ePoster listing and sessions

Topic: ESOPRS 2021 ePoster sessions
Time: Sep 17, 2021 16:00 Amsterdam, Berlin, Rome, Stockholm, Vienna, 15:00 London

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Developing a Radiological Activity Score for the diagnosis and surveillance of Graves’ Orbitopathy

Author: Nicole George
ePoster Number: 235


The Clinical Activity Score (CAS) and EUGOGO Severity Scale (ESS) are used to assess Graves’ Orbitopathy (GO). These are qualitative, subjective measures that mostly assess the anterior orbit. Non-echoplanar diffusion-weighted (non-EPI-DWI) MRI measures the movement of water molecules within tissues, producing an apparent diffusion coefficient (ADC). This provides an objective, quantitative measure of GO for timely treatment. We evaluated the correlation between the clinical scores and radiological parameters (non-EPI-DWI and proptosis), the use of non-EPI-DWI as a diagnostic test for dysthyroid optic neuropathy (DON) and explored the association of DON and specific extraocular muscle enlargement.


We conducted a retrospective observational study from 3 multidisciplinary GO clinics of patients with at least 1 non-EPI-DWI, with a concurrent CAS. Statistical analysis was used to determine the relationship between the clinical and radiological parameters. We produced receiver operating characteristics (ROC) and odds ratio for associated factors of DON.


There was a significant positive correlation between CAS and ADC (P≤0.001). There was significantly higher ADC in sight-threatening patients than mild patients (P≤0.01). There was no significant correlation between CAS and proptosis, but proptosis was worse in moderate-severe patients than mild patients (P≤0.01). There was a correlation between ADC and the degree of radiological proptosis. ROC provided ‘cutoff’ ADC for those requiring treatment (<1082) and those developing DON (<1183). The likelihood of developing DON was greater in those with superior levator involvement than those without (P≤0.05).


Non-EPI-DWI correlated with CAS in a large patient cohort, replicating previous findings. ADC correlated with ESS emphasising the merit of non-EPI-DWI in identifying active, severe disease. Radiological superior levator involvement is associated with a greater risk of DON. Non-EPI-DWI offers quantitative assessment to aid clinical practice, particularly in severe patients where clinical measures may be unreliable.

Additional Authors

First nameLast nameBase Hospital / Institution
VickieLeeImperial College Healthcare Trust
ClaireFeeneyImperial College Healthcare Trust
KunwarBhatiaImperial College Healthcare Trust
ParizadAvariImperial College Healthcare Trust

Abstract ID: 21-129