Skip to main content

Advertisement

SpringerLink
Log in

Quantitative analysis of orbital soft tissues on computed tomography to assess the activity of thyroid-associated orbitopathy

  • Oculoplastics and Orbit
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the validity of using quantitative volume and density measurements from orbital computed tomography (CT) images to assess the inflammatory activity of patients with thyroid-associated orbitopathy (TAO).

Methods

Computed tomography (CT) scans were obtained from 80 TAO patients and 40 controls, and 3D image analysis was conducted to measure the volume and density (in HU units) of intraorbital and extraorbital fat, extraocular muscle (EOM), and the lacrimal gland. Volume and density measurements of the orbital tissues were compared among active TAO, inactive TAO, and control subjects by ANCOVA. To determine the predictive value of each parameter for TAO activity, logistic regression was performed.

Results

The mean volume of extraorbital and intraorbital fat was significantly higher in patients with TAO than controls (p = 0.0019, p = 0.0004), with no significant difference between active and inactive TAO subjects. The mean total EOM volume and lacrimal gland volume was greater in active TAO patients than other groups (p < 0.0001, p < 0.0001). The mean density of extraorbital fat and the lacrimal gland was significantly different between active TAO, inactive TAO, and control groups (p = 0.0002, and p = 0.0487, respectively). Regression models incorporating total EOM volume, lacrimal gland volume, intraorbital fat volume, and density of extraorbital fat and the lacrimal gland could predict active inflammation in patients with TAO with accuracy of 84.5 %.

Conclusions

The measurements of orbital soft tissue volume and density using CT scans can be used as a reliable and feasible technique to establish active inflammation in patients with TAO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jacobson DH, Gorman CA (1984) Endocrine ophthalmopathy: current ideas concerning etiology, pathogenesis, and treatment. Endocr Rev 5:200–220

    Article  CAS  PubMed  Google Scholar 

  2. Dickinson AJ, Perros P (2001) Controversies in the clinical evaluation of active thyroid-associated orbitopathy: use of a detailed protocol with comparative photographs for objective assessment. Clin Endocrinol (Oxf) 55:283–303

    Article  CAS  Google Scholar 

  3. Regensburg NI, Kok PH, Zonneveld FW, Baldeschi L, Saeed P, Wiersinga WM, Mourits MP (2008) A new and validated CT-based method for the calculation of orbital soft tissue volumes. Investig Ophthalmol Vis Sci 49:1758–1762

    Article  Google Scholar 

  4. Hallin ES, Feldon SE (1988) Graves’ ophthalmopathy: II. Correlation of clinical signs with measures derived from computed tomography. Br J Ophthalmol 72(9):678–82

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Feldon SE, Lee CP, Muramatsu SK, Weiner JM (1985) Quantitative computed tomography of Graves’ ophthalmopathy. Extraocular muscle and orbital fat in development of optic neuropathy. Arch Ophthalmol 103(2):213–5

    Article  CAS  PubMed  Google Scholar 

  6. Ozgen A, Alp MN, Ariyurek M, Tutuncu NB, Can I, Gunalp I (1999) Quantitative CT of the orbit in Graves’ disease. Br J Radiol 72(860):757–62

    Article  CAS  PubMed  Google Scholar 

  7. Souza AD, Ruiz EE, Cruz AA (2007) Extraocular muscle quantification using mathematical morphology: a semi-automatic method for analyzing muscle enlargement in orbital diseases. Comput Med Imaging Graph 31(1):39–45

    Article  PubMed  Google Scholar 

  8. Regensburg NI, Wiersinga WM, Berendschot TT, Saeed P, Mourits MP (2011) Densities of orbital fat and extraocular muscles in graves orbitopathy patients and controls. Ophthal Plast Reconstr Surg 27(4):236–40

    Article  PubMed  Google Scholar 

  9. Barras CD, Tress BM, Christensen S, Collins M, Desmond PM, Skolnick BE, Mayer SA, Davis SM, Recombinant Activated Factor VII Intracerebral hemorrhage Trial investigators (2013) Quantitative CT densitometry for predicting intracerebral hemorrhage growth. AJNR Am J Neuroradiol 34(6):1139–44

    Article  CAS  PubMed  Google Scholar 

  10. Ahmadi N, Hajsadeghi F, Conneely M, Mingos M, Arora R, Budoff M, Ebrahimi R (2013) Accurate detection of metabolically active “brown” and “white” adipost tissues with computed tomography. Acad Radiol 20(11):1443–7

    Article  PubMed  Google Scholar 

  11. Bartley GB, Gorman CA (1995) Diagnostic criteria for Graves’ ophthalmopathy. Am J Ophthalmol 119(6):792–5

    Article  CAS  PubMed  Google Scholar 

  12. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L (1997) Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 47(1):9–14

    Article  CAS  Google Scholar 

  13. Goncalves AC, Silva LN, Gebrim EM, Monteiro ML (2012) Quantification of orbital apex crowding for screening of dysthyroid optic neuropathy using multidetector CT. AJNR Am J Neuroradiol 33(8):1602–7

    Article  CAS  PubMed  Google Scholar 

  14. Goncalves AC, Silva LN, Gebrim EM, Matayoshi S, Monteiro ML (2012) Predicting dysthyroid optic neuropathy using computed tomography volumetric analyses of orbital structures. Clinics (Sao Paulo) 67(8):891–6

    Article  Google Scholar 

  15. Yamamoto K, Itoh K, Yoshida S, Saito K, Sakamoto Y, Matsuda A, Saito T, Kuzuya T (1979) A quantitative analysis of orbital soft tissue in Graves’ disease based on B-mode ultrasonography. Endocrinol Jpn 26(2):255–61

    Article  CAS  PubMed  Google Scholar 

  16. Harris MA, Realini T, Hogg JP, Sivak-Callcott JA (2012) CT dimensions of the lacrimal gland in Graves orbitopathy. Ophthal Plast Reconstr Surg 28(1):69–72

    Article  PubMed  Google Scholar 

  17. Weis E, Heran MK, Jhamb A, Chan AK, Chiu JP, Hurley MC, Rootman J (2012) Quantitative computed tomographic predictors of compressive optic neuropathy in patients with thyroid orbitopathy: a volumetric analysis. Ophthalmology 119(10):2174–8

    Article  PubMed  Google Scholar 

  18. Eckstein AK, Finkenrath A, Heiligenhaus A, Renzing-Kohler K, Esser J, Kruger C, Quadbeck B, Steuhl KP, Gieseler RK (2004) Dry eye syndrome in thyroid-associated ophthalmopathy: lacrimal expression of TSH receptor suggests involvement of TSHR-specific autoantibodies. Acta Ophthalmol Scand 82(3 Pt 1):291–7

    Article  CAS  PubMed  Google Scholar 

  19. Huang D, Luo Q, Yang H, Mao Y (2014) Changes of lacrimal gland and tear inflammatory cytokines in thyroid-associated ophthalmopathy. Invest Ophthalmol Vis Sci 55(8):4935–43

    Article  CAS  PubMed  Google Scholar 

  20. Bingham CM, Harris MA, Realini T, Nguyen J, Hogg JP, Sivak-Callcott JA (2014) Calculated computed tomography volumes of lacrimal glands and comparison to clinical findings in patients with thyroid eye disease. Ophthal Plast Reconstr Surg 30(2):116–8

    Article  PubMed  Google Scholar 

  21. Wiersinga WM, Regensburg NI, Mourits MP (2013) Differential involvement of orbital fat and extraocular muscles in graves’ ophthalmopathy. Eur Thyroid J 2(1):14–21

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Weetman AP, Cohen S, Gatter KC, Fells P, Shine B (1989) Immunohistochemical analysis of the retrobulbar tissues in Graves’ ophthalmopathy. Clin Exp Immunol 75(2):222–7

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Al-Bakri M, Rasmussen AK, Thomsen C, Toft PB (2014) Orbital volumetry in Graves’ orbitopathy: muscle and fat involvement in relation to dysthyroid optic neuropathy. ISRN Ophthalmol 2014:435276

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kvetny J, Puhakka KB, Rohl L (2006) Magnetic resonance imaging determination of extraocular eye muscle volume in patients with thyroid-associated ophthalmopathy and proptosis. Acta Ophthalmol Scand 84(3):419–23

    Article  PubMed  Google Scholar 

  25. Trokel SL, Jakobiec FA (1981) Correlation of CT scanning and pathologic features of ophthalmic Graves’ disease. Ophthalmology 88(6):553–64

    Article  CAS  PubMed  Google Scholar 

  26. Uhlenbrock D (1988) Computed tomography in Graves’ ophthalmopathy—evaluation regarding the muscle size and density units. Neurosurg Rev 11(1):45–51

    Article  CAS  PubMed  Google Scholar 

  27. Hiromatsu Y, Yang D, Bednarczuk T, Miyake I, Nonaka K, Inoue Y (2000) Cytokine profiles in eye muscle tissue and orbital fat tissue from patients with thyroid-associated ophthalmopathy. J Clin Endocrinol Metab 85(3):1194–9

    CAS  PubMed  Google Scholar 

  28. Forbes G, Gorman CA, Brennan MD, Gehring DG, Ilstrup DM, Earnest F 4th (1986) Ophthalmopathy of Graves’ disease: computerized volume measurements of the orbital fat and muscle. AJNR Am J Neuroradiol 7(4):651–6

    CAS  PubMed  Google Scholar 

  29. Nunery WR, Martin RT, Heinz GW, Gavin TJ (1993) The association of cigarette smoking with clinical subtypes of ophthalmic Graves’ disease. Ophthal Plast Reconstr Surg 9(2):77–82

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea

    Jun Soo Byun

  2. Department of Ophthalmology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul, 156-755, South Korea

    Nam Ju Moon & Jeong Kyu Lee

Authors
  1. Jun Soo Byun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nam Ju Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeong Kyu Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong Kyu Lee.

Ethics declarations

Funding

This research was supported by Basic Science Research Program through the National Research foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A1A01060016). The sponsor had no role in the design or conduct of this study.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speaker’s bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patient-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter of materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Byun, J.S., Moon, N.J. & Lee, J.K. Quantitative analysis of orbital soft tissues on computed tomography to assess the activity of thyroid-associated orbitopathy. Graefes Arch Clin Exp Ophthalmol 255, 413–420 (2017). https://doi.org/10.1007/s00417-016-3538-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-016-3538-0

Keywords

Search

Navigation