The Clinical Application Of Quantitative Analysis Based On MRI Three-dimensional Reconstruction In The Condition Assessment And Curative Effect Evaluation Of Thyroid-associated Ophthalmopathy

Chapter 1 Analysis of the clinical value of the volume of the retrobulbar soft group in the evaluation of thyroid-related ophthalmopathyObiective Use Mimics software to reconstruct the 3D model of the orbital MRI data of TAO patients,and accurately measure the volume of the posterior eyeball and extraocular muscles.Analyze its correlation with clinical related indicators,and explore the value of retrobulbar fat and extraocular muscle volume in the evaluation of TAO disease.Methods A total of 135 patients with TAO who were newly diagnosed with TAO in our hospital from September 2016 to March 2019 were collected,with a total of 270 eyes.The detailed clinical data of the patients were collected,and 3.0T magnetic resonance scan of the orbit was performed,including the 3D-FFE sequence.Use Mimics software to reconstruct the 3D model of the orbital MRI data of TAO patients,and measure the volume of the posterior eyeball and extraocular muscles.Comparing the differences in disease severity,activity,smoking history and disease course groupings,analyzing its correlation with the clinical characteristics of patients,and using receiver operating characteristic(ROC)curve to calculate the diagnostic value of judging TAO activity.Results 1.The volume of retrobulbar fat,extraocular muscle and total extraocular muscle volume of retrobulbar fat in moderate to severe group were larger than those in mild group,the volume of extraocular muscle and total extraocular muscle volume of retrobulbar fat in threat vision group were larger than those in mild group,and the volume of extraocular muscle in threat Vision Group was larger than that in moderate to severe group(P<0.05).There was no significant difference in the volume of retrobulbar fat between the vision threatening group and the mild group,moderate and severe group(P>0.05).The retrobulbar fat volume,extraocular muscle volume and total extraocular muscle volume of the active group were higher than those of the inactive group(P<0.05).The volume of retrobulbar fat,extraocular muscle and total volume in smoking group were higher than those in non-smoking group(P<0.05).The extraocular muscle volume of the patients with the course of disease≤12 months was higher than that of the patients with the course of disease>12 months(P<0.05),but there was no significant difference in retrobulbar fat.volume and total extraocular muscle volume(P>0.05).2.Retrobulbar fat volume and extraocular muscle volume were positively correlated with exophthalmos degree,CAS score and course of disease.3.The extraocular muscle volume judged TAO in the active phase AUC was 0.665(P<0.001),the 95%confidence interval was(0.600,0730),the sensitivity was 0.33,and the specificity was 0.93.The extraocular muscle volume used to judge the severity of TAO to be above moderate to severe AUC was 0.700(P<0.001),the 95%confidence interval was(0.633,0.766),the sensitivity was 0.86,and the specificity was 0.43.Conclusion The measurement of retrobulbar fat and extraocular muscle volume is of great significance for the evaluation of thyroild-related ophthalmopathy.It is related to disease activity,CAS score and severity,and has reference value for disease evaluation.Chapter 2 Preliminary study on the changes of imaging indexes in patients with thyroid-related ophthalmopathy before and after treatmentObiective Analyze the changes of the patient’s imaging indicators before and after treatment and their predictive effects.Methods A total of 34 eyes were collected from 17 TAO patients who were first diagnosed and followed up in our hospital from November 2016 to May 2019.The detarled clinical data of the patients were collected,and the patients received glucocortieoid pulse therapy.The orbital 3.0T magnetic resonance scan was performed before and after the treatment for six months to one year after the treatment,including the 3D-FFE sequence.Use Mimics software to reconstruct the 3D model of the orbital MRI data of TAO patients,and measure the volume of the posterior eyeball and extraocular muscles.Analyze the changes of posterior fat and extraocular muscle volume in TAO patients before and after treatment,and their relationship with changes in clinical indicators.Results 1.There are significant differences in the volume of posterior fat and extraocular muscles before and after treatment in the affected eye(P<0.001,P<0.001).The CAS score and exophthalmos of the affected eye decreased significantly after treatment(P<0.001,P=0.004),and the width of the palpebral fissure was not significantly improved(P=0.424).2.Based on the efficacy evaluation criteria,the affected eyes were divided into an improvement group(N=26)and an unchanged group(N=8),and there was no deterioration of the affected eyes.There was no significant difference between the improvement group and the unchanged group in the volume of post-bulbar fat and extraocular muscle volume(P=0.570,P=0123).Conclusion The volume of fat and extraocular muscles after the ball was significantly decreased after the treatment There was no statistical difference in the changes of retrobulbar fat volume and extraocular muscle volume between the clinical treatment improvement group and the unchanged group,and the changes were still unable to distinguish the clinical efficacy of the treatment.