Application of quantitative analysis of extraocular muscles to evaluate the inflammatory activity of thyroid associated ophthalmopathy
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摘要:
目的 评估99mTc-DTPA眼眶SPECT/CT显像眼外肌定量分析技术在甲状腺相关眼病（TAO）炎性活动性的临床应用价值。 方法 回顾性分析我院行99mTc-DTPA眼眶SPECT/CT显像检查的44例TAO患者，按照临床活动性评分（CAS）将TAO患者分为活动期组（CAS≥3，n=23）和非活动期组（CAS < 3，n=21）。在99mTc-DTPA眼眶SPECT/CT衰减校正图像中，选择眼外肌区域中摄取放射性核素最多的图像层面，分别勾画双侧眼外肌的感兴趣区，测量其放射性计数最大值，选取视神经水平枕叶脑组织的感兴趣区作为本底，计算眼外肌与视神经水平枕叶脑组织显像剂摄取比值（UR），同时将每侧UR值最高的眼外肌作为炎症程度受累最为严重的眼外肌，选取URmax值比较其组间差异，以评价对TAO活动性的诊断效能。 结果 活动期TAO患者的眼外肌URmax高于非活动期TAO患者，差异有统计学意义(P < 0.05)。TAO患者的眼外肌URmax与其CAS呈正相关关系(r=0.799, P < 0.05)；在评估TAO临床活动性方面，眼外肌URmax和CAS具有一致性（Kappa值=0.915, P < 0.05）；ROC曲线下面积为0.975，区分活动期与非活动期的URmax阈值为5.2，其敏感度为87.5%，特异性为100%。 结论 本研究所使用眼外肌定量分析技术的测量方法能够直接显示每条眼外肌的炎性反应，可准确定位受累的眼外肌，使双侧眼外肌靶区勾画更加精准，还可以测量各眼外肌的放射性核素摄取比值即UR值，能够更加准确地评估TAO的炎症活动性程度。 -
关键词:
- 甲状腺相关性眼病 /
- 99m锝-二乙烯三胺五乙酸 /
- SPECT/CT /
- 眼外肌与视神经水平枕叶脑组织显像剂摄取比值 /
- 临床活动性评分
Abstract:Objective To assess the clinical value of the 99mTc-DTPA orbital SPECT/CT imaging technique for quantitative analysis of extraocular muscles in the inflammatory activity of thyroid associated ophthalmopathy (TAO). Methods Forty-four patients with TAO who underwent 99mTc-DTPA orbital SPECT/CT imaging in our hospital were retrospectively analyzed, and the patients with TAO were classified into an active group [clinical activity score (CAS)≥3] and an inactive group (CAS < 3) according to CAS scores, with 23 patients (46 eyes) in the active group and 21 patients (42 eyes) in the inactive group. In the consensus on SPECT images corrected for CT attenuation, the uptake values were determined by placing a region of interest within the area of the highest uptake in each extraocular muscle. To determine the background uptake values, a circular region of interest was placed on the occipital lobe at the level of the optic nerve. The UR was calculated as the ratio of the maximum uptake value in the region of interest to the maximum uptake value in the background. And the highest UR value of extraocular muscles was considered as the most severely involved extraocular muscle. The URmax value of extraocular muscles was selected for statistical analysis of intergroup variability, which was used to evaluate the diagnostic efficacy for the diagnosis of TAO activity. Results The URmax of the extraocular muscles was significantly higher in patients with active TAO than inactive TAO, and the difference was statistically significant. (P < 0.05). The results showed a significant correlation between the URmax and CAS (r=0.799, P < 0.05). The URmax of the extraocular muscles and CAS were in agreement in assessing the clinical activity of TAO (Kappa value=0.915, P < 0.05); The area under the ROC curve was 0.975, and the URmax threshold for distinguishing between active and inactive periods was 5.2, with a sensitivity of 87.5% and a specificity of 100%. Conclusion The measurements of quantitative extra-ocular muscles analysis technique used in this study is able to directly show the inflammatory response of extra-ocular muscles, which can accurately localize the involved extra-ocular muscles and enable more precise outlining region of interest, as well as measure the uptake ratio of each extra-ocular muscle, and more accurately assess the degree of inflammatory. -
图 1 活动期TAO患者可见放射性核素在眼外肌、球后脂肪等眼眶组织中摄取明显增高
Figure 1. Patients with active TAO showed significantly increased radionuclide uptake in orbital tissues such as extraocular muscles and posterior bulbar fat.
图 2 非活动期TAO患者的放射性核素摄取轻度增高或不增高
Figure 2. Patients with inactive TAO showed radionuclide uptake mildly increased or not increased.
图 3 URmax值判断TAO活动性的ROC曲线
Figure 3. ROC curve for determining TAO activity by URmax values.
表 1 活动期与非活动期TAO患者的URmax比较
Table 1. Comparison of URmax of extraocular muscles between active and inactive TAO patients
Index Active TAO (n=23) Inactive TAO (n=21) P Female [n(%)] 11(47.8) 12(57.1) 0.563 Age (year, Mean±SD) 39.67±15.017 38.28±14.392 0.718 Smoker [n(%)] 7(30.4) 6(28.6) 0.817 URmax(Mean±SD) 7.0318±2.05644 3.8238±0.63080 < 0.001 
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