MR高清扩散加权成像在甲状腺相关性眼病诊断中的应用

目的：研究磁共振(MR)高清扩散加权成像(RESOLVE-DWI)在甲状腺相关性眼病(TAO)诊断中的应用价值及其对TAO活动性的预测价值。

方法：选取2017-01/2019-12在本院收治的TAO患者82例155眼，为TAO组。另选取同期收治的无TAO的初诊Graves病患者50例100眼，为对照组。TAO组患者根据临床活动性评分(CAS)分为活动期与非活动期。纳入研究者均实施MR检查，对比TAO组与对照组的RESOLVE-DWI表观扩散系数(ADC)值差异。以受试者工作特征曲线(ROC)评价RESOLVE-DWI的ADC测量值对TAO的诊断价值。统计可能影响TAO活动性的相关因素，以Logistic回归分析明确危险因素。ROC曲线评价ADC值对TAO活动性的预测价值。

结果：TAO组的ADC值大于对照组(P<0.001)。ROC曲线显示，RESOLVE-DWI的ADC值诊断TAO的最佳截断点为1.302×10^-3mm²/s，其灵敏度、特异度、曲线下面积(AUC)分别为87.10%、81.94%、0.895。TAO活动期的年龄、美国甲状腺学会颁布的分级标准(NOSPECS)、ADC值均大于非活动期(P<0.05)； Logistic回归分析显示年龄、NOSPECS分级、ADC值是影响TAO活动期的危险因素(P<0.05)。ROC曲线分析，RESOLVE-DWI的ADC值预测TAO活动性的最佳截断点1.522×10^-3mm²/s，其灵敏度、特异度、AUC分别为82.58%、76.77%、0.801。

结论：RESOLVE-DWI的ADC测量值诊断TAO和预测活动性的最佳截断点分别为1.302×10^-3、1.522×10^-3mm²/s，以最佳截断点进行TAO诊断和活动性预测具有较高的临床价值。

Application of MR high-definition resolution readout segmentation of long variable echo-trains diffusion weighted imaging in the diagnosis of thyroid associated ophthalmopathy

AIM: To study the application value of magnetic resonance(MR)high-definition readout segmentation of long variable echo-trains diffusion weighted imaging(RESOLVE-DWI)in the diagnosis of thyroid associated ophthalmopathy(TAO)and its predictive value for the activity of TAO activity.

METHODS: A total of 82 patients(155 eyes)with TAO admitted to the hospital from January 2017 to December 2019 were selected as TAO group. Another 50 patients(100 eyes)with Graves disease without TAO who were admitted during the same period were selected as control group. According to the clinical activity score(CAS)the patients with TAO were divided into active period and inactive period. All the participants were examined by magnetic resonance(MR). The difference of RESOLVE-DWI apparent diffusion coefficient(ADC)values between TAO Group and control group was compared. The receiver operating characteristic curve(ROC)was used to evaluate the diagnostic value of the ADC measurement of RESOLVE-DWI for TAO. Count the related factors that may affect the activity of TAO, and use Logistic regression analysis to clarify the risk factors. ROC curve was used to evaluated the predictive value of RESOLVE-DWI ADC for TAO activity.

RESULTS: The ADC value of the TAO group was greater than that of the control group(P<0.001). ROC curve showed that the best cut-off point of RESOLVE-DWI ADC value in diagnosing TAO was 1.302×10^-3mm²/s, and the sensitivity, specificity and AUC were 87.10%, 81.94% and 0.895, respectively. The age, grading standard promulgated by the American Thyroid Society(NOSPECS)and ADC value of TAO in active period were higher than those in inactive period, and the differences were statistically significant(P<0.05). Logistic regression analysis showed that age, NOSPECS grade and ADC value were the risk factors of TAO activity, and the differences were statistically significant(P<0.05). ROC curve analysis showed that the best cut-off point of RESOLVE-DWI ADC value in predicting TAO activity was 1.522×10^-3mm²/s, and the sensitivity, specificity, and AUC were 82.58%, 76.77%, 0.801, respectively.

CONCLUSION: The best cut-off points of RESOLVE-DWI ADC value in diagnosing TAO and predicting activity are 1.302×10^-3mm²/s and 1.522×10^-3mm²/s, respectively, and use the best cut-off point for TAO diagnosis and activity sexual prediction has high clinical value.