Using Morphologic Parameters of Extraocular Muscles for Diagnosis and  Follow-Up of Graves' Ophthalmopathy: Diameters, Areas, or Volumes?

Szücs-Farkas, Zsolt; Tóth, Judit; Balázs, Erzsébet; Galuska, László; Burman, Kenneth D.; Karányi, Zsolt; Leövey, A; Nagy, Endre

doi:10.2214/ajr.179.4.1791005

Cited by 55 publications

(56 citation statements)

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“…Magnetic resonance imaging (MRI) is a good objective tool for the diagnosis and follow-up of GO [8]. The cross-sectional area or volume of the enlarged extraocular muscles [9], T2 relaxation time [10], and signal intensity ratio (SIR) of the extraocular muscles [11] have been suggested as useful MRI parameters. However, the data on the correlation between MRI findings and treatment response is very limited [12].…”

Section: Clinical and Ophthalmic Measurementsmentioning

confidence: 99%

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

et al. 2016

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Abstract. The objective of this study was to compare the safety and efficacy of high-dose and low-dose intravenous (iv) glucocorticoid (GC) therapy in patients with Graves' ophthalmopathy (GO) and to investigate which factors may help determine appropriate iv GC doses. The medical records of 43 patients who received different doses of iv GCs for GO were retrospectively reviewed. Twenty patients received high-dose iv GCs (HD group, cumulative dose 9.0-12.0 g) and 18 received low-dose iv GCs (LD group, cumulative dose 4.5 g). Five patients with previous treatment for GO were excluded. Changes in ophthalmic parameters after treatment and frequencies of adverse effects due to GCs of the 2 groups were compared. We also reviewed the incidence of GO progression and hepatic dysfunction after patients were discharged. We evaluated correlations among pretreatment (before treatment) ophthalmic parameters and investigated useful predictive factors for determining iv GC doses. There were no significant differences in ophthalmic parameters reflecting treatment efficacy or overall safety between the groups. Among baseline ophthalmic parameters, corrected signal intensity ratio (cSIR) correlated well with magnetic resonance imaging findings and were more strongly associated with changes in ophthalmic parameters after treatment in the HD group than in the LD group, indicating that pretreatment cSIR might be useful for determining iv GC doses. In conclusion, there were no significant differences in overall safety and efficacy between high-dose and low-dose iv GC therapy in patients with active GO. Further randomized clinical trials with longer observation periods are required to establish the optimal treatment regimen of GO.Key words: Graves' ophthalmopathy, Thyroid-associated ophthalmopathy, Intravenous glucocorticoid therapy, MRI, STIR Since GO is generally considered an autoimmune disorder, glucocorticoid (GC) therapy has been used for GO for the last few decades. Different routes of administration and dosages have been used, and various studies have attempted to identify the optimal regimen Original ©The Japan Endocrine Society Submitted Jan. 20, 2016; Accepted May 10, 2016 as EJ16-0038 Released online in J-STAGE as advance publication Jun. 5, 2016 Correspondence to: Naotetsu Kanamoto, M.D., Ph.D., Department of Endocrinology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan. E-mail: kyotetsu@kuhp.kyoto-u.ac.jp * Current affiliation Abbreviations: GO, Graves' ophthalmopathy; GD, Graves' disease; GC, glucocorticoid; iv, intravenous; mPSL, methylprednisolone; EUGOGO, European Group on Graves' Orbitopathy; MRI, magnetic resonance imaging; CAS, Clinical Activity Score; SIR, signal intensity ratio; PSL, prednisolone; CAS, clinical activity score; STIR, short tau inversion recovery; T1W, T1-weighted; ROIs, regions-of-interest; cSIR, corrected SIR; ANCOVA, analysis of covariance. decreasing visual acuity; and one or more enlarged extraocular muscles with high intensity signals on T2-we...

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Section: Clinical and Ophthalmic Measurementsmentioning

confidence: 99%

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

et al. 2016

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“…Intraobserver and interobserver variation of orbital volumes was in the order of 1-4%. Orbital volumetry can also be done on MRI, with T2-weighted scans and T1-weighted fat suppression scans [7,9,10]. 3D image sets offer better results than 2D MRI [11,12].…”

Section: Orbital Volumetry - Techniquementioning

confidence: 99%

Differential Involvement of Orbital Fat and Extraocular Muscles in Graves' Ophthalmopathy

2013

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Graves' ophthalmopathy (GO) is characterized by swelling of orbital fat and extraocular muscles, but little attention has been given to differential involvement of fat and muscles. Advancements in imaging allow rather accurate measurements of orbital bony cavity volume (OV), fat volume (FV) and muscle volume (MV), and are the topics of this review. Ratios of FV/OV and MV/OV neutralize gender differences. In adult Caucasian controls, mean values ± SD of FV/OV are 0.56 ± 0.11 and of MV/OV are 0.15 ± 0.02. FV increases substantially and MV decreases slightly with advancing age, requiring age-specific reference ranges. In 95 consecutive untreated Caucasian GO patients, both FV and MV were within normal limits in 25%, increased FV but normal MV was present in 5%, normal FV but increased MV was detected in 61%, and both increased FV and MV was evident in 9%. Increased FV was associated with more proptosis and longer GO duration. Increased MV was associated with older age, more severe GO (more proptosis and diplopia, worse eye muscle ductions), higher TBII and current smoking. At the cellular and molecular level differential involvement of fat and muscles might be related to differences between fibroblast phenotypes and cytokine profiles in each compartment, to different orbital T cell subsets during the course of the disease and to peroxisome proliferator activator receptor-γ polymorphisms and modulation of 11β-hydroxysteroid dehydrogenase-1. Enlarged muscles are apparently a rather early phenomenon in GO, whereas increases in fat mass occur relatively late. Why a minor subset of GO patients presents with an increase of only fat remains poorly understood.

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“…MRI is suitable for showing the fat and orbital connective tissue, and can describe the condition of the lacrimal glands and the ophthalmic nerves [9,10]. Prolongation of the T2 relaxation time in the eye muscles is a reliable MRI marker of disease activity in the muscles.…”

Section: Non-nuclear Imagingmentioning

confidence: 99%

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

Galuska

Barna²,

Varga

et al. 2018

Nucl. Med. Rev.

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The pathogenesis of Graves' orbitopathy (GO) is not completely understood. Coexistent hyperfunction of the thyroid gland is frequent; however, GO may also coexist with hypo-or euthyrodism. The course of GO is largely independent of thyroid function, although elevated serum TSH is known to negatively interfere with GO course. GO is severe in 10% of the cases; sight threatening complications may also develop. A successful therapy of GO requires the assesment of both the severity and activity of orbital inflammation. Based on relevant studies and our own experiences, the possible management choices are reviewed here. For this purpose, we compare the clinical value of imaging techniques for detecting the activity of the disease. During the last 15 years, we used 99m Tc-DTPA retrobulbar SPECT routinely in more than 1400 patients to facilitate the right therapeutic decision. This diagnostic utility simplified management decisions compared to previously applied alternative techniques. We recommended the routine use of 99m Tc-DTPA retrobulbar SPECT for the evaluation and follow-up of GO.

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Using Morphologic Parameters of Extraocular Muscles for Diagnosis and Follow-Up of Graves' Ophthalmopathy: Diameters, Areas, or Volumes?

Abstract: In Graves' ophthalmopathy, the volume of three of the rectus muscles can be well estimated by simple measurements on a single coronal slice, and the largest transverse diameter of the lateral rectus is suitable for the same purpose.

Cited by 55 publications

References 14 publications

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Differential Involvement of Orbital Fat and Extraocular Muscles in Graves' Ophthalmopathy

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

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Using Morphologic Parameters of Extraocular Muscles for Diagnosis and Follow-Up of Graves' Ophthalmopathy: Diameters, Areas, or Volumes?

Abstract: In Graves' ophthalmopathy, the volume of three of the rectus muscles can be well estimated by simple measurements on a single coronal slice, and the largest transverse diameter of the lateral rectus is suitable for the same purpose.

Cited by 55 publications

References 14 publications

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves&rsquo; ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves&rsquo; ophthalmopathy

Differential Involvement of Orbital Fat and Extraocular Muscles in Graves' Ophthalmopathy

The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy

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Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy