References

Czech and Slovak Ophthalmology

106

10.31348/2019/1/2

Original article

Use of Shear Wave Elastography in Diagnosing Changes to the Oculomotor Muscles in Patients with Endocrine Orbitopathy

Zemanová

Markéta

24 4 2020

Background: Shear wave elastography (SWE) is an imaging modality using advantage of ultrasound to detect differences of elastic properties (mechanical rigidity) of tissues. SWE increasingly develops across medical specialities and is already used in hematology, urology and oncology. In the field of ophthalmology using SWE to evaluate corneal mechanical properties, peripapillary biomechanical qualities in glaucoma patients several papers were published Also SWE ultrasound mechanical specificity safety studies were published. Aim of this work is to review SWE technique and its potentional using during examination in patients with endocrine orbitopathy (EO). In practical part of this work is evaluated the elasticity of oculomotor rectus muscles in healthy population, in patients with EO in early stage of disease (oculomotor muscles oedema) and in patients with EO in terminal stage of this disease (oculomotor muscles fibrosis) is determinate. Also possibility of using SWE (in comparison with standard ultrasound examination) for measuring thickness of oculomotor muscles is evaluated. Methods: There were 60 eyes in 30 patients with EO examined and the elasticity of oculomotor muscles was determined. Results were compared with values of elasticity in 40 eyes in healthy population of 20 people. All measurements were performed with ultrasonic system Aixplorer of SuperSonic manufacturer in standardized terms and been undertaken by the same performer. Each value was measured several times to reduce measurement errors. Results: Oculomotor rectus muscle elasticity values in healthy population measured by using SWE were as follows: musculus rectus superior (MRS) 19.7 ± 3.2 kPa, musculus rectus medialis (MRM) 20.5 ± 3.6 kPa, musculus rectus inferior (MRI) 20.4 ± 3.1 kPa and musculus rectus temporalis (MRT) 20.2 ± 1.7 kPa. As statistical analysis shows, there is no significant difference between muscles (ANOVA test p > 0.05); overall elasticity of oculomotor muscles in healthy population is 20.3 ± 3.0 kPa. Elasticity of muscles in group of EO patients in oedema stage and EO patients in fibrosis stage is 18.4 ± 3.2 kPa and 34.6 ± 7.5 kPa respectively. Both values show statistical significance in the comparison with healthy population (p < 0.05). Conclusion: This work result shows SWE as an EO diagnostic possibility. Elasticity of oculomotor muscles correlates with stages of the disease. Higher elasticity in oedema stage and higher stiffness in fibrosis stage. By involving and including into diagnostic algorithm, SWE could help with EO patient’s examination, offer chance to confirm more accurately the diagnosis and in some cases might even replace magnetic resonance (MRI), which is more expensive and time consuming method.

endocrine orbitopathy thyroid associated orbitopathy ultrasound elastography shear-wave ophthalmology extraocular muscles

References

Barr, RG., Memo, R., Schaub, CR.: Shear wave ultrasound elastography of the prostate: initial results. Ultrasound Q, 28(1); 2012: 13-20.

Bartalena, L., Baldeschi, L., Dickinson, AJ. et al.: Consensus statement of the European group on Graves‘ orbitopathy (EUGOGO) on management of Graves‘ orbitopathy. Thyroid, 18(3); 2008: 333-46.

Bercoff, J., Tanter, M., Fink, M.: Supersonic shear imaging: A new technique for soft tissues elasticity mapping. IEEE Trans. Ultrason. Ferroelectr., Freq. Control, 51(4); 2004: 396-409.

Byrne, SF., Gendron, EK., Glaser, JS. et al.: Diameter of normal extraocular recti muscles with echography. Am J Ophthalmol., 112(6); 1991: 706-13.

Detokaris, ET., Drakonaki, EE., Ginis, H. et al.: Evaluation of iridociliary and lenticular elasticity using shear-wave elastography in rabbit eyes. Acta Medica (Hradec Králové), 57(1); 2014: 9-14.

Detorakis, ET., Drakonaki, EE., Tsilimbaris, MK. et. al.: Real-time ultrasound elastographic imaging of ocular and periocular tissues: a feasibility study. Ophthalmic Surg Lasers Imaging, 41(1); 2010: 135-41.

Dikici, AS., Mihmanli, I., Kilic, F. et al.: In Vivo Evaluation of the Biomechanical Properties of Optic Nerve and Peripapillary Structures by Ultrasonic Shear Wave Elastography in Glaucoma. Iran J Radiol, 13(2); 2016: e36849.

Ferraioli, G., Tinelli, C., Dal Bello, B. et al.: Accuracy of realtime shear wave elastography in the assessment of liver fibrosis in chronic hepatitis C: A pilot study. Hepatology, 56(6); 2012: 2125–33.

Haen, TX., Roux, A., Soubeyrand, M. et. al.: Shear waves elastography for assesment of human Achilles tendon`s biomechanical properties: an experimental study. J Mech Behav Biomed Mater, 69; 2017: 178-84.

Hrazdira, I.: Úvod do ultrasonografie v otázkách a odpovědích: pro studenty lékařské fakulty. Brno, Klinika zobrazovacích metod LF MU, Fakutlní nemocnice u Sv.Anny v Brně. 2008. dostupné na www: www.med.muni.cz/dokumenty/pdf/uvod_ do_ultrasonografie1.pdf.

Hrdá, P., Novák, Z., Šterzl, I.: Endokrinní orbitopatie: Edice far - makoterapie pro praxi. Svazek 41. Praha, Maxdorf; 2009. ISBN 978-80-7345-194-3.

Karhanová, M.: Diagnostika endokrinní orbitopatie v praxi. In: Rozsíval, P. (Ed), Trendy soudobé oftalmologie: svazek 8. Praha, Galén, 2012, s. 15-32.

Karhanová, M., Kovář, R., Fryšák, Z. et al.: Postižení okohybných svalů u pacientů s endokrinní orbitopatií. Cesk Slov Oftalmol, 70(2); 2014: 66-71.

Khatib, Z.: Ultrasound methods for evaluating orbital diseases. [online]. [cit. 2018-06-02]. Dostupné na www: www. slideshare.net/vaibhavkhanna1048/usg-69421051.

Kim, H., Youk, JH., Gweon, HM. et al.: Diagnostic performance of qualitative shear-wave elastography according to different color map opacities for breast masses. Eur J Radiol, 82(8); 2013: 326-31.

Medata: Supersonic Imagine The Theragnostic CompanyTM. Teoretické základy a principy ShearWaveTM Elastografie [online]. Brno: Medata spol. s.r.o. [cit. 2018-06-02]. Dostupné na www: http://www.medata.cz/_docs/cz_supersonicimagine-swe_teorie.pdf.

Nguyen, TM., Aubry, JF., Fink, M. et. al.: In vivo evidence of porcine cornea anisotropy using supersonic shear wave imaging. Invest Ophthalmol Vis Sci, 55(11); 2014: 7545-52.

Nguyen, TM., Aubry, JF., Touboul, D. et al.: Monitoring of cornea elastic properties changes during UV-A/Riboflavin-induced corneal collagen cross-linking using Supersonic Shear Wave Imaging: A Pilot Study. Invest Ophthalmol Vis Sci, 53(9); 2012: 5948-54.

Özgen, A., Ariyurek, M.: Normative measurements of orbital structures using CT. Am J Roentgenol, 170(4); 1998: 1093-6.

Özgen, A., Aydingöz, U.: Normative measurements of orbital structures using MRI. J Comput Assist Tomogr, 24(3); 2000: 493-6.

Pekel, G., Ağladıoğlu, K., Acer, S. et. al: Evaluation of ocular elasticity in high myopia. Optom Vis Sci, 92(5); 2015: 573-8.

Pekel, G., Ağladıoğlu, K., Acer, S. et. al.: Evaluation of ocular and periocular elasticity after panretinal photocoagulation: an ultrasonic elastography study. Curr Eye Res, 40(3); 2015: 332-7.

Sebag, F., Vaillant-Lombard, J., Berbis, J. et al.: Shear Wave Elastography: A New Ultrasound Imaging Mode for the Differential Diagnosis of Benign and Malignant Thyroid Nodules. J Clin Endocrinol Metab, 95(12); 2013: 5281-8.

Schovánek, J., Cibičková, L., Karhanová, M. et. al.: Endokrinní orbitopatie a nová doporučení. Interní Med, 19(5); 2017: 246-50.

Sit, AJ., Lin, SC., Kazemi, A. et. al.: In vivo noninvasive measurement of Young’s modulus of elasticity in human eyes: A feasibility study. J Glaucoma, 26(11); 2017: 967-73.

Tanter, M., Touboul, D., Gennisson, J. L. et al.: High-resolution quantitative imaging of cornea elasticity using supersonic shear imaging. IEEE Trans Med Imaging, 28(12); 2009: 1881- 1893.

Touboul, D., Gennisson, JL., Nguyen, TM. et al.: Supersonic shear wave elastography for the in vivo evaluation of transepithelial corneal collagen cross-linking. Invest Ophthalmol Vis Sci, 55(3); 2014: 1976-84.

Unal, O., Cay, N., Yulek, F. et. al.: Real-Time Ultrasound Elastographic Features of Primary Open Angle Glaucoma. Ultrasound Q, 32(4); 2016: 333-7.

Zemanová, M.: Nová diagnostická zobrazovací metoda-she - ar waves elastografie. Čes. a slov. Oftal, 72(4); 2016:103-10.

Zha, L., Chen, KQ., Zheng, XZ. et. al.: The safety and feasibility of diagnostic acoustic radiation force impulse elastography used for eyes. A preliminary in vivo study. Med Ultrason, 19(2); 2017: 185-9. tional US examination, SWE, thanks to its high resolution capacity, specificity and possibility of changing the scope of the examined area of interest, represents a more sensitive method and enables us to better evaluate the retrobulbar space. The results of the study indicate the possibility of using SWE in the diagnosis of EO, in which elasticity of the oculomotor muscles correlates with the degree of affliction, both in the phase of edema and inflammatory infiltration, and in the state of fibrosis. Inclusion of the method within diagnostic procedures would ease and increase the precision of examination of patients with EO. The method could become an alternative to magnetic resonance imaging, which is more time consuming and also more expensive.