2023 - 6 Issue

Review

Computed Tomography and Magnetic Resonance Imaging of the Orbit in the Diagnosis and Treatment of Thyroid-Associated Orbitopathy – Experience from Practice. A Review

Marta Karhanová ORCID
Jakub Čivrný ORCID – Jana Kalitová ORCID – Jan Schovánek ORCID – Barbora Pašková ORCID – Zuzana Schreiberová ORCID – Petra Hübnerová ORCID

Full Text links

DOI: 10.31348/2023/10

Published in Czech and Slovak Ophtalmology: 2023 - 6

Published on website: 20.02.2023

Keywords: thyroid-associated orbitopathy, magnetic resonance imaging, computed tomography, extraocular muscles, activity

Summary

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO).

Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included.

Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

References

  1. Knol. 2001:107-118. https://doi.org/10.1530/eje.0.1450107
  2. Rabinowitz MP, Carrasco JR. Update on advanced imaging options for thyroid-associated orbitopathy. Saudi J Ophthalmol. 2012;26:385-392. https://doi.org/10.1016/j.sjopt.2012.07.006
  3. Karhanova M, Kovar R, Frysak Z et al. Correlation between magnetic resonance imaging and ultrasound measurements of eye muscle thickness in thyroid-associated orbitopathy. Biomed Pap. 2015;159:307-312. https://doi.org/10.5507/bp.2014.001
  4. Jiskra J, Gabalec F, Diblík P et al. Doporučený postup pro diagnostiku a léčbu endokrinní orbitopatie, NOVELIZACE. 3/2022 n.d. 5. Česká oftalmologická společnost ČLS JEP. Doporučený postup pro diagnostiku a léčbu endokrinní orbitopatie [internet]. Available from: www.oftalmologie.com/cs/doporucene-postupy/doporuceny-postup-pro-diagnostiku-a-lecbu-endokrinni-orbitopatie.html Czech. n.d.
  5. Shampo MA, Kyle RA, Steensma DP. Isidor Rabi-1944 Nobel Laureate in Physics. Mayo Clin Proc. 2012;87:e11. https://doi.org/10.1016/j.mayocp.2011.11.012
  6. Pohost GM, Elgavish GA, Evanochko WT. Nuclear magnetic resonance imaging: With or without nuclear? J Am Coll Cardiol. 1986;7:709-710. https://doi.org/10.1016/S0735-1097(86)80486-7 8. Bloch F. Nuclear Induction. Phys Rev. 1946;70:460-474. https://doi. org/10.1103/PhysRev.70.460
  7. Bley TA, Wieben O, François CJ, Brittain JH, Reeder SB. Fat and water magnetic resonance imaging: Fat and Water MRI. J Magn Reson Imaging. 2010;31:4-18. https://doi.org/10.1002/jmri.21895 10. Rana K, Juniat V, Patel S, Selva D. Extraocular muscle enlargement. Graefes Arch Clin Exp Ophthalmol. 2022. https://doi.org/10.1007/ s00417-022-05727-1
  8. Kuriyan AE, Woeller CF, O’Loughlin CW, Phipps RP, Feldon SE. Orbital Fibroblasts From Thyroid Eye Disease Patients Differ in Proliferative and Adipogenic Responses Depending on Disease Subtype. Investig Opthalmology Vis Sci. 2013;54:7370. https://doi. org/10.1167/iovs.13-12741 12. Ozgen A, Ariyurek M. Normative measurements of orbital structures using CT. Am J Roentgenol. 1998;170:1093-1096. https://doi. org/10.2214/ajr.170.4.9530066
  9. Dodds NI, Atcha AW, Birchall D, Jackson A. Use of high-resolution MRI of the optic nerve in Graves’ ophthalmopathy. Br J Radiol. 2009;82:541-544. https://doi.org/10.1259/bjr/56958444 14. Barrett L, Glatt JH, Burde RM. Ronald, Gado H. Optic nerve dysfunction in thyroid eye disease: CT. Head Neck Radiol. 1988;167:503- 507. https://doi.org/10.1148/radiology.167.2.3357962.
  10. Monteiro MLR, Gonçalves ACP, Silva CTM, Moura JP, Ribeiro CS, Gebrim EMMS. Diagnostic Ability Of Barrett’s Index to Detect Dysthyroid Optic Neuropathy Using Multidetector Computed Tomography. Clinics. 2008;63:301-306. https://doi.org/10.1590/S1807- 59322008000300003
  11. Nagy E, Toth J, Kaldi I et al. Graves’ ophthalmopathy: eye muscle involvement in patients with diplopia. Eur J Endocrinol. 2000;142:591-597. https://doi.org/10.1530/eje.0.1420591 17. Majos A, Pajak M, Stefanczyk L. Magnetic Resonance evaluation of disease activity in Graves’ ophthalmopathy: T2-time and signal in- tensity of extraocular muscles. Med Sci Monit. 2007;13:44-48.
  12. Kirsch EC, Kaim AH, De Oliveira MG, von Arx G. Correlation of signal intensity ratio on orbital MRI-TIRM and clinical activity score as a possible predictor of therapy response in Graves’ orbitopathy- —a pilot study at 1.5 T. Neuroradiology. 2010;52:91-97. https://doi. org/10.1007/s00234-009-0590-z
  13. Mayer EJ, Fox DL, Herdman G et al. Signal intensity, clinical acti- 292 vity and cross-sectional areas on MRI scans in thyroid eye disease. Eur J Radiol. 2005;56(1):20-24. https://doi.org/10.1016/j.ejrad.2005.03.027
  14. Yokoyama N, Nagataki S, Uetani M, Ashizawa K, Eguchi K. Role of Magnetic Resonance Imaging in the Assessment of Disease Acti- vity in Thyroid-Associated Ophthalmopathy. Thyroid. 2002;12:223- 227. https://doi.org/10.1089/105072502753600179 21. Politi LS, Godi C, Cammarata G et al. Magnetic resonance imaging with diffusion-weighted imaging in the evaluation of thyroid-associated orbitopathy: getting below the tip of the iceberg. Eur Radiol. 2014;24:1118-1126. https://doi.org/10.1007/s00330-014-3103-3
  15. Prummel MF, Gerding MN, Zonneveld FW, Wiersinga WM. The usefulness of quantitative orbital magnetic resonance imaging in Graves’ ophthalmopathy: Quantitative orbital MRI in Graves’ ophthalmopathy. Clin Endocrinol (Oxf ). 2001;54:205-209. https:// doi.org/10.1046/j.1365-2265.2001.01220.x
  16. Cheng HLM, Stikov N, Ghugre NR, Wright GA. Practical medical applications of quantitative MR relaxometry. J Magn Reson Ima- ging. 2012;36:805-824. https://doi.org/10.1002/jmri.23718
  17. Jiang H, Wang Z, Xian J, Li J, Chen Q, Ai L. Evaluation of rectus extraocular muscles using dynamic contrast- enhanced MR imaging in patients with Graves’ ophthalmopathy for assessment of disea- se aktivity. Acta Radiol. 2012;53(1):87-94. https://doi.org/ 10.1258/ ar.2011.110431
  18. Das T, Roos JCP, Patterson AJ, Graves MJ, Murthy R. T2-relaxation mapping and fat fraction assessment to objectively quantify cli- nical activity in thyroid eye disease: an initial feasibility study. Eye. 2019;33:235-243. https://doi.org/10.1038/s41433-018-0304-z
  19. Lin C, Song X, Li L et al. Detection of active and inactive phases of thyroid-associated ophthalmopathy using deep convolutional neural network. BMC Ophthalmol. 2021;21:39. https://doi. org/10.1186/s12886-020-01783-5
  20. Yuan MK, Tsai DC, Chang SCet al. The Risk of Cataract Associated With Repeated Head and Neck CT Studies: A Nationwide Popula- tion-Based Study. Am J Roentgenol. 2013;201:626-630. https://doi. org/10.2214/AJR.12.9652
  21. Bednarczuk T, Brix TH, Schima W, Zettinig G, Kahaly GJ. 2021 European Thyroid Association Guidelines for the Management of Iodine-Based Contrast Media-Induced Thyroid Dysfunction. Eur Thyroid. J 2021;10:269-284. https://doi.org/10.1159/000517175