目的:使用磁共振成像(MRI)测量分析甲状腺眼病(TED)合并重度主观性干眼症(DED)患者泪腺(LG)和眼外肌(EOM)的影像学特征。
方法:在这项横断面研究中,机械眼部暴露,收集干眼评估和MRI数据.将患者分为眼表疾病指数(OSDI)<33的非重度主观DED组和OSDI≥33的重度主观DED组。应用线性回归模型比较TED患者OSDI<33和OSDI≥33组。通过受试者工作特征曲线(ROC)分析评估MRI参数和模型的预测性能。
结果:本研究连续纳入88例TED患者(176只眼)。在OSDI<33组中,52名TED患者(104只眼),平均临床活动评分(CAS)为0.63±0.75。在OSDI≥33组中,有36位TED患者(72只眼),平均CAS为1.50±1.54。两组患者的年龄和性别相匹配。OSDI≥33组泪液破裂时间较短,上睑提肌/上直肌(LPS/SR),下直肌和外侧直肌,更小的LG,与OSDI<33DED组相比,炎症LPS/SR和下直肌更多(P<0.05)。在线性回归分析中,与OSDI<33DED组相比,OSDI≥33组内侧直肌横截面积较大(β=0.06,95CI:(0.02,0.10),P=0.008),下直肌横截面积较大(β=0.06,95CI:(0.00,0.12),P=0.048),较小的LG横截面积(β=-0.14,95CI:(-0.25,-0.04),P=0.008)。在ROC分析中,内侧直肌的曲线下面积,下直肌,LG,组合模型分别为0.625、0.640、0.661和0.716。
结论:重度主观DED的TED患者LG和EOM的多参数MRI参数有显著改变。结合LG横截面积的新型号,在患有严重主观DED的TED患者中,内侧直肌和下直肌显示出良好的预测性能。
OBJECTIVE: To analyze the radiological features of the lacrimal gland (LG) and extraocular muscle (EOM) in thyroid eye disease (TED) patients with severe subjective dry eye disease (DED) using magnetic resonance imaging (MRI) measurements.
METHODS: In this cross-sectional
study, mechanical ocular exposure, dry eye assessment and MRI data were collected. Patients were classified into non-severe subjective DED group with ocular surface disease index (OSDI) < 33 and severe subjective DED group with OSDI ≥ 33. Linear regression model was applied for comparing the OSDI < 33 and OSDI ≥ 33 group in TED patients. The predictive performance of MRI parameters and models was assessed by receiver operating characteristic curve (ROC) analysis.
RESULTS: Consecutive 88 TED patients (176 eyes) were included in this
study. In the OSDI < 33 group, 52 TED patients (104 eyes) with a mean clinical activity score (CAS) of 0.63 ± 0.75. In the OSDI ≥ 33 group, there are 36 TED patients (72 eyes), with a mean CAS of 1.50 ± 1.54. The age and sex of the patients were matched between the two groups. The OSDI ≥ 33 group had shorter tear break-up time, larger levator palpebrae superioris / superior rectus (LPS/SR), inferior rectus and lateral rectus, smaller LG, more inflammatory LPS/SR and inferior rectus than OSDI < 33 DED group (P < 0.05). In the linear regression analysis, compare to the OSDI < 33 DED group, the OSDI ≥ 33 group had larger medial rectus cross-sectional area (β = 0.06, 95%CI: (0.02, 0.10), P = 0.008), larger inferior rectus cross-sectional area (β = 0.06, 95%CI: (0.00, 0.12), P = 0.048), smaller LG cross-sectional area (β = -0.14, 95%CI: (-0.25, -0.04), P = 0.008). In the ROC analysis, the area under curve of medial rectus, inferior rectus, LG, and combined model are 0.625, 0.640, 0.661 and 0.716, respectively.
CONCLUSIONS: Multiparametric MRI parameters of the LG and EOM in TED patients with severe subjective DED were significantly altered. Novel models combining the cross-sectional area of LG, medial rectus and inferior rectus showed good predictive performance in TED patients with severe subjective DED.