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Reliability of Orbital MRI-Based Proptosis Measurement: A Multicenter Prospective Study
Xinyi Gou1, Cenyang Wu2, Zhengyong Huang2
1Department of Radiology, Peking University People's Hospital, Beijing, China (X.G., J.C., N.H.).
Academic Radiology
|July 23, 2026
Summary
Magnetic resonance imaging (MRI) offers a reproducible method for measuring proptosis in thyroid-associated ophthalmopathy (TAO). An automated MRI tool enhances diagnostic accuracy and standardization, providing a reliable alternative to traditional clinical measurements.
Area of Science:
- Ophthalmology and Radiology
- Medical Imaging and Diagnostics
Background:
- Accurate proptosis measurement is crucial for managing thyroid-associated ophthalmopathy (TAO).
- Traditional Hertel exophthalmometry exhibits significant inter-observer inconsistency, impacting diagnostic reliability.
- Need for a more reproducible and accurate method for proptosis assessment in TAO.
Purpose of the Study:
- To evaluate the efficacy of magnetic resonance imaging (MRI)-based proptosis measurement.
- To develop and validate an automated tool for enhanced diagnostic reproducibility in TAO.
- To compare MRI measurements with traditional Hertel exophthalmometry.
Main Methods:
- Retrospective analysis of 250 TAO patients from Center 1, with prospective enrollment.
- Proptosis measured using 2D and 3D MRI sequences by three radiologists; clinical Hertel measurements obtained for comparison.
- Development and internal validation of an automated MRI measurement tool, followed by external validation on two independent cohorts (Center 2: n=65, Center 3: n=48).
Main Results:
- Excellent inter-observer agreement for MRI proptosis measurements (2D ICC: 0.948, 3D ICC: 0.954).
- Strong correlation between MRI findings and Hertel exophthalmometry (Spearman's ρ = 0.76-0.80).
- Automated tool demonstrated high performance across all cohorts (CCC: 0.928-0.973, ICC: 0.916-0.973).
Conclusions:
- An automated MRI-based tool offers a reliable, standardized alternative to Hertel exophthalmometry for TAO management.
- The tool is particularly valuable for discordant clinical measurements or when high precision is needed for longitudinal monitoring.
- Demonstrated excellent accuracy, efficiency, and cross-center generalizability, enhancing diagnostic reproducibility.