Dixon MRI-based quantitative parameters of extraocular muscles, intraorbital fat, and lacrimal glands for staging thyroid-associated ophthalmopathy

Abstract Objective To investigate the value of Dixon magnetic resonance imaging (MRI)-based quantitative parameters of extraocular muscles (EOMs), intraorbital fat (IF), and lacrimal glands (LGs) in staging patients with thyroid-associated ophthalmopathy (TAO). Methods Two hundred patients with TAO (211 active and 189 inactive eyes) who underwent Dixon MRI for pretreatment evaluation were retrospectively enrolled and divided into training (169 active and 151 inactive eyes) and validation (42 active and 38 inactive eyes) cohorts. The maximum, mean, and minimum values of the signal intensity ratio (SIR), fat fraction (FF), and water fraction (WF) of EOMs, IF, and LGs were measured and compared between the active and inactive groups in the training cohort. Binary logistic regression analysis, receiver operating characteristic curve analysis, and the Delong test were used for further statistical analyses, as appropriate. Results Compared with inactive TAOs, active TAOs demonstrated significantly greater EOM-SIR max , EOM-SIR mean , EOM-SIR min , IF-SIR max , IF-SIR mean , LG-SIR max , LG-SIR mean , EOM-WF mean , EOM-WF min , IF-WF max , IF-WF mean , and LG-WF mean and lower EOM-FF max , EOM-FF mean , IF-FF mean , IF-FF min , and LG-FF mean values (all p < 0.05). The EOM-SIR mean , LG-SIR mean , and LG-FF mean values were independently associated with active TAO (all p < 0.05). The combination of the EOM-SIR mean , LG-SIR mean , and LG-FF mean values showed better performance than the EOM-SIR mean value alone in staging TAO in both the training (AUC, 0.820 vs 0.793; p = 0.016) and validation (AUC, 0.751 vs 0.733, p = 0.341) cohorts. Conclusion Dixon MRI-based parameters of EOMs, LGs, and IF are useful for differentiating active from inactive TAO. The integration of multiple parameters can further improve staging performance. Critical relevance statement In this study, the authors explored the combined value of quantitative parameters of EOMs, IF, and LGs derived from Dixon MRI in staging TAO patients, which can support the establishment of a proper therapeutic plan. Key Points The quantitative parameters of EOMs, LGs, and IF are useful for staging TAO. The EOM-SIR mean , LG-SIR mean , and LG-FF mean values were found to independently correlate with active TAO. Joint evaluation of orbital tissue improved the ability to assess TAO activity. Graphical Abstract