Clinical Data Analysis Of 225 Patients With Thyroid Associated Ophthalmopathy And The Exploration On Clinical Application Of MRI Fat Quantification In Evaluating Disease

Chapter 1 Clinical data analysis of 225 patients with thyroid associated ophthalmopathyObjective To summarize the clinical data of patients with thyroid-related eye disease(TAO)and the grading characteristics of EUGOGO system.Methods 225 patients with TAO admitted to the department of endocrinology,the third affiliated hospital of southern medical university from January 2016 to December 2019 were collected.We collected the patients' age,gender,history of hyperthyroidism as well as eye evaluation,evaluated the disease's severity and activity according to EUGOGO,also summarized their clinical features.Results(1)A total of 225 TAO patients were included in this study,including 84 males and 141 females,male to female ratio of 1:1.68.(2)The median age was 37.00(26.00,51.00)years for males and 36.00(26.00,48.00)years for females.(3)Most cases with bilateral eye disease and 4 cases with unilateral;(4)Most of the patients had thyroid dysfunction before eye signs,with a median course of thyroid disease of 14.00(7.00,36.00)months and an eye history of 8.00(4.00,24.00)months.(5)The median of exophthalmos was 18.00(16.00,20.00)mm.(6)51 patients had a history of TAO treatment,the CAS of the affected eyes was still higher than that of the untreated eyes.Besides,50 of the affected eyes were still active.(7)Inactivated eyes was slightly more than active eyes.In EUGOGO severity grading,moderate-to-severe eyes were the majority.Combined with severity grading and activity stage,it was found that the number of mildly affected and inactive eyes was the largest.(8)The NOSPECS of the affected eye are mostly graded at level III and level ?.Conclusion The current assessment system is highly defective,subjective and difficult to quantify.It is mainly based on Caucasian population.In the future,it is hoped that the collection of TAO cases in China and the assistance of imaging can help establish a disease diagnosis system in line with the disease characteristics of patients in China,so that the diagnosis and treatment of TAO can be accurate and quantifiable.Chapter 2 The Exploration On Clinical Value Of MRI Fat Quantification In Patients With Thyroid Associated OphthalmopathyObjective To rapidly quantify the fat fraction(FF)of the extraocular muscle in TAO patients with MRI fat-water separation technique,and to explore the clinical value of fat quantification in evaluating thyroid-related eye diseases.Methods 66 patients(129 eyes)with TAO were included from November 2017 to July 2019.The age,gender,course of disease,disease activity and severity were collected.Orbital 3.0 T MRI examination was performed,and ISP software was used to generate the fat fraction image and other sequence images at the post-processing workstation.The extraocular muscles' FF and SIR(Signal intensity ratio of extraocular muscle to ipsilateral white matter)were measured.Taking each orbit as the research object.FFmax was the FF of the extraocular muscle with highest inflamed(i.e.,SIR was the largest)in each orbit,FFmean was the average FF of the four extraocular muscles in each orbit.The differences of FF in groups based on disease severity,activity,smoking history and disease course were compared,the correlation between FF and patients' clinical characteristics was analyzed.Besides,the diagnostic value of FF in determining TAO's activity was calculated using ROC curve.Results(1)FFmean and FFmax of mild group were higher than moderate-to-severe as well as sight-threatening group.In male patients,active group's FFmean and FFmax were lower.FF were different in groups based on smoking history and disease course(P<0.05).(2)Spearman correlation analysis showed a positive correlation between FF and disease course.Besides,there was a negative correlation between FF and disease activity,clinical activity score,disease severity(P<0.05).(3)FF had no predictive significance for activity determination.The diagnostic performance of FFmax combined with SIRmax was slightly better than that of SIRmax,with a sensitivity of 56.10%and a specificity of 80.68%,AUC=0.696(p<0.001).Conclusion MRI fat fraction can relatively quantify the fat of extraocular muscle quickly and objectively,maybe providing a new reference index for TAO's disease evaluation.Chapter 3 The Exploration Of Fat Fraction Changes In Patients With Thyroid Associated Ophthalmopathy Before And After TreatmentObjective To explore whether the extraocular muscle's fat fraction of TAO patients change before and after treatment.Also to discuss whether FF can be used as an indicator of efficacy evaluation to distinguish the difference of efficacy.Methods 9 patients with TAO who were admitted to our hospital from November 2017 to July 2019 and needed further treatment were selected.The patients were treated with glucocortieoid pulse therapy or orbital radiation,age,gender and course of disease were collected.The results of eye evaluation before and after treatment were recorded,the eyes were divided into effective and ineffective group according to the improvement criteria.Orbital 3.0 T MRI examination was performed before and after treatment about 11.00(6.50,12.50)months apart,and ISP software was used to generate the fat fraction image and other sequence images at the post-processing workstation.The extraocular muscles' FF and SIR(Signal intensity ratio of extraocular muscle to ipsilateral white matter)were measured.Taking each orbit as the research object.The same level were measured before and after treatment of the same extraocular muscle.FFmax was the FF of the extraocular muscle with highest inflamed(i.e.,SIR was the largest)in each orbit,FFmean was the average FF of the four extraocular muscles in each orbit.We compared the difference of FF before and after treatment,analyzed the relationship between FF variation and clinical efficacy.Results(1)The CAS and intraocular pressure of the eye decreased significantly after treatment,but there were no significant differences in degree of exophthalmos,width of palpebral fissure and degree of upper or lower eyelid contracture.(2)The FFmean and FFmax of the same eye before treatment were lower than that after treatment(32.26%E6.06%vs 34.03%±6.75%,P=0.040 and 29.04%±8.45%vs 33.43%±9.44%,P=0.006).(3)There was no significant difference in variation of FFmax and FFmean between the effective group and the invalid group(P>0.05)after treatment.Conclusion The FFmean and FFmax of extraocular muscle after treatment in follow-up patients with TAO were significantly higher than before treatment,may be associated with reduced inflammation,but the FF variation could not distinguish the clinical efficacy.