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Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity

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Abstract

Background

Lacrimal gland (LG) involvement in patients with Graves ophthalmopathy (GO) has been considered as a potential cause of the associated GO symptoms and different studies demonstrated the LG involvement in patients with GO than healthy controls. The aim of this study was to evaluate LG involvement, through measurement of its herniation, using a magnetic resonance imaging (MRI) index, in patients with different GO activities.

Methods

Thirty-two consecutive Caucasian patients affected by GO were enrolled and grouped in group A (16 with inactive GO, CAS < 3) and B (16 with active GO, CAS ≥ 3) according to their GO activity. All patients underwent clinical-endocrinological assessment, a complete ocular evaluation, and orbital MRI examination.

Results

No difference was found between the hormonal parameters, thyroid ultrasound-derived parameters, and thyroid-stimulating hormone (TSH) receptor (TSH-R) antibodies (TRAb) levels in group B and those in group A. The LG herniation (LGH) measurement evaluated by MRI was significantly higher in group B for both right (10.1 (7.3–17) vs. 7 (0–3.4) mm; p = 0.004) and left (8.5 (6.6–13) vs. 5.8 (0–12) mm; p = 0.026) eye than group A. A positive correlation was found between TRAb and LGH herniation (Rho 0.462, p = 0.009).

Conclusions

Measurement of LGH seems to be a good marker of the disease and GO activity.

Key Points

• Lacrimal gland herniation is a simple index related to disease activity

• Lacrimal gland herniation is correlated to TRAb levels

• Lacrimal gland evaluation could be useful to differentiate active from inactive Graves ophthalmopathy in an early stage of disease

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Abbreviations

CAS:

Clinical activity score

CT:

Computed tomography

EUGOGO:

European Group On Graves Orbitopathy

FT3:

Triiodothyronine

FT4:

Free thyroxine

GD:

Graves disease

GO:

Graves ophthalmopathy

LG:

Lacrimal gland

LGH:

Lacrimal gland herniation

MRI:

Magnetic resonance imaging

TRAb:

TSH-R autoantibodies

TSH:

Thyroid-stimulating hormone (thyrotropin)

TSH-R:

Thyroid-stimulating hormone receptor

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Cesare Gagliardo and Stefano Radellini contributed equally to this work.

Authors and Affiliations

  1. Section of Radiological Sciences - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy

    Cesare Gagliardo, Giorgia Falanga & Massimo Midiri

  2. Section of Endocrinology - Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy

    Stefano Radellini, Raffaella Morreale Bubella, Pierina Richiusa, Alessandro Ciresi & Carla Giordano

  3. Section of Ophthalmology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy

    Maria Vadalà

Authors
  1. Cesare Gagliardo
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  2. Stefano Radellini
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  3. Raffaella Morreale Bubella
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  4. Giorgia Falanga
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  5. Pierina Richiusa
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  6. Maria Vadalà
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  7. Alessandro Ciresi
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  8. Massimo Midiri
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  9. Carla Giordano
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Corresponding author

Correspondence to Carla Giordano.

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Guarantor

The scientific guarantor of this publication is Prof Carla Giordano (Section of Endocrinology - Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy).

Conflict of interest

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

At least one of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Gagliardo, C., Radellini, S., Morreale Bubella, R. et al. Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity. Eur Radiol 30, 2138–2141 (2020). https://doi.org/10.1007/s00330-019-06570-5

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  • DOI: https://doi.org/10.1007/s00330-019-06570-5

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