Graves Ophthalmopathy: The Bony Orbit in Optic Neuropathy, Its Apical Angular Capacity, and Impact on Prediction of Risk

被引:49
作者
Chan, L. -L. [1 ]
Tan, H. -E. [1 ]
Fook-Chong, S. [3 ]
Teo, T-H [1 ]
Lim, L-H [2 ]
Seah, L-L [2 ]
机构
[1] Singapore Gen Hosp, Dept Diagnost Radiol, Singapore 169608, Singapore
[2] Singapore Natl Eye Ctr, Singapore, Singapore
[3] Singapore Gen Hosp, Dept Clin Res, Singapore 169608, Singapore
关键词
FAT; CT; ORBITOPATHY; DISEASE; DECOMPRESSION; INVOLVEMENT; MUSCLE;
D O I
10.3174/ajnr.A1413
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND AND PURPOSE: Optic neuropathy (ON), a serious complication of Graves ophthalmopathy, is often subclinical and masked by symptoms of orbitopathy. We examined herein bony and soft-tissue CT features associated with ON, including an angular assessment of orbital apex capacity, and their usefulness in the risk prediction of ON. MATERIALS AND METHODS: The CT scans of 41 patients with Graves ophthalmopathy (17 men, 24 women; mean age, 49.1 years) clinically diagnosed with (19 patients, 32 orbits) or without ON were evaluated by 2 independent raters. Quantitative linear and angular measurements of the orbital structures and bony walls and categoric scores of apical crowding and intracranial fat prolapse were assessed on a clinical workstation. Inter- and intrarater variability of these features was determined. The CT features of the 2 patient groups were compared, and multivariate logistic regression analysis was performed to evaluate the predictive features of ON. RESULTS: Bony orbital angles (P < .005), length of the lateral orbital wall (P < .05), muscular diameters (P < .0005), muscular bulk of the medial rectus muscle relative to the bony orbit (P < .05), and apical crowding (P < .0005) were associated with clinical ON, Stepwise multivariate logistic regression analysis revealed the muscle diameter index and medial and lateral wall angles to be independent predictors. Combining these in a single multivariate equation yielded sensitivity, specificity, and positive and negative predictive values of 73%, 90%, 82%, and 85%, respectively. CONCLUSIONS: Orbital wall angles, especially the medial wall, and muscular enlargement are independent risk predictors.
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收藏
页码:597 / 602
页数:6
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