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Predicting dysthyroid optic neuropathy using computed tomography volumetric analyses of orbital structures
Allan C Pieroni Gonçalves1, Lucas Nunes Silva, Eloísa M M S Gebrim
1Division of Ophthalmology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo, Brazil)
|September 6, 2012
Summary
Multidetector-computed tomography (MDCT) can detect dysthyroid optic neuropathy by measuring orbital apex crowding volume. The volumetric orbital apex crowding index showed high accuracy in predicting this condition.
Area of Science:
- Ophthalmology
- Radiology
- Endocrinology
Background:
- Graves' orbitopathy is an autoimmune condition affecting the eye socket.
- Dysthyroid optic neuropathy (DON) is a sight-threatening complication of Graves' orbitopathy.
- Accurate detection of DON is crucial for timely intervention.
Purpose of the Study:
- To evaluate the diagnostic capability of orbital apex crowding volume measurements using multidetector-computed tomography (MDCT) in detecting dysthyroid optic neuropathy (DON).
- To compare the effectiveness of different volumetric indexes in identifying DON.
Main Methods:
- Prospective study of 93 patients with Graves' orbitopathy undergoing neuro-ophthalmic examination and MDCT.
- Calculation of orbital fat and muscle volumes using dedicated workstation software.
- Derivation of two crowding indexes: volumetric crowding index (axial scans) and volumetric orbital apex crowding index (coronal scans).
Main Results:
- Analysis of 102 orbits revealed significant differences in both volumetric indexes between orbits with and without DON (p<0.001).
- The volumetric orbital apex crowding index demonstrated superior performance with 92% sensitivity and 86% specificity.
- This index achieved 88% accuracy in detecting DON at a cutoff value of 4.14.
Conclusions:
- Orbital volumetric crowding index measurements, particularly the volumetric orbital apex crowding index, are effective predictors of dysthyroid optic neuropathy.
- MDCT-based volumetric analysis offers a valuable tool for diagnosing DON in patients with Graves' orbitopathy.
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