T2-relaxation mapping and fat fraction assessment to objectively quantify clinical activity in thyroid eye disease: an initial feasibility study
T2-relaxation mapping and fat fraction assessment to objectively quantify clinical activity in thyroid eye disease: an initial feasibility study
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DOI：
10.1038/s41433-018-0304-z
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发表时间：
2019-02-01
期刊：
影响因子：
3.9
通讯作者：
Murthy, Rachna
中科院分区：
文献类型：
--
作者：
Das, Tilak;Roos, Jonathan C. P.;Murthy, Rachna
甲状腺眼病（TED）的成像用于排除其他诊断，评估根尖拥挤和计划手术。但是为了客观地量化TED活动，主观临床评分评估仍然是标准。磁共振成像（MRI）T2弛豫时间与眼外肌（EOM）炎症相关，但受到脂肪信号的混淆。我们研究了T2弛豫映射结合脂肪分数（FF）测量是否可以客观地量化EOM中的疾病活动。62名TED患者和6名对照者被招募进行眼眶冠状短tau反转恢复（STIR）、T2多回波快速自旋回波和多回波快速梯度回波MRI。STIR信号强度比（SIR），T2弛豫时间和百分比FF推导出双侧下，外，上级和内侧直。12例患者在免疫抑制治疗后重新扫描。结果发现，所有受试者的T2和SIR之间呈正相关（p <0.001），但只有平均T2在患者和对照组之间存在显著差异（p <0.001）。我们首次测量了眼外肌的FF，发现TED的FF更大（p <0.001）。治疗后平均T2也显著降低，几乎所有患者的临床活动评分（CAS）也相应降低。我们表明，T2弛豫时间可以区分正常和炎症性EOM，并且对治疗有反应。结合，独特地，与FF测量EOM，一个客观的，定量的标记物的炎症在TED影响的肌肉可以得到。T2弛豫时间反映了治疗后CAS的改善，偶尔在治疗前。它们很少出现分歧，表明CAS作为疾病负担标志物的局限性。
Imaging in thyroid eye disease (TED) is used to exclude other diagnoses, assess for apical crowding and plan surgery. But to quantify TED activity objectively, subjective clinical scoring assessments remain the norm. Magnetic resonance imaging (MRI) T2-relaxation times correlate with extra-ocular muscle (EOM) inflammation, but are confounded by signal from fat. We investigated whether T2-relaxation mapping in combination with fat fraction (FF) measurements could quantify disease activity in EOMs objectively. Sixty-two TED patients and six controls were enroled for coronal short tau inversion recovery (STIR), T2 multi-echo fast-spin echo and multi-echo fast-gradient echo MRI of the orbits. STIR signal intensity ratios (SIRs), T2-relaxation times and percentage FF were derived for inferior, lateral, superior and medial recti bilaterally. Twelve patients were re-scanned following immunosuppressive treatment. The results found a positive correlation for all subjects between T2 and SIR (p < 0.001), but only mean T2 differed significantly between patients and controls (p < 0.001). We measured FF in EOMs for the first time and found it greater in TED (p < 0.001). There was also a significant reduction in mean T2 after treatment, with a corresponding reduction in the clinical activity score (CAS) in almost all patients. We show that T2-relaxation times differentiate between normal and inflamed EOMs and are responsive to treatment. Combined, uniquely, with FF measurement in EOMs, an objective, quantitative marker of inflammation in TED-affected muscles could be derived. T2-relaxation times mirrored improvements in CAS after treatment, occasionally preceding them. Rarely, they diverged, suggesting limitations in the CAS as a disease burden marker.