Prednisone's Therapeutic Effect In Graves' Ophthalmopathy Patients With Upper Eyelid Retraction Evaluated And Predicted By Orbital MR

Objective:To assess the changes of levator palpebrae muscle before and after treatment with prednisone in Graves' ophthalmopathy(GO)patients with upper eyelid retraction and to explore the value of levator palpebrae muscle changes in the evaluation of curative effect by MRI.Methods:GO Patients with upper eyelid retraction were collected,and predible subconjunctival injection of prednisone was used.Among them,41 cases had the images of orbital enhanced MRI before and after treatment.According to the treatment effect of upper eyelid retraction,they were divided into two groups:effectivenessgroup and noneffectivenessgroup.The thickness(T)at thickest and signal intensity(SI)at highest of the levator palpebrae muscle,medial rectus,and inferior rectus muscle signals were measured on the sequences of coronal T2WI-fs,and T1 Wl-fs+C,respectively.Meanwhile,the SI of the ipsilinferior temporalis was measured,and then the SI ratio(SIR)(extraocular muscle SI/ipsilinferior temporalis SI)of the three extraocular muscles was calculated.The extraocular muscle T and SIR of the two groups were analyzed using t test.Results:(1)The T value of levatorpal pebrae muscle decreased significantly after treatment in different treatment groups.(effectivenessgroup PT2=0.000,PT1+C=0.000;non-effectivenessgroup PT2=0.048,PT1+C=0.001);(2)In the effectiveness group,the SIR of levatorpal pebrae muscle decreased significantly after treatment in the sequences of T2WI-fs and T1WI-fs+C(PT2=0.000,PT1+C=0.000).In the non-effectiveness group,the SIR of levatorpal pebrae muscle decreased significantly after treatment in T2WI-fs(PT2=0.049).Conclusion:Orbital enhanced MRI has certain value in evaluating the therapeutic effect of intraorbital injection of prednisone,in particular,the SIR changes in the levator palpebral muscle in T1WI-fs+C can be accurately assess the therapeutic response.Objective:To analyze the characteristics of levator palpebrae muscle in Graves'ophthalmopathy(GO)patients with upper eyelid retraction in orbital enhanced magnetic resonance(MRI)and to explore the value of orbital enhanced magnetic resonance(MRI)in predicting the curative effect of predible subconjunctival injection of prednisone.Methods:Sixty-six GO patients with upper eyelid retraction as the main symptom were prospectively collected and treated with prednisone injection under conjunctiva after orbital enhanced MRI.Followed up by ophthalmologists,according to the treatment effect of upper eyelid retraction,they were divided into two groups:effectivenessgroup and noneffectivenessgroup.And collected 20 patients with orbital enhanced MR in the same period,no hyperthyroidism,exophthalmia symptoms and abnormal eye muscle movement,set as a control group.The thickness(T)at thickest and signal intensity(SI)at highest of the levator palpebrae muscle,medial rectus,and inferior rectus muscle signals were measured on the sequences of coronal T2WI-fs,and T1WI-fs+C,respectively.Meanwhile,the SI of the ipsilinferior temporalis was measured,and then the SI ratio(SIR)(extraocular muscle SI/ipsilinferior temporalis SI)of the three extraocular muscles was calculated.The extraocular muscle T and SIR of the two groups were analyzed using t test.Results:(1)The SIR and T values of levatorpal pebrae muscle before treatment in the different treatment groups were higher than those in the control group;(2)In the effectiveness group,the SIR of levatorpal pebrae muscle in T1WI-fs+C was lower than that in non-effectivenessgroup,the difference was statistically significant(PT1+C=0.001,<0.05);(3)The area under the ROC curve(AUC)of the SIR before treatment of levatorpal pebrae muscle in T1WI-fs+C was 0.840,with the pre-treatment SIR?1.56 as the threshold,the sensitivity of diagnosis effective treatment was 87.5%,and the specificity was 66.7%.Conclusion:Orbital enhanced MRI has a certain value in predicting the effect of prednisone in GO patients with with upper eyelid retraction as the main symptom.In particular,the SIR changes of levatorpal pebrae muscle in the T1WI-fs+C sequence can quantitatively predict its efficacy.