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Diagnosis of dysthyroid optic neuropathy: combined value of orbital MRI and intracranial visual pathway diffusion kurtosis imaging

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Abstract

Objectives

To evaluate the combined performance of orbital MRI and intracranial visual pathway diffusion kurtosis imaging (DKI) in diagnosing dysthyroid optic neuropathy (DON).

Methods

We retrospectively enrolled 61 thyroid-associated ophthalmopathy (TAO) patients, including 25 with DON (40 eyes) and 36 without DON (72 eyes). Orbital MRI–based apical muscle index (MI), diameter index (DI) of the optic nerve (ON), area index (AI) of the ON, apparent diffusion coefficient (ADC) and signal intensity ratio (SIR) of the ON, DKI-based kurtosis fractional anisotropy (KFA) and mean kurtosis (MK) of the optic tract (OT), optic radiation (OR), and Brodmann areas (BAs) 17, 18, and 19 were measured and compared between groups. The diagnostic performances of models were evaluated using receiver operating characteristic curve analyses and compared using the DeLong test.

Results

TAO patients with DON had significantly higher apical MI, apical AI, and SIR of the ON, but significantly lower ADC of the ON than those without DON (p < 0.05). Meanwhile, the DON group exhibited significantly lower KFA across the OT, OR, BA17, BA18, and BA19 and lower MK at the OT and OR than the non-DON group (p < 0.05). The model integrating orbital MRI and intracranial visual pathway DKI parameters performed the best in diagnosing DON (AUC = 0.926), with optimal diagnostic sensitivity (80%) and specificity (94.4%), followed by orbital MRI combination (AUC = 0.890), and then intracranial visual pathway DKI combination (AUC = 0.832).

Conclusion

Orbital MRI and intracranial visual pathway DKI can both assist in diagnosing DON. Combining orbital and intracranial imaging parameters could further optimize diagnostic efficiency.

Clinical relevance statement

The novel finding could bring novel insights into the precise diagnosis and treatment of dysthyroid optic neuropathy, accordingly, contributing to the improvement of the patients’ prognosis and quality of life in the future.

Key Points

• Orbital MRI and intracranial visual pathway diffusion kurtosis imaging can both assist in diagnosing dysthyroid optic neuropathy.

• Combining orbital MRI and intracranial visual pathway diffusion kurtosis imaging optimized the diagnostic efficiency of dysthyroid optic neuropathy.

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Abbreviations

ADC:

Apparent diffusion coefficient

AI:

Area index

AUC:

Area under the curve

BA:

Brodmann area

BCVA:

Best-corrected visual acuity

CAS:

Clinical activity score

CT:

Computed tomography

DI:

Diameter index

DKI:

Diffusion kurtosis imaging

DON:

Dysthyroid optic neuropathy

DTI:

Diffusion tensor imaging

EOM:

Extraocular muscle

FT3:

Free triiodothyronine

FT4:

Free thyroxine

ICC:

Intraclass correlation coefficient

IOP:

Intraocular pressure

KFA:

Kurtosis fractional anisotropy

MD:

Mean deviation

MI:

Muscle index

MK:

Mean kurtosis

MRI:

Magnetic resonance imaging

ON:

Optic nerve

OR:

Optic radiation

OT:

Optic tract

PSD:

Pattern standard deviation

ROC:

Receiver operating characteristic

ROI:

Region of interest

SI:

Signal intensity

SIR:

Signal intensity ratio

T2WI:

T2-weighted imaging

TAO:

Thyroid-associated ophthalmopathy

TRAb:

Thyrotropin receptor antibody

TSH:

Thyroid-stimulating hormone

VFI:

Visual field index

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Funding

This work was supported by the National Natural Science Foundation of China (NSFC) (81801659 to Hao Hu), Jiangsu Province Hospital (the First Affiliated Hospital with Nan**g Medical University) Clinical Capacity Enhancement Project (JSPH-MC-2021-8 to **ao-Quan Xu), and Jiangsu Province Capability Improvement Project through Science, Technology and Education (JSDW202243 to Fei-Yun Wu).

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Author notes

  1. Hao Hu and Jiang Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Nan**g Medical University, Nan**g, China

    Hao Hu, Jiang Zhou, Wen-Hao Jiang, Qian Wu, **ong-Ying Pu, **ao-Quan Xu & Fei-Yun Wu

  2. Department of Ophthalmology, The First Affiliated Hospital of Nan**g Medical University, Nan**g, China

    Hu Liu

  3. Department of Endocrinology, The First Affiliated Hospital of Nan**g Medical University, Nan**g, China

    Huan-Huan Chen

Authors
  1. Hao Hu
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Corresponding authors

Correspondence to **ao-Quan Xu or Fei-Yun Wu.

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The scientific guarantor of this publication is Fei-Yun Wu.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

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Hu, H., Zhou, J., Jiang, WH. et al. Diagnosis of dysthyroid optic neuropathy: combined value of orbital MRI and intracranial visual pathway diffusion kurtosis imaging. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10615-9

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  • DOI: https://doi.org/10.1007/s00330-024-10615-9

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