Relationship between orbital tissues and diplopia in thyroid-associated ophthalmopathy based on MRI
Objective:To explore the correlation between extraocular muscles,orbital fat,and thyroid-associated ophthalmopathy (TAO) diplopia using MRI technology. Materials and Methods:The subjects of the study included the TAO diplopia group (79 cases,157 eyes),the TAO non-diplopia group (36 cases,72 eyes) and the normal control group (30 cases,60 eyes). The extraocular muscle thickness,extraocular muscle volume (EMV),extraocular muscle-to-white matter signal intensity ratio (SIR),intraorbital fat volume (FV),and orbital volume (OV) of the study subjects were measured,and clinical and laboratory data were collected,including age,gender,smoking history,thyroid-stimulating hormone (TSH),free triiodothyronine (FT3),free thyroxine (FT4),thyroglobulin (TG),thyroxine receptor antibody (TRAb),anti-thyroglobulin antibody (anti-TGAb) and anti-thyroid peroxidase utoantibody (anti-TPOAb). One-way analysis of variance,Mann-Whitney U test,Kruskal-Wallis H test and chi-square test were used to compare the baseline data,clinical indicators and imaging parameters of the three groups. Then univariate and multivariate logistic regression analysis were used to analyze the independent risk factors of TAO diplopia,and the receiver operating characteristics (ROC) curves were plotted to evaluate the diagnostic value of risk factors. Results:There were statistically significant differences in age,superior rectus thickness (SR-T),inferior rectus thickness (IR-T),medial rectus thickness (MR-T),lateral rectus thickness (LR-T),EMV,FV/OV,SIRmean,and SIRmax between TAO diplopia,TAO non-diplopia,and normal control groups (P<0.05). There were statistically significant differences in the distribution of IR-T,MR-T,FV/OV,EMV,and SIRmax between TAO diplopia and TAO non-diplopia (P<0.05). There was no statistically significant difference in SR-T,LR-T,and SIRmean (P>0.05),and there was also a statistically significant difference between TAO diplopia and TAO non-diplopia in TSH and TRAb (P<0.05). Univariate and multivariate logistic regression analysis showed that TRAb,FV/OV and EMV were independent risk factors of TAO diplopia,and the receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic efficacy of individual and combined indicators for TAO diplopia. The ROC analysis showed that the combined index had the best diagnostic efficacy,AUC=0.853 (95％ confidence interval:0.792-0.915) (P<0.001),sensitivity was 82.7％,and specificity was 79.6％,the Yoden index is 0.623. Conclusions:TAO diplopia is not only related to the enlargement of extraocular muscles and SIR values mentioned in previous studies,but also closely related to the volume of intraorbital fat. Comprehensive analysis of extraocular muscles and orbital fat can provide a more comprehensive and objective basis for clinical practice,which is helpful for clinical selection of appropriate treatment options.
万方数据
维普
