目的 应用3 T眼眶MRI技术评估Graves眼病(Graves ophthalmopathy,GO)患者泪腺参数与临床活动性评分(clinical activity score,CAS)的相关性.材料与方法 前瞻性纳入2020年2月至2023年6月安徽医科大学附属阜阳医院和安徽医科大学第一附属医院确诊的GO患者40例80只眼作为GO组,选取与GO组性别与年龄段匹配的健康人群40例80眼作为对照组.根据CAS评分将GO患者分为活动期GO组、非活动期GO组.分别对三组进行MRI常规图像及读出分段平面回波弥散加权成像(readout segmentation of long variable echo-trains diffusion weighted imaging,RESOLVE DWI)图像采集,横断位T2加权成像脂肪抑脂(T2-weighted imaging fat suppression,T2WI-FS)获得眼球突出度、泪腺突出度,横断位及冠状位T2WI-FS测量获得泪腺最大截面时的长径、短径、面积,记录横断位泪腺表观扩散系数(apparent dispersion coefficient,ADC)平均值.使用SPSS 24.0软件进行统计学分析,P<0.05为差异有统计学意义.定量资料组间比较采用两独立样本t检验,性别、吸烟史、饮酒史、CAS评分的组间差异采用卡方检验.采用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under the curve,AUC)评价GO活动性的诊断效能.采用Spearman's相关分析泪腺各定量参数与CAS评分的相关性.结果 (1)活动期GO组眼球突出度、横断位泪腺各参数,包含泪腺突出度、长径、短径、面积及ADC平均值,均较非活动期GO组、对照组增大,非活动期GO组较对照组升高(P均<0.05).(2)ROC曲线结果显示,眼球突出度、横断位泪腺面积对GO患者的诊断效能最高(AUC为 0.906、0.905),泪腺突出度、横断位泪腺ADC平均值对GO患者也有一定的诊断价值(0.793、0.702).RESOLVE DWI ADC值预测GO活动性的最佳截断点为1.181×10-3 mm2/s,其敏感度高达95.00%,特异度76.30%.(3)眼球突出度(r=0.734,P<0.05)、泪腺突出度(r=0.719,P<0.05)、泪腺ADC值(r=0.742,P<0.05)与CAS呈高度相关.结论 横断位泪腺突出度、泪腺DWI ADC平均值可作为GO诊断及分期的重要参考指标.
Diagnostic value of quantitative measurement of orbital structure by 3 T MRI in staging of Graves ophthalmopathy
Objective:To evaluate the correlation between lacrimal gland parameters and clinical activity score(CAS)in patients with Graves ophthalmopathy(GO)by 3 T MRI.Materials and Methods:A total of 40 patients with 80 eyes of diagnosed with GO from Fuyang Hospital Affiliated to Anhui Medical University and the First Affiliated Hospital of Anhui Medical University from February 2020 to June 2023 were prospectively selected as the GO group,and 40 healthy people with 80 eyes matching the gender and age of the GO group were selected as the control group.According to CAS score,GO patients were divided into active GO group and inactive GO group.The conventional MRI images and readout segmentation of long variable echo-trains diffusion weighted images(RESOLVE DWI)were used to collect images of the three groups respectively,T2-weighted imaging(T2WI)was used to obtain exophthalmos and lacrimal gland exophthalmos.The long diameter,short diameter,and area of the lacrimal gland at the maximum cross section were measured on T2-weighted imaging,and the apparent dispersion coefficient(ADC)of transverse lacrimal gland was recorded.SPSS 24.0 software was used for statistical analysis,and P<0.05 was considered statistically significant.The t test of two independent samples was used to compare the quantitative data between groups.The Chi-square test was used for the differences between groups in gender,smoking history,drinking history and CAS score.Receiver operating characteristic(ROC)curve and its area under the curve(AUC)were used to evaluate the diagnostic efficiency of GO activity.Spearman's correlation analysis was used to analyze the correlation between lacrimal gland quantitative parameters and CAS score.Results:(1)The parameters of ocular exophthalmia and transverse lacrimal gland,including lacrimal gland exophthalmia,long diameter,short diameter,area and ADC mean value,were increased in active phase GO group compared the inactive phase GO group and control group,while those in inactive GO group were higher compared with control group(all P<0.05).(2)ROC curve results:ocular exophthalmia and transverse lacrimal gland area had the highest diagnostic efficacy in GO patients(AUC=0.906 and 0.905),and lacrimal gland exophthalmia and the mean value of ADC in transverse lacrimal gland also had certain diagnostic values in GO patients(0.793 and 0.702).The optimal cut-off point of the optimal cut-off point of RESOLVE DWI ADC value for predicting GO activity was 1.181×10-3 mm2/s,with a sensitivity of 95.00%and a specificity of 76.30%.(3)The exophthalmis(r=0.734,P<0.05),lacrimal gland prominence(r=0.719,P<0.05),mean ADC of lacrimal gland(r=0.742,P<0.05)were strongly correlated with CAS.Conclusions:The prominence of transverse lacrimal gland and the mean value of DWI ADC value can be used as important reference indexes for diagnosis and staging of ophthalmopathy of GO patients.
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