B-scan ultrasonography in Graves' Orbitopathy

Delint, P. J.; Mourits, Maarten P.; Kerlen, C. H.; Scheenloop, J. J.; Wittebol–Post, D.

doi:10.1007/bf01268094

Cited by 11 publications

(3 citation statements)

References 18 publications

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“…Similar to other studies (8,32,33), no correlation was found between CAS and reflectivity or SIR, perhaps because CAS has wide a variation among observers (1,4) or because the great majority of imaging methods assesses only the EOM and not orbital fat inflammation (4,8). We noted that combining the US and MRI resulted in significant increase in the positive predictive value and in specificity.…”

Section: Discussionsupporting

confidence: 70%

Ultrasonography compared to magnetic resonance imaging in thyroid-associated Graves' ophthalmopathy

Vlainich

Romaldini

Pedro

et al. 2011

Arq Bras Endocrinol Metab

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Objective: To compare ultrasonography (US) to magnetic resonance imaging (MRI) and the clinical activity score (CAS) in Graves' ophthalmopathy. Subjects and methods: Nineteen patients underwent extraocular muscle thickness measurements by US and MRI, reflectivity by US and signal-intensity ratio by MRI. There were also twelve US control subjects. Results: US median thicknesses were greater than in controls. Correlation was found between US and MRI in the median thickness of the left eye rectus medial muscle as well as between signal-intensity ratio (SIR) and thickness by US. An inverse correlation was found between reflectivity and SIR in the inferior and lateral rectus. On associating the tests for detecting activity the best results were obtained with CAS plus MRI (sensitivity 75%), and US and MRI (positive predictive value 77% and specificity 80%). Conclusion: CAS and US results showed poor correlation with MRI results suggesting that they cannot replace each other but when combined these methods can improve the evaluation of thyroid-associated ophthalmopathy. Arq Bras Endocrinol Metab. 2011;55(3):184-8 Keywords Graves' disease; thyroid-associated ophthalmopathy; orbital ultrasonography; magnetic resonance imaging RESUMO Objetivo: Comparar a ultrassonografia (US) à ressonância magnética nuclear (RMN) e o índice de atividade clínica (IAC) na oftalmopatia de Graves. Sujeitos e métodos: Dezenove pacientes submetidos à medida da espessura dos músculos extraoculares por US e RMN, refletividade ao US e razão da intensidade de sinal (RIS) à RMN. Grupo controle para US de 12 indivíduos. Resultados: Espessura mediana ao US foi maior que dos controles. Houve correlação entre US e RMN na espessura mediana dos músculos retos mediais dos olhos esquerdos e entre a RIS e a espessura ao US e correlação inversa entre refletividade e SIR nos retos inferior e lateral. Detectando atividade, os melhores resultados foram associando IAC e RMN (sensitividade de 75%) e US e RMN (valor preditivo positivo de 77% e especificidade de 80%). Conclusão: Resultados do IAC e US mostraram pouca correlação com a RMN, sugerindo que não podem ser substituídos, mas, quando combinados, esses métodos podem melhorar a avaliação da oftalmopatia associada à tiroide. Arq Bras Endocrinol Metab. 2011;55(3):184-8 Descritores Doença de Graves; oftalmopatia associada à tiroide; ultrassonografia orbitária; ressonância magnética nuclear

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Section: Discussionsupporting

confidence: 70%

Ultrasonography compared to magnetic resonance imaging in thyroid-associated Graves' ophthalmopathy

Vlainich

Romaldini

Pedro

et al. 2011

Arq Bras Endocrinol Metab

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“…The frequency of the involvement of each muscle was comparable to the findings of three other groups (18)(19)(20), in spite of the exclusion of GO patients with no diplopia from our series. Muscle thickness correlated only weakly with the activity of disease estimated from the T2 relaxation time.…”

Section: Discussionsupporting

confidence: 65%

Graves' ophthalmopathy: eye muscle involvement in patients with diplopia

Nagy

Tóth

Káldi³

et al. 2000

Eur J Endocrinol

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Background: Diplopia identifies patients with eye muscle involvement in Graves' ophthalmopathy (GO). Objective: To identify clinical parameters that could eliminate the need for magnetic resonance imaging (MRI) to assess the activity of inflammation in the eye muscles of GO patients with diplopia. Methods: In 43 patients with GO with recently developed diplopia, orbital ultrasound and MRI were performed. Muscle diameters and MRI T2 relaxation times were measured, and the amount of orbital connective tissue was calculated from MRI scans and compared with ultrasound readings, diplopia grades, degree of protrusion, ocular pressure, tear production, antibody levels and hormonal parameters of thyroid function. Results: No correlation was found between diameters of 233 extraocular muscles measured by MRI and by ultrasound. For each of the four muscles, there was a diameter above which ultrasound was always unreliable. MRI data were used in further analysis. Of the muscles examined, the inferior rectuses were the most frequently enlarged -at least one, in 93% of cases. Medial, lateral and superior rectuses were enlarged in 59%, 37% and 34% of the orbits respectively. The pattern of muscle involvement of the two orbits tended to be symmetric (r ¼ 0.49, P ¼ 0.003), particularly for the medial rectuses (r ¼ 0.90, P ¼ 0.000). Proptosis correlated with the sum of the muscle diameters for a given eye (right eye: r ¼ 0.54, P ¼ 0.003; left eye: r ¼ 0.57, P ¼ 0.001), but it failed to correlate with the amount of orbital connective tissue. In 53% of the patients, normal T2 relaxation times were found in all eight muscles. There was only a weak correlation between muscle thickness and T2 relaxation time (r ¼ 0.49, P ¼ 0.003), indicating that muscle enlargement alone is not a sign of disease activity. The severity of diplopia was independent of T2 relaxation time. The amount of orbital connective tissue showed a negative correlation with the greatest T2 relaxation time for a given eye (r ¼ ¹ 0.52, P ¼ 0.004); this suggests that disease types exist that have predominant muscle involvement and predominant connective tissue expansion. No correlation between connective tissue expansion and proptosis, diplopia grade, muscle thickness or disease duration was found -that is, connective tissue expansion is not a major factor in diplopia. Both muscle and connective tissue findings were independent of thyroid function. Conclusion: Ultrasound and MRI eye muscle diameter readings do not correlate, because of the inherent inaccuracy of orbital ultrasound. Muscle enlargement alone does not mean oedematous swelling and active disease. Neither ultrasound, nor any combination of 11 clinical and laboratory parameters provided the degree of information on muscles and connective tissue that was obtainable by MRI. In unclear cases of recently developed diplopia, before orbital decompression surgery, in the case of treatment failure or if, for any other reason, imaging is needed in GO, MRI is the method of choice.

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“…For patient follow-up in Graves' ophthalmopathy, the most widely used imaging methods are sonography, CT, and MR imaging. The accuracy of A-and B-mode sonography is less reliable than CT or MR imaging [9][10][11]. To visualize the muscle belly at its greatest diameter on sonography requires unrestricted free gaze by the patient in several directions during examination, which is usually impossible because of eye muscle dysfunction in these patients.…”

Section: Discussionmentioning

confidence: 99%