of its main advantages over other methods is its ability to detect early inflammatory stages prior to structural changes in the tissue [88]. Recently, García-Rojas et al demonstrated in PET combined with CT (PET/CT) imaging a significant correlation between extraocular muscle uptake of 18-fluorodeoxyglucose (18-FDG) radiotracer and GO developed in hyperthyroid patients [89]. These studies indicate that modern PET/CT imaging modality may provide the valuable clinical information and may be a helpful tool in detecting, localizing, and quantifying the GO inflammation.…”

Section: Radionuclide-based Imaging Evaluation Of Graves' Ophthalmopathymentioning

confidence: 99%

“…Lately, the high-resolution PET/CT have been introduced to clinical practice for improved detection, disease grading, and follow-up of patients with GO in order to optimize the treatment in the inflammatory GO phase. Several novel radiotracers have been employed in PET/CT imaging, including gallium-68 and fluor-18 to supply valuable information on localizing and quantifying of GO-related inflammation in retrobulbar tissues [89][90]. Importantly, the availability of novel PET tracers for high-resolution and hybrid imaging in PET/CT enables to evaluate selectively the actual status of immune activity in any single extraorbital muscle.…”

Section: Predicting Therapeutic Efficacy and Disease Activity Based Omentioning

confidence: 99%

Graves’ Ophthalmopathy Imaging Evaluation

Kawa¹,

Machalińska²,

Wilk³

et al. 2014

Thyroid Disorders - Focus on Hyperthyroidism

View full text Add to dashboard Cite

Graves ophthalmopathy GO , known as Graves orbitopathy or thyroid eye disease TED , is an autoimmune disorder and the main extrathyroidal expression of Graves' disease GD . GO occurs mainly, but not exclusively, in patients with Graves disease up to % of GD patients have clinically apparent ophthalmopathy . The major clinical risk factor for developing thyroid eye disease is smoking. Moreover, radioactive iodine used to treat hyperthyroidism can worsen GO. There is an age-specific and gender-related distribution of GO, and the annual incidence is . % for women and . % for men but this largely reflects the increased incidence of GD in women [ ]. In addition to GD, thyroid eye disease can also be seen in chronic autoimmune thyroiditis, albeit is far less common and occurs in % of these patients [ ]. "lthough the link between GD and GO is still not totally clear, the close association between onset of GD and the development of GO suggests that both disorders would have common pathogenic mechanisms [ ]. The ocular involvement of GD is explained by the expression of receptor for thyroid-stimulating hormone TSH-R present not only in the thyroid follicular cells but also in adipocytes, and fibroblasts located in the orbit, and lymphocytes infiltrating orbit tissues [ ]. Likewise, the signs and symptoms of GO occur due to inflammatory reaction and subsequent fibrosis of the orbital components, including orbital connective tissue, and the extraocular muscles [ ]. Inflammatory cell infiltration of extraocular muscles is associated with increased secretion of glycosaminoglycans and osmotic retention of water. The muscles become enlarged, sometimes up to eight times their normal size, and may compress the optic nerve. Subsequent degeneration of muscle fibers eventually leads to fibrosis, which exerts a tethering effect on the involved muscle resulting in the muscle dysfunction and ophthalmoplegia. Infiltration of interstitial tissues, orbital fat and lacrimal glands with lymphocytes, plasma cells, macrophages and mast cells along with accumulation of glycosaminoglycans and

show abstract

18-Fluorodeoxyglucose Uptake by Positron Emission Tomography in Extraocular Muscles of Patients with and without Graves' Ophthalmology

Cited by 13 publications

References 15 publications

Orbital positron emission tomography/computed tomography (PET/CT) imaging findings in graves ophthalmopathy

Orbital positron emission tomography/computed tomography (PET/CT) imaging findings in graves ophthalmopathy

Thyroid antibody-negative euthyroid Graves’ ophthalmopathy

Graves’ Ophthalmopathy Imaging Evaluation

Contact Info

Product

Resources

About