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International Ophthalmology

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01-03-2020 | Diplopia | Original Paper

99mTc-DTPA SPECT/CT provided guide on triamcinolone therapy in Graves’ ophthalmopathy patients

Authors: Dan Liu, Xueliang Xu, Sha Wang, Chengzhi Jiang, Xinhui Li, Jia Tan, Zhihong Deng

Published in: International Ophthalmology | Issue 3/2020

Abstract

Introduction

Distinguishing between the active and inactive stages of Graves’ ophthalmopathy (GO) is essential for making treatment decisions. 99mTc-DTPA SPECT/CT is sensitive in identifying inflammation in extraocular muscles of GO patients, which we designate 99mTc-DTPA-active. This study aimed to evaluate the response of 99mTc-DTPA-active GO patients to local immunosuppressive therapy.

Materials and methods

Sixty-four 99mTc-DTPA-active GO patients (89 eyes) were retrospectively analyzed. Forty-five patients (64 eyes) received repeated peribulbar triamcinolone injection, and 19 patients (25 eyes) received no immunosuppressive treatment. Ophthalmological assessment, including clinical activity score, eyelid retraction, eyelid aperture, proptosis, diplopia, and ocular mobility, was recorded before and after treatment.

Results

Compared with untreated patients, the clinical activity score decreased significantly (P < 0.001) while eye symptoms (soft-tissue swelling and eyelid retraction and aperture) improved significantly (P = 0.02, P < 0.001, P < 0.001, respectively) in treated patients after six months. The inferior and medial recti were significantly smaller (P < 0.001, P < 0.001, respectively), and 99mTc-DTPA uptake in the two recti was significantly less (P = 0.001, P = 0.01, respectively) in treated patients than in untreated patients after 3 months.

Conclusion

Clinical activity score of < 3 does not indicate inactive GO, as revealed with 99mTc-DTPA SPECT/CT. Patients with 99mTc-DTPA-active GO can improve the symptoms with peribulbar triamcinolone injection.

Bahn RS (2010) Graves’ ophthalmopathy. N Engl J Med 362(8):726–738CrossRef

Dolman PJ (2012) Evaluating Graves’ orbitopathy. Best Pract Res Clin Endocrinol Metab 26(3):229–248CrossRef

Tong BD et al (2015) MiRNA-21 promotes fibrosis in orbital fibroblasts from thyroid-associated ophthalmopathy. Mol Vis 21:324–334PubMed

Menconi F, Profilo MA, Leo M et al (2014) Spontaneous improvement of untreated mild Graves’ ophthalmopathy: Rundle’s curve revisited. Thyroid 24(1):60–66CrossRef

Bartley GB (1994) The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc 92:477–588PubMedPubMedCentral

Bartalena L, Baldeschi L, Boboridis K et al (2016) The 2016 European Thyroid Association/European Group on Graves’ orbitopathy guidelines for the management of graves’ orbitopathy. Eur Thyroid J 5(1):9–26CrossRef

Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der Gaag R (1989) Clinical criteria for the assessment of disease activity in Graves’ ophthalmopathy: a novel approach. Br J Ophthalmol 73(8):639–644CrossRef

Savku E, Gündüz K (2015) Diagnosis, follow-up and treatment results in thyroid ophthalmopathy. Turk J Ophthalmol 45(4):156–163CrossRef

Wu Y, Tong B, Luo Y, Xie G, Xiong W (2015) Effect of radiotherapy on moderate and severe thyroid associated ophthalmopathy: a double blind and self-controlled study. Int J Clin Exp Med 8(2):2086–2096PubMedPubMedCentral

10.

Wu YJ, Wei X, Xiao MY, Xiong W (2016) Orbital decompression surgery and horse chestnut seed extract improved superior orbital vein blood flow in patients with thyroid-associated ophthalmopathy. Int J Ophthalmol 9(6):869–875PubMedPubMedCentral

11.

Mourits MP, Prummel MF, Wiersinga WM, Koornneef L (1997) Clinical activity score as a guide in the management of patients with Graves’ ophthalmopathy. Clin Endocrinol (Oxf) 47(1):9–14CrossRef

12.

Tachibana S, Murakami T, Noguchi H, Noguchi Y, Nakashima A, Ohyabu Y, Noguchi S (2010) Orbital magnetic resonance imaging combined with clinical activity score can improve the sensitivity of detection of disease activity and prediction of response to immunosuppressive therapy for Graves’ ophthalmopathy. Endocr J 57(10):853–861CrossRef

13.

Galuska László, Barna Sándor K, Varga József, Garai Ildikó, Nagy Endre V (2018) The role of 99mTc-DTPA retrobulbar SPECT in staging and follow-up of Graves’ orbitopathy. Nucl Med Rev 21(1):54–58CrossRef

14.

Galuska L, Leovey A, Szucs-Farkas Z, Garai I, Szabo J, Varga J, Nagy EV (2002) SPECT using 99mTc-DTPA for the assessment of disease activity in Graves’ ophthalmopathy: a comparison with the results from MRI. Nucl Med Commun 23(12):1211–1216CrossRef

15.

Szabados L, Nagy EV, Ujhelyi B, Urbancsek H, Varga J, Nagy E, Galuska L (2013) The impact of 99mTc-DTPA orbital SPECT in patient selection for external radiation therapy in Graves’ ophthalmopathy. Nucl Med Commun 34(2):108–112CrossRef

16.

Galuska L, Leovey A, Szucs-Farkas Z, Szabados L, Garai I, Berta A, Balazs E, Varga J, Nagy EV (2005) Imaging of disease activity in Graves’ orbitopathy with different methods: comparison of (m)Tc-DTPA and (m)Tc-depreotide single photon emission tomography, magnetic resonance imaging and clinical activity scores. Nucl Med Commun 26(5):407–414CrossRef

17.

Bahn RS, Heufelder AE (1993) Pathogenesis of Graves’ ophthalmopathy. N Engl J Med 329:1468–1475CrossRef

18.

Bordaberry M et al (2009) Repeated peribulbar injections of triamcinolone acetonide: a successful and safe treatment for moderate to severe Graves’ ophthalmopathy. Acta Ophthalmol 87(1):58–64CrossRef

19.

Alkawas AA, Hussein AM, Shahien EA (2010) Orbital steroid injection versus oral steroid therapy in management of thyroid-related ophthalmopathy. Clin Exp Ophthalmol 38:692–697CrossRef

20.

Lee SJ et al (2013) Treatment of upper eyelid retraction related to thyroid-associated ophthalmopathy using subconjunctival triamcinolone injections. Graefes Arch Clin Exp Ophthalmol 251(1):261–270CrossRef

Title: 99mTc-DTPA SPECT/CT provided guide on triamcinolone therapy in Graves’ ophthalmopathy patients
Authors: Dan Liu
Xueliang Xu
Sha Wang
Chengzhi Jiang
Xinhui Li
Jia Tan
Zhihong Deng
Publication date: 01-03-2020
Publisher: Springer Netherlands
Keyword: Diplopia
Published in: International Ophthalmology / Issue 3/2020
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI: https://doi.org/10.1007/s10792-019-01213-6

At a glance: The STEP trials

Springer Medicine

99mTc-DTPA SPECT/CT provided guide on triamcinolone therapy in Graves’ ophthalmopathy patients

Abstract

Introduction

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

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