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Multimodal MRI reveals structural and functional alterations in thyroid-associated ophthalmopathy.

Xuejia Pu1, Xiling Hu2, Liyu Hu3

  • 1Department of Radiology, Shenzhen Traditional Chinese Medical Hospital, Shenzhen, Guangdong, China.

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|April 6, 2026
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Summary

Thyroid-associated ophthalmopathy (TAO) causes white matter damage and alters brain activity in visually impaired patients. Multimodal MRI reveals microstructural changes and functional reorganization, aiding early diagnosis.

Keywords:
amplitude of low-frequency fluctuationdiffusion kurtosis imagingfunctional connectivitythyroid-associated ophthalmopathyvisual pathway injury

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Area of Science:

  • Neuroimaging
  • Ophthalmology
  • Neurology

Background:

  • Thyroid-associated ophthalmopathy (TAO) can lead to visual impairment.
  • The central neuropathological mechanisms underlying TAO-related visual impairment are not fully understood.

Purpose of the Study:

  • To investigate white matter microstructural damage, spontaneous brain activity, and functional connectivity alterations in TAO patients with visual impairment using multimodal MRI.

Main Methods:

  • Forty-five TAO patients and 32 healthy controls (HCs) underwent diffusion kurtosis imaging (DKI) and resting-state functional MRI (rs-fMRI).
  • Microstructural changes were quantified using fractional anisotropy (FA), mean kurtosis (MK), and mean diffusivity (MD).
  • Spontaneous neural activity and functional connectivity were assessed using amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and seed-based functional connectivity (FC) analyses.

Main Results:

  • TAO patients showed decreased MK, FA, and MD in the visual pathway (optic radiation, lateral geniculate body, optic tract, optic nerve), with MK being most reduced.
  • Aberrant ALFF/fALFF patterns were observed in visual and sensorimotor network regions.
  • Altered functional connectivity (FC) was found between visual and other brain regions, including the supplementary motor area and fusiform gyrus.

Conclusions:

  • TAO is associated with significant white matter microstructural damage and altered spontaneous brain activity and functional connectivity.
  • Combined DKI and rs-fMRI (ALFF/fALFF, FC) offer comprehensive insights into TAO's central neuropathological mechanisms.
  • These findings support early diagnosis and targeted interventions for TAO-related visual impairment.