Abstract
BackgroundStudies on the factors related to lacrimal gland prolapse (LGP) in patients with thyroid-associated ophthalmopathy (TAO) are limited. This study aimed to assess the factors associated with LGP on magnetic resonance imaging (MRI) and its relation to TAO activity .MethodsThirty-six patients (72 orbits) with inactive TAO (43 orbits, Clinical Activity Score [CAS] < 3) or active TAO (29 orbits, CAS ≥3) were investigated retrospectively. All patients underwent ophthalmic evaluation and orbital magnetic resonance imaging. The severity of LGP and proptosis and the extraocular muscle (EOM) volume were measured. LGP and related factors were assessed by correlational and linear regression analyses. The value of LGP for discriminating the activity of TAO was evaluated by receiver-operating characteristic curve analysis.ResultsThe mean LGP was significantly higher in the active TAO group than in the inactive TAO group (P < 0.001). There were significant positive correlations between LGP severity and the CAS (r = 0.51, P < 0.001), proptosis (r = 0.72, P < 0.001), and EOM volume (superior rectus [r = 0.49, P < 0.001], inferior rectus [r = 0.47, P < 0.001], lateral rectus [r = 0.59, P < 0.001], medial rectus [r = 0.62, P < 0.001], superior oblique [r = 0.48, P < 0.001], and all EOMs [r = 0.59, P < 0.001]). Receiver-operating characteristic curve analysis revealed an LGP of 13.65 mm (area under the curve, 0.824; sensitivity, 79.3%; specificity, 81.4%) to be the cut-off value that differentiated active and inactive TAO.ConclusionsLGP measurements obtained from orbital magnetic resonance images were positively correlated with CAS, proptosis and EOM volume. The extent of LGP appears to be a good indicator of disease activity in patients with TAO.
Highlights
Studies on the factors related to lacrimal gland prolapse (LGP) in patients with thyroid-associated ophthalmopathy (TAO) are limited
Comparison of LGP between the active and inactive TAO groups The mean LGP was significantly greater in the active group than in the inactive group (15.50 ± 3.25 vs 12.21 ± 2.09 mm; P < 0.001) (Fig. 3)
This study aimed to identify a simple and convenient quantitative magnetic resonance imaging (MRI) parameter that can be used to measure the degree of LGP and determine its correlation with disease activity
Summary
Studies on the factors related to lacrimal gland prolapse (LGP) in patients with thyroid-associated ophthalmopathy (TAO) are limited. This study aimed to assess the factors associated with LGP on magnetic resonance imaging (MRI) and its relation to TAO activity. Thyroid-associated ophthalmopathy (TAO) is the most common extrathyroidal manifestation of Graves’ disease [1, 2] and is found in 25–50% of patients with this disorder [3]. Previous studies have shown that 65–85% of patients with TAO have lacrimal gland involvement, which leads to reduced tear secretion [4]. Several magnetic resonance imaging (MRI) and computed tomography (CT) studies have demonstrated that the volume of the lacrimal gland is significantly larger in patients with TAO than in healthy controls [5,6,7]. The purpose of this study was to identify a simple and convenient quantitative MRI parameter that can measure the degree of LGP and to be a good indicator of TAO activity
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