Application Of Ultrasound In Extraocular Myopathy In Patients With Graves Ophthalmopathy

Objective:Use high-frequency ultrasound and shear wave elastography(SWE)technology to evaluate the thickness and elasticity of the extraocular muscles of Graves ophthalmopathy(GO)patients,analyze its correlation with the exophthalmus,to explore the application value and prospect of ultrasound in GO patients.Methods:This study selected 65 GO patients diagnosed in the endocrinology and ophthalmology department of our hospital from January 2019 to October 2020,and divided them into two groups according to the 2016 European Thyroid Association’s grading diagnosis and treatment criteria for GO: the active GO group(44 cases)and Inactive GO group(21 cases),50 healthy volunteers with the same age and gender distribution and no history of thyroid and ophthalmology were selected as the control group.The thickness of extraocular muscles of all subjects was measured using high-frequency ultrasound.SWE evaluated the average Young’s modulus of 4extraocular muscles,expressed in Emean.using The Hertel exophthalmoscope measured the exophthalmos of the eyes of all subjects,and analyzed its correlation with the thickness of the extraocular muscles and the Emean value.The receiver operating characteristic curve(ROC)was drawn based on the GO diagnostic criteria formulated by Bartley to determine the sensitivity,specificity and optimal cut-off value of the extraocular muscle Emean for the diagnosis of GO.Results:1.The thickness of medial,lateral,superior and inferior rectus in GO group was significantly higher than that in normal control group(p<0.001),while there was no significant difference in the thickness of rectus in GO group(p>0.05).The Emean values of medial,lateral,superior and inferior rectus in GO group were higher than those in the control group,and the difference between each group was statistically significant p<0.001).The exophthalmus of GO group was higher than that of control group(p<0.001),and there was no significant difference in GO group(p>0.05).2.The exophthalmos was positively correlated with the thickness of the medial rectus(r=0.518,p < 0.001),inferior rectus(r=0.582,p < 0.001)and lateral rectus(r=0.293,p=0.018);There was a slight positive correlation between exophthalmos and Emean value of medial rectus(r=0.280,p=0.024).3.ROC curve showed that the optimal cut-off value of elasticity of medial,lateral,superior and inferior rectus for GO diagnosis were 9.65 k Pa,9.85 k Pa,9.65 k Pa,9.7k Pa,respectively;area under the curve was 0.94,0.93,0.94,0.94,respectively;sensitivity was 95%,92%,93%,98%;specificity was 84%,84%,86%,82%.Conclusion:The extraocular muscles of GO patients are all thicker than normal people,among which the medial rectus and inferior rectus muscles are more obvious.Compared with normal people,the extraocular muscles of GO patients are more stiff,indicating that high frequency Ultrasound and SWE can be used as a new imaging tool to provide more valuable information for clinical diagnosis of GO.