MRI多参数评估甲状腺相关眼病眼眶软组织改变  

Multiparametric quantitative MRI for the evaluation of orbital soft tissue in patients with thyroid associated ophthalmopathy

作　　者：李瑞[1] 李静[1] 赵田瑞 董力宁 王振常[1] LI Rui;LI Jing;ZHAO Tianrui;DONG Lining;WANG Zhenchang(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《实用放射学杂志》2023年第10期1578-1582,共5页Journal of Practical Radiology

摘　　要：目的探讨扩散张量成像(DTI)技术及常规MRI眼眶软组织定量测量在判断甲状腺相关眼病(TAO)严重程度的价值。方法对57例TAO患者(TAO组)(轻度22例,中重度35例)和30例健康对照(HC)(HC组)行MRI检查。分别测量内直肌、外直肌DTI技术参数,眶内脂肪厚度、泪腺长径、短径及泪腺与同侧颞肌信号强度比(SIR)。比较不同严重程度TAO患者眼眶软组织定量参数差异,二分类logistic回归判定诊断TAO的眼眶软组织定量参数,受试者工作特征(ROC)曲线分析有差异参数在诊断TAO中的效能。结果中重度TAO组较HC组外直肌、内直肌各向异性分数(FA)值明显下降,平均扩散率(MD)值明显升高(P<0.05),中重度TAO组内直肌DTI参数较轻度TAO组有明显差异(PFA=0.021,PMD=0.003)。中重度TAO组较HC组泪腺长径、短径、眶内脂肪厚度明显增加,泪腺SIR明显升高(P<0.05)。二分类logistic回归筛选诊断TAO的眼眶软组织定量参数为内直肌FA值、MD值,外直肌MD值及泪腺短径。内直肌MD值≤1.614×10^(-3)mm^(2)/s诊断TAO可获得最佳诊断效能,曲线下面积(AUC)0.726,敏感度0.49,特异度0.90。结论中重度TAO患者眼眶软组织MRI定量参数发生明显改变。眼眶软组织MRI定量参数可以敏感探测TAO患者眼眶软组织微结构改变。Objective To study the alterations of orbital soft tissue in patients with thyroid associated ophthalmopathy(TAO)via diffusion tensor imaging(DTI)and conventional MRI.Methods MRI was performed on 57 TAO patients(TAO group)(including 22 mild patients and 35 moderate-severe patients)and 30 healthy controls(HC)(HC group).The DTI parameters of medial and lateral extraocular muscles,thickness of fatty tissue,axial length and axial width of lacrimal gland were measured.The signal intensity ratio(SIR)of the lacrimal gland to the ipsilateral temporal muscle was also calculated.Measurement results were compared among HC,mild,and moderate-severe group.Binary logistic regression was used in determining the orbital soft tissue quantitative parameters for diagnosing TAO.Receiver operating characteristic(ROC)curve analyses were performed to assess the diagnostic performance of independent variables in patients with TAO.Results Moderate-severe TAO group showed significantly lower fractional anisotropy(FA)and higher mean diffusivity(MD)compared with HC group in both medial and lateral extraocular muscles(P<0.05).The DTI parameters of medial extraocular muscles were significantly different in moderate-severe group compared with that of mild group(PFA=0.021,PMD=0.003,respectively).Moderate-severe TAO group had significantly increased lacrimal gland axial length,axial width,the thickness of fatty tissue,and significantly higher lacrimal SIR compared with HC group(P<0.05).The FA and MD of medial extraocular muscles,MD of lateral extraocular muscles,and the axial width of lacrimal gland were the significant predictors for the diagnosis of TAO disease via binary logistic regression.The optimal predicative value can be achieved via setting 1.614×10^(-3) mm^(2)/s as the threshold value for medial extraocular muscles,area under the curve(AUC)was 0.726,sensitivity was 0.49,and specificity was 0.90,respectively.Conclusion Significant changes of MRI quantitative parameters of orbital soft tissue are observed in moderate-severe TAO patients

关 键 词：甲状腺相关眼病 磁共振成像 泪腺 眼外肌 眶内脂肪 

分 类 号：R777.5[医药卫生—眼科] R445.2[医药卫生—临床医学]