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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Quantitative MRI orbit characteristics and clinical correlation in dysthyroid optic neuropathy (DON)

Author: Gabriella Guevara
ePoster Number: 115


Purpose

To characterize the radiological findings in patients with DON at presentation and follow up correlated with clinical findings and final visual outcome.


Methods

A retrospective observational study of the clinical characteristics of adult DON patients in a multidisciplinary GO clinic with a minimum follow up for 6 months after diagnosis correlated with sequential novel quantitative DWI-MRI imaging findings.


Results

10 patients (18 eyes) , mean age 50.7, 6 female. 3 Caucasian, 2 Black, 2 South Asian and 3 mixed ethnicity were included. 7 were euthyroid at presentation, 5 smokers. Presenting visual acuity (VA) was worse than 0.3LogMar in 6.

Radiological proptosis was seen in all 18 eyes but degree was not correlated however with visual impairment. Radiological apical crowding was noted in 10/18 orbits and 3 had additional optic nerve signal changes observed. 2 patients had severe diffuse muscle involvement without sparing of the tendons. Predominant muscle expansion (6) was more commonly seen than fat expansion (3). DWI MRI imaging in 4/6 showed significantly elevated apparent diffusion coefficient (ADC) values with a mean value 1303.

Vision in 15 of 18 eyes had stabilised or significantly improved at final follow up with 3 eyes worse than 0.2 LogMAR. While CAS score improved from mean 3.7 to 0.4 by final follow up 7 still had intractable diplopia. 9 patients required immunomodulatory treatment with mycophenolate mofetil, 2 patients also had orbital radiotherapy and 7 underwent orbital decompression to treat their DON.

Follow up imaging in 6 patients after mean of 9 months showed improvement in proptosis and muscle swelling with reduction in ADC values in 3/6, 2 showed reduced proptosis only and 1 scan showed no interval change.


Conclusion

Radiological imaging findings can vary significantly in DON and there is little characterisation of muscle changes following treatment although reduction in proptosis post decompression was expected. As there is no gold standard diagnostic clinical signs quantitative MRI aids in the diagnosis and monitoring of this sight threatening condition.


Additional Authors

First nameLast nameBase Hospital / Institution
AhmedAl-NahrawyWestern Eye Hospital, Imperial College Healthcare NHS Trust
KunwarBhatiaCharing Cross Hospital, Imperial College Healthcare NHS Trust
VickieLeeWestern Eye Hospital,Imperial College Healthcare and North West London NHS Trust

Abstract ID: 21-144