Purpose: Early diagnosis and treatment of Graves orbitopathy (GO) are essential to prevent physical and psychological burdens of advanced disease. MRI diffusion weighted imaging (DWI) is an emerging modality to assist with timely diagnosis. We investigated the value of DWI in early diagnosis and monitoring and its relationship with the clinical activity score (CAS) and quality of life (QoL) scores in a joint endocrine/ophthalmology clinic.
Methods: Ninety-one patients were referred to the clinic between 2011 to 2016. Forty-seven had clinical indices of orbital involvement and underwent MRI DWI imaging. Of these, 20 patients had at least one further scan during the course of the disease. The apparent diffusion coefficient (ADC) was calculated for the most affected muscle on each DWI scan and correlated with CAS and QoL outcome measures (GO-Qol, TED-QoL).
Main Results: Thirteen patients received intravenous methylpredisolone, 5/20 completed orbital radiotherapy and 3/20 had an orbital decompression during monitoring. The most active muscle at presentation was the right inferior rectus (n=7, 35%).
Mean CAS at presentation was 2.3/7, followed by CAS 1.2, 0.8 and 0.0 at scan 2, 3 & 4 respectively. Mean ADC value fell over the disease course during treatment from 1120.5 to 766.5. A positive correlation was found between initial CAS and ADC (r=0.45, P=0.04). All patients who did not subsequently develop significant disease had ADC values <1000 (mean 674.7) at baseline.
Conclusions: We present novel data demonstrating correlation between DWI, CAS and QoL. This may offer predictive benefit that DWI is elevated prior to other disease parameters so may help target patients at high risk of developing severe GO. DWI may serve a valuable adjunct in early diagnosis and monitoring with potential to identify low risk groups whereby low CAS at baseline combined with DWI <1000 may predict a relatively quiet disease course.