Clinical Application Of MRI T2 Mapping、STIR Sequences In Activity Evaluation And Efficacy Evaluation Of Thyroid-associated Ophthalmopathy

Chapter Ⅰ Clinical application of MRI T2 mapping、STIR sequences in the activity evaluation of thyroid-associated ophthalmopathyObjective To investigate the value of T2 mapping and STIR sequences in the evaluation of activity degree of thyroid-associated Ophthalmopathy(TAO)at the initial diagnosis,and to provide an objective basis for clinical diagnosis and treatment.Methods From December 2016 to September 2019,a total of 184 newly diagnosed TAO patients were collected from the outpatient and inpatient wards of the department of endocrinology and metabolism of the third affiliated hospital of southern medical university.CAS≥3 was the active group,and 76 eyes were affected There were 108 eyes in the inactive group with CAS<3.Normal control group included 8 patients with 16 eyes.To collect the demographic data and eye assessment,and carry out orbital 3.0T MRI scanning,,including T2 mapping and STIR(short time inversion recovery)sequence,a experienced physician measure the T2 relaxation time(T2RT)and the extraocular muscle and ipsilateral cerebral white matter signal intensity ratio(SIR),the comparison between the three groups of signal differences,explore its correlation with clinical activity score and severity grade,ROC curve was used to investigate the tangent value.Another 10 patients were randomly selected and repeated by another physician to compare the repeatability of the two measurements.Results1.The coefficient of variation of both measurements was within the acceptable range,and the correlation coefficient within the group was greater than 0.8.2.The values of T2RT and SIR in the active TAO patients were significantly higher than those in the inactive patients and the normal control group(1.82±0.34 VS 1.68±0.28 VS 1.52±0.13,all P<0.01;81.55±14.31 VS 72.67±10.12 VS 64.05±4.12ms,all P<0.01).3.The maximum SIR,average SIR,maximum T2RT and average T2RT were positively correlated with CAS(r=0.541,r=0.535,r=0.444,r=0.422,all P<0.001).4.Maximum SIR,average SIR,maximum T2RT and average T2RT were correlated with EUGOGO severity(r=0.415,r=0.408,r=0.474,r=0.495,all P<0.01).5.The ROC curve indicated that when the maximum T2RT≥80.32ms,the diagnostic efficacy of TAO in the active stage was the best,with a sensitivity of 72.9%and specificity of 70%(AUC=0.759,P<0.001).Conclusion Both T2 mapping and STIR sequences imaging could evaluate the course of thyroid-associated ocular disease activity,and the combination of T2RT(OR SIR)and CAS could improve the efficiency of TAO activity evaluation.Besides,the sensitivity of T2RT was better than that of SIR,and TAO activity was judged to be the best when T2RT≥80.32ms.Chapter Ⅱ Evaluation of the therapeutic effect of T2 mapping、STIR sequences in thyroid-associated ophthalmopathy before and after treatmentObjective To dynamically observe the signal changes of T2 mapping and STIR sequences in TAO patients before and after glucocorticoid treatment,and to explore the value of T2 mapping and STIR sequences in the evaluation of therapeutic efficacy of drug therapy.Methods According to EUGOGO severity grading and CAS assessment,glucocorticoid therapy was given to TAO patients in the moderate to severe active stage.Eye evaluation and orbital 3.0T MRI scan were performed on 7 patients before and after treatment for 6 months to 1 year,and the changes of CAS,T2RT and SIR and extraocular muscle area were compared before and after treatment.Results1.CAS decreased after treatment compared with before treatment(3(3,4.25)VS 0.5(0,2)),the difference was statistically significant(P<0.001)2.There was no significant change in SIR before and after treatment.3.T2RT before treatment was 79.82±16.22ms,and decreased to 72.94±9.70 after treatment,with statistically significant difference(P=0.005).4.The extraocular muscle area was 46.69±30.09mm2 before treatment,and decreased to 35.46±9.70mm2 after treatment(P=0.005).Conclusion T2 mapping sequence of magnetic resonance imaging is helpful for the monitoring of the efficacy of glucocorticoid therapy in patients with thyroid-associated ophthalmopathy.T2RT after treatment is significantly lower than that before treatment.