Top

Published in:

01-07-2021 | Thyroid Disease | Head and Neck

Dixon-T2WI magnetic resonance imaging at 3 tesla outperforms conventional imaging for thyroid eye disease

Authors: Alexis Ollitrault, Frédérique Charbonneau, Marie-Laure Herdan, Olivier Bergès, Kevin Zuber, Lama Giovansili, Pauline Launay, Julien Savatovsky, Augustin Lecler

Published in: European Radiology | Issue 7/2021

Abstract

Objectives

To determine the diagnostic performances of a single Dixon-T2-weighted imaging (WI) sequence compared to a conventional protocol including T1-, T2-, and fat-suppressed T2-weighted MRI at 3 T when assessing thyroid eye disease (TED).

Materials and methods

This IRB-approved prospective single-center study enrolled participants presenting with confirmed TED from April 2015 to October 2019. They underwent an MRI, including a conventional protocol and a Dixon-T2WI sequence. Two neuroradiologists, blinded to all data, read both datasets independently and randomly. They assessed the presence of extraocular muscle (EOM) inflammation, enlargement, fatty degeneration, or fibrosis as well as the presence of artifacts. The Wilcoxon signed-rank test was used.

Results

Two hundred six participants were enrolled (135/206 [66%] women, 71/206 [34%] men, age 52.3 ± 13.2 years). Dixon-T2WI was significantly more likely to detect at least one inflamed EOM as compared to the conventional set (248/412 [60%] versus 228/412 [55%] eyes; (p = 0.02). Dixon-T2WI was more sensitive and specific than the conventional set for assessing muscular inflammation (100% versus 94.7% and 71.2% versus 68.5%, respectively). Dixon-T2WI was significantly less likely to show major or minor artifacts as compared to fat-suppressed T2WI (20/412 [5%] versus 109/412 [27%] eyes, p < 0.001, and 175/412 [42%] versus 257/412 [62%] eyes, p < 0.001). Confidence was significantly higher with Dixon-T2WI than with the conventional set (2.35 versus 2.24, p = 0.003).

Conclusion

Dixon-T2WI showed higher sensitivity and specificity and showed fewer artifacts than a conventional protocol when assessing thyroid eye disease, in addition to higher self-reported confidence.

Key Points

• Dixon-T2WI has better sensitivity and specificity than a conventional protocol for assessing inflamed extraocular muscles in patients with thyroid eye disease.

• Dixon-T2WI shows significantly fewer artifacts than fat-suppressed T2WI.

• Dixon-T2WI is faster and is associated with significantly higher self-reported reader confidence as compared to a conventional protocol when assessing inflammatory extraocular muscles.

Available only for authorised users

Parmar H, Ibrahim M (2008) Extrathyroidal manifestations of thyroid disease: thyroid ophthalmopathy. Neuroimaging Clin N Am 18:527–536. https://doi.org/10.1016/j.nic.2008.03.003CrossRefPubMed

Hiromatsu Y, Eguchi H, Tani J, Kasaoka M, Teshima Y (2014) Graves’ ophthalmopathy: epidemiology and natural history. Intern Med 53:353–360. https://doi.org/10.2169/internalmedicine.53.1518

Bahn RS (2010) Graves’ ophthalmopathy. N Engl J Med 362:726–738. https://doi.org/10.1056/NEJMra0905750CrossRefPubMedPubMedCentral

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 73:639–644. https://doi.org/10.1136/bjo.73.8.639

Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria A, Galofré JC (2015) Graves’ ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management. J Ophthalmol 2015:1–16. https://doi.org/10.1155/2015/249125

Tachibana S, Murakami T, Noguchi H et al (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 57:853–861. https://doi.org/10.1507/endocrj.K10E-156CrossRefPubMed

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 5:9–26. https://doi.org/10.1159/000443828CrossRefPubMedPubMedCentral

Siakallis LC, Uddin JM, Miszkiel KA (2018) Imaging investigation of thyroid eye disease. Ophthal Plast Reconstr Surg:1. https://doi.org/10.1097/IOP.0000000000001139

Gagliardo C, Radellini S, Morreale Bubella R et al (2020) Lacrimal gland herniation in Graves ophthalmopathy: a simple and useful MRI biomarker of disease activity. Eur Radiol 30:2138–2141. https://doi.org/10.1007/s00330-019-06570-5CrossRefPubMed

10.

Hiwatashi A, Togao O, Yamashita K, Momosaka D, Honda H (2018) Diffusion-weighted magnetic resonance imaging of extraocular muscles in patients with Grave’s ophthalmopathy using turbo field echo with diffusion-sensitized driven-equilibrium preparation. Diagn Interv Imaging 99:457–463. https://doi.org/10.1016/j.diii.2018.02.007

11.

Garau LM, Guerrieri D, De Cristofaro F, Bruscolini A, Panzironi G (2018) Extraocular muscle sampled volume in Graves’ orbitopathy using 3-T fast spin-echo MRI with iterative decomposition of water and fat sequences. Acta Radiol Open 7:2058460118780892. https://doi.org/10.1177/2058460118780892

12.

Rutkowska-Hinc B, Maj E, Jabłońska A, Milczarek-Banach J, Bednarczuk T, Miśkiewicz P (2018) Prevalence of radiological signs of dysthyroid optic neuropathy in magnetic resonance imaging in patients with active, moderate-to-severe, and very severe Graves orbitopathy. Eur Thyroid J 7:88–94. https://doi.org/10.1159/000486828

13.

Higashiyama T, Iwasa M, Ohji M (2017) Quantitative analysis of inflammation in orbital fat of thyroid-associated ophthalmopathy using MRI signal intensity. Sci Rep 7:16874. https://doi.org/10.1038/s41598-017-17257-6CrossRefPubMed

14.

Xu L, Li L, Xie C, Guan M, Xue Y (2017) Thickness of extraocular muscle and orbital fat in MRI predicts response to glucocorticoid therapy in Graves’ ophthalmopathy. Int J Endocrinol 2017:3196059. https://doi.org/10.1155/2017/3196059

15.

Higashiyama T, Nishida Y, Morino K et al (2015) Use of MRI signal intensity of extraocular muscles to evaluate methylprednisolone pulse therapy in thyroid-associated ophthalmopathy. Jpn J Ophthalmol 59:124–130. https://doi.org/10.1007/s10384-014-0365-xCrossRefPubMed

16.

Tortora F, Cirillo M, Ferrara M et al (2013) Disease activity in Graves’ ophthalmopathy: diagnosis with orbital MR imaging and correlation with clinical score. Neuroradiol J 26:555–564. https://doi.org/10.1177/197140091302600509CrossRefPubMedPubMedCentral

17.

Politi LS, Godi C, Cammarata G et al (2014) Magnetic resonance imaging with diffusion-weighted imaging in the evaluation of thyroid-associated orbitopathy: getting below the tip of the iceberg. Eur Radiol 24:1118–1126. https://doi.org/10.1007/s00330-014-3103-3CrossRefPubMed

18.

Delfaut EM, Beltran J, Johnson G, Rousseau J, Marchandise X, Cotten A (1999) Fat suppression in MR imaging: techniques and pitfalls. Radiographics 19:373–382. https://doi.org/10.1148/radiographics.19.2.g99mr03373

19.

Anzai Y, Lufkin RB, Jabour BA, Hanafee WN (1992) Fat-suppression failure artifacts simulating pathology on frequency-selective fat-suppression MR images of the head and neck. AJNR Am J Neuroradiol 13(3):879–884

20.

Herrick RC, Hayman LA, Taber KH, Diaz-Marchan PJ, Kuo MD (1997) Artifacts and pitfalls in MR imaging of the orbit: a clinical review. Radiographics 17:707–724. https://doi.org/10.1148/radiographics.17.3.9153707

21.

Dixon WT (1984) Simple proton spectroscopic imaging. Radiology 153:189–194. https://doi.org/10.1148/radiology.153.1.6089263CrossRefPubMed

22.

Kijowski R, Woods MA, Lee KS et al (2009) Improved fat suppression using multipeak reconstruction for IDEAL chemical shift fat-water separation: application with fast spin echo imaging. J Magn Reson Imaging 29:436–442. https://doi.org/10.1002/jmri.21664CrossRefPubMedPubMedCentral

23.

Duron L, Balvay D, Vande Perre S et al (2019) Gray-level discretization impacts reproducible MRI radiomics texture features. PLoS One 14:e0213459. https://doi.org/10.1371/journal.pone.0213459CrossRefPubMed

24.

Lecler A, Duron L, Balvay D et al (2019) Combining multiple magnetic resonance imaging sequences provides independent reproducible radiomics features. Sci Rep 9:2068. https://doi.org/10.1038/s41598-018-37984-8CrossRefPubMed

25.

Kaichi Y, Tanitame K, Terada H et al (2019) Thyroid-associated orbitopathy: quantitative evaluation of the orbital fat volume and edema using IDEAL-FSE. Eur J Radiol Open 6:182–186. https://doi.org/10.1016/j.ejro.2019.05.003CrossRefPubMed

26.

Kaichi Y, Tanitame K, Itakura H et al (2016) Orbital fat volumetry and water fraction measurements using T2-weighted FSE-IDEAL imaging in patients with thyroid-associated orbitopathy. AJNR Am J Neuroradiol 37:2123–2128. https://doi.org/10.3174/ajnr.A4859CrossRefPubMedPubMedCentral

27.

Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363. https://doi.org/10.2307/2529786CrossRefPubMed

28.

R Core Team (2014) R: a language and environment for statistical computing. In: R Found. Stat. Comput. Vienna Austria. http://www.R-project.org/. Accessed 2 April 2020

29.

Marcocci C, Watt T, Altea MA et al (2012) Fatal and non-fatal adverse events of glucocorticoid therapy for Graves’ orbitopathy: a questionnaire survey among members of the European Thyroid Association. Eur J Endocrinol 166:247–253. https://doi.org/10.1530/EJE-11-0779CrossRefPubMed

30.

Wendl CM, Eiglsperger J, Dendl L-M et al (2018) Fat suppression in magnetic resonance imaging of the head and neck region: is the two-point DIXON technique superior to spectral fat suppression? Br J Radiol 20170078. https://doi.org/10.1259/bjr.20170078

31.

Gaddikeri S, Mossa-Basha M, Andre JB, Hippe DS, Anzai Y (2018) Optimal fat suppression in head and neck MRI: comparison of multipoint Dixon with 2 different fat-suppression techniques, spectral presaturation and inversion recovery, and STIR. AJNR Am J Neuroradiol 39:362–368. https://doi.org/10.3174/ajnr.A5483

32.

Huijgen WHF, van Rijswijk CSP, Bloem JL (2019) Is fat suppression in T1 and T2 FSE with mDixon superior to the frequency selection-based SPAIR technique in musculoskeletal tumor imaging? Skeletal Radiol 48:1905–1914. https://doi.org/10.1007/s00256-019-03227-8CrossRefPubMedPubMedCentral

33.

Jaubert O, Cruz G, Bustin A et al (2020) Water–fat Dixon cardiac magnetic resonance fingerprinting. Magn Reson Med 83:2107–2123. https://doi.org/10.1002/mrm.28070CrossRefPubMed

34.

van Vucht N, Santiago R, Lottmann B et al (2019) The Dixon technique for MRI of the bone marrow. Skeletal Radiol 48:1861–1874. https://doi.org/10.1007/s00256-019-03271-4CrossRefPubMed

35.

Sollmann N, Mönch S, Riederer I, Zimmer C, Baum T, Kirschke JS (2020) Imaging of the degenerative spine using a sagittal T2-weighted DIXON turbo spin-echo sequence. Eur J Radiol 131:109204. https://doi.org/10.1016/j.ejrad.2020.109204

36.

Scannell CM, Correia T, Villa ADM et al (2020) Feasibility of free-breathing quantitative myocardial perfusion using multi-echo Dixon magnetic resonance imaging. Sci Rep 10:12684. https://doi.org/10.1038/s41598-020-69747-9CrossRefPubMed

37.

Hayashi T, Fukuzawa K, Yamazaki H et al (2018) Multicenter, multivendor phantom study to validate proton density fat fraction and T2* values calculated using vendor-provided 6-point DIXON methods. Clin Imaging 51:38–42. https://doi.org/10.1016/j.clinimag.2018.01.011CrossRefPubMed

Title: Dixon-T2WI magnetic resonance imaging at 3 tesla outperforms conventional imaging for thyroid eye disease
Authors: Alexis Ollitrault
Frédérique Charbonneau
Marie-Laure Herdan
Olivier Bergès
Kevin Zuber
Lama Giovansili
Pauline Launay
Julien Savatovsky
Augustin Lecler
Publication date: 01-07-2021
Publisher: Springer Berlin Heidelberg
Keywords: Thyroid Disease
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Thyroid Disease
Published in: European Radiology / Issue 7/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07540-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dixon-T2WI magnetic resonance imaging at 3 tesla outperforms conventional imaging for thyroid eye disease

Abstract

Objectives

Materials and methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusion

Key Points

Please log in to get access to this content

Other articles of this Issue 7/2021

Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation

Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement

Risk factors for local tumor progression after RFA of pulmonary metastases: a matched case-control study

Prognostic risk factors and survival models for T3 locally advanced rectal cancer: what can we learn from the baseline MRI?

The Lisbon Agreement on Femoroacetabular Impingement Imaging—part 3: imaging techniques

Retrospective analysis of current guidelines for hepatocellular carcinoma diagnosis on gadoxetic acid–enhanced MRI in at-risk patients