定量动态增强MRI对评价慢性期甲状腺相关眼病眼外肌受累的价值

摘要

目的回顾性分析慢性期甲状腺相关眼病(TAO)眼外肌受累的定量动态增强MRI (DCE-MRI)特点。材料与方法 TAO组17例及正常对照组27例，均行DCE-MRI检查，利用后处理软件分别得到TAO组和正常对照组的内直肌、下直肌、外直肌及上直肌复合体的各个动态增强参数值，包括Ktrans、Kep、Ve及IAUC，ROI选取要避开肌腹边缘，包括每一条直肌肌腹的所有层面，并在相隔一月后重新测量，取平均值。结果正常对照组与TAO组各DCE-MRI参数值左右眼之间均无差异(P＞0.05)。与正常对照组相比，TAO组内直肌Ktrans、Kep、IAUC、下直肌Ktrans、Kep、Ve值减低(P<0.05)，上直肌Kep、Ve、IAUC值增高(P<0.05)。外直肌各参数值及内直肌Ve、下直肌IAUC、上直肌Ktrans无差异(P＞0.05)。在定量DCE-MRI四个参数中，Ktrans值最为敏感(内直肌与下直肌ROC曲线下面积分别为0.753和0.650)。结论 DCE-MRI能应用于TAO 眼外肌特点研究， TAO发生时，内直肌与下直肌是最常受累的眼外肌，Ktrans值可以用来评价眼外肌的微循环状态。%Objective:To evaluate retrospectively dynamic-enhanced MRI (DCE-MRI) features of involved extra-ocular muscle in patiens with chronic thyroid-associated ophthalmopathy (TAO). Materials and Methods:MRI examination were performed on 17 patients with chronic TAO and 27 healthy controls. Parameters of extra-ocular muscles of patients and controls, including Ktrans, Kep, Ve, IAUC, were produced by post process software. ROIs were drawn slice by slice along the edge of muscle belly, and repeated one month later. Results:There were no statistical difference between left and right muscles both in patients and controls (P>0.05). The mean values of Ktrans, Kep, IAUC of medial rectus and mean values of Ktrans, Kep, Ve value of inferior rectus in patiets were lower than those of healthy controls (P<0.05). The mean values of Kep, Ve, IAUC of superior rectus muscle complex in patients were higher than those of controls (P<0.05). There were no statistic differences in mean value of Ktrans, Kep, Ve, IAUC of lateral rectus and the mean value of Ve of medial rectus, the mean value of IAUC of inferior rectus and the mean value of Ktrans of superior rectus muscle complex between patients and controls (P>0.05). Among the all quantitative parameters, the mean value of Ktrans was most sensitive (The area under ROC curve of Ktrans was 0.753 in medial rectus and 0.650 in inferior rectus). Conclusions:DCE-MRI could be applied to evaluate extra-ocular muscles involvement in patients with chronic TAO. The medial rectus muscle and the inferior rectus muscle were most commonly involved in patients with TAO. The mean value of Ktrans value could be used to relfect the microcirculatory perfusion.