Imaging Investigation of Thyroid Eye Disease

Siakallis, Loizos; Uddin, Jimmy; Miszkiel, Katherine

doi:10.1097/iop.0000000000001139

Cited by 43 publications

(31 citation statements)

References 74 publications

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“…In this study, the radiologists were able to diagnose TED with an accuracy of 73.2%. There are some previously well-known radiologic characteristics of TED including bilateral tendon-sparing extra-ocular muscle (EOM) enlargement, orbital fat expansion, proptosis, and/or lacrimal gland (LG) enlargement 11 – 14 . Radiologic imaging is not usually essential for the diagnosis of TED because TED has discriminating ophthalmic characteristics such as eyelid retraction and lid lag.…”

Section: Discussionmentioning

confidence: 99%

Radiologic imaging shows variable accuracy in diagnosing orbital inflammatory disease and assessing its activity

Lee

Hamilton

Pettersson

et al. 2020

Sci Rep

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Radiologic orbital imaging provides important information in the diagnosis and management of orbital inflammation. However, the diagnostic value of orbital imaging is not well elucidated. This study aimed to investigate the diagnostic accuracy of orbital imaging to diagnose orbital inflammatory diseases and its ability to detect active inflammation. We collected 75 scans of 52 patients (49 computed tomography (CT) scans; 26 magnetic resonance (MR) imaging scans). Clinical diagnoses included thyroid eye disease (TED) (41 scans, 31 patients), non-specific orbital inflammation (NSOI) (22 scans, 14 patients), sarcoidosis (4 scans, 3 patients), IgG4-related ophthalmic disease (IgG4-ROD) (5 scans, 3 patients), and granulomatosis with polyangiitis (GPA) (3 scans, 1 patient). Two experienced neuroradiologists interpreted the scans, offered a most likely diagnosis, and assessed the activity of inflammation, blinded to clinical findings. The accuracy rate of radiological diagnosis compared to each clinical diagnosis was evaluated. Sensitivity and specificity in detecting active inflammation were analyzed for TED and NSOI. The accuracy rate of radiologic diagnosis was 80.0% for IgG4-ROD, 77.3% for NSOI, and 73.2% for TED. Orbital imaging could not diagnose sarcoidosis. Orbital CT had a sensitivity of 50.0% and a specificity of 75.0% to predict active TED using clinical assessment as the gold standard. The sensitivity/specificity of orbital MR was 83.3/16.7% for the detection of active NSOI. In conclusion, orbital imaging is accurate for the diagnosis of IgG4, NSOI, and TED. Further studies with a large number of cases are needed to confirm this finding, especially with regard to uncommon diseases. Orbital CT showed moderate sensitivity and good specificity for identifying active TED.

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Section: Discussionmentioning

confidence: 99%

Radiologic imaging shows variable accuracy in diagnosing orbital inflammatory disease and assessing its activity

Lee

Hamilton

Pettersson

et al. 2020

Sci Rep

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“…Поражение орбиты в рамках IgG4-АЗ является типичным проявлением заболевания и встречается в 3,6-12,5% случаев, наиболее часто (62%) в патологический процесс вовлекается слезная железа [3,4,6,9,10]. При вовлечении экстраокулярных мышц КТ-картина отличается от таковой при ЭОП, при которой наиболее часто в патологический процесс вовлекаются нижняя и медиальная прямые мышцы [11]. В нашем случае наибольшим изменениям были подвергнуты наружные прямые мышцы, размер которых намного превосходил размеры остальных экстраокулярных мышц.…”

Section: Discussionunclassified

IgG4-associated disease in differential diagnosis of inflammatory orbitopathy

Груша¹,

Исмаилова²,

Свириденко³

et al. 2019

Probl Endokrinol (Mosk)

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IgG4-associated disease (IgG4-RD) is a systemic inflammatory disease characterized by tumorlike sclerosing masses in different organs. Differential diagnosis in orbital IgG4-RD includes majority of conditions, such as thyroid eye disease (TED), sarcoidosis, granulomatosis with polyangiitis, idiopatic orbital inflammation, limphoproliferative diseases and others. A case of IgG4-RD with different organs involvement and complicated differential diagnosis is presented. This case demonstrates very uncommon manifestation of IgG4-RD, when orbital involvement was very similar with TED. Systemic process was not recognized during a long period of time and diagnosis of IgG4-RD was established only after biopsy of abnormally increased lacrimal gland. Differential diagnosis included other systemic diseases, first of all sarcoidosis, GPA, and lymphoma. Biopsy results were consistent with the gold standard of diagnosis, e. g. more than 40% of plasma cells were IgG4 positive. This case demonstrates the necessity of orbital biopsy before starting immunosuppression to avoid inappropriate treatment strategy.

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“…This distance should not exceed 22 mm, or the difference between the two sides should not be more than 2 mm. 32 Measurements between the interzygomatic line and the posterior sclera can also be used; proptosis is suggested when less than one-third of the eyeball lies behind this line. 33 In TED, imaging studies are not mandatory for diagnosis, but they are utilized in cases where a diagnosis is difficult, such as uniocular cases.…”

Section: Investigations Primary Investigationsmentioning

confidence: 99%