MRI在甲状腺相关性眼病活动性评估方面的研究进展

Research progress of magnetic resonance imaging in the assessment of TAO activity

甲状腺相关性眼病(thyroid-associated ophthalmopathy,TAO)是一种自身免疫性眼眶疾病,会影响患者容貌,甚至引起失明,使患者的生活质量下降。对TAO活动性和症状严重程度的评估是制订治疗方案的基础,临床上主要用临床活动度评分来对其分期,但存在局限性。TAO患者影像学上主要表现为眼球突出、眼外肌水肿增粗及眼眶脂肪水肿,其他表现可合并泪腺体积增大,眼睑和视神经水肿等。T2WI脂肪抑制序列、动态对比增强MRI、弥散磁共振成像、mapping、磁化传递成像等多模态MRI技术及基于MRI图像的人工智能分析等技术能从多种角度为TAO的活动性分期提供更客观的信息,本文通过总结这些技术在TAO患者的眼外肌、眼眶脂肪、泪腺、视神经等的应用并结合测量得到的参数值来确定TAO的分期,以期指导临床决策,并为将来的研究提供参考方向。

Thyroid-associated ophthalmopathy(TAO)is an autoimmune orbital disease.TAO affects the patient's appearance and even causes blindness,which reduces the patient's quality of life.The assessment of its disease activity and symptom severity is the basis for formulating treatment plans.Clinical activity score is mainly used to evaluate the stage of TAO.The imaging manifestations of TAO patients are mainly exophthalmos,extraocular myoedema thickening and orbital lipopedema,and other manifestations may be combined with enlarged tear gland volume,eyelid and optic nerve edema.Multi-modal MRI techniques such as T2WI fat suppression sequence,dynamic enhanced MRI,diffusion magnetic resonance imaging,mapping,magnetization transfer imaging and artificial intelligence analysis based on MRI images can provide more objective information for the activity staging of TAO from a variety of perspectives.In this paper,we summarized the application of these techniques in the extraocular muscle,orbital fat,lacrimal gland and optic nerve of TAO patients,and combined with the measured parameter values to determine the stage of TAO.It is of great significance to guide clinical decision-making,and is expected to provide reference direction for future research.