18 F-FDG-PET/MRI in patients with Graves’ orbitopathy

Purpose Currently, therapeutic management of patients with Graves’ orbitopathy (GO) relies on clinical assessments and MRI. However, monitoring of inflammation remains difficult since external inflammatory signs do not necessarily represent the orbital disease activity. Therefore, we aimed to evalua...

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Bibliographic Details
Published in:Graefe's archive for clinical and experimental ophthalmology 2021-10, Vol.259 (10), p.3107-3117
Main Authors: Weber, Manuel, Deuschl, Cornelius, Bechrakis, Nikolaos, Umutlu, Lale, Antoch, Gerald, Eckstein, Anja, Binse, Ina, Oeverhaus, Michael
Format: Article
Language:English
Subjects:
Disease management
Eye
Fibrosis
Fluorodeoxyglucose F18
Glycolysis
Graves Ophthalmopathy - diagnosis
Humans
Inflammation
Magnetic resonance imaging
Medicine
Medicine & Public Health
Motility
Muscles
Oculoplastics and Orbit
Ophthalmology
Patients
Positron emission tomography
Prognosis
Retrospective Studies
Statistical analysis
Tomography, X-Ray Computed
Tumor Burden
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Summary:Purpose Currently, therapeutic management of patients with Graves’ orbitopathy (GO) relies on clinical assessments and MRI. However, monitoring of inflammation remains difficult since external inflammatory signs do not necessarily represent the orbital disease activity. Therefore, we aimed to evaluate the diagnostic value of 18 F-FDG-PET/MRI to assess the inflammation of GO patients. Methods Enrolled patients with new onset of GO underwent ophthalmological examinations to evaluate the activity (CAS) and severity of GO (NOSPECS), as well as an 18 F-FDG-PET/MRI (Siemens Biograph mMR) with dual time point imaging (immediately post-injection and 60 min p.i.). A subset of PET parameters including maximum standardized uptake value (SUVmax), metabolic target volume (MTV), and total lesion glycolysis (TLG) were obtained separately per eye and per extraocular eye muscle (EOM). EOM thickness was measured on the co-registered MRI. Results Of 14 enrolled patients, three showed mild, seven moderate-to-severe, and four sight-threatening GO. Patients with severe GO showed statistically significant higher TLG than patients with mild GO ( p  = 0.02) and higher MTV than patients with mild ( p  = 0.03) and moderate ( p  = 0.04) GO. Correlation between NOSPECS on one hand and MTV and TLG on the other was significant ( R 2  = 0.49–0.61). Conclusion TLG and MTV derived from FDG-PET appear to be good discriminators for severe vs. mild-to-moderate GO and show a significant correlation with NOSPECS. As expected, PET parameters of individual eye muscles were not correlated with associated eye motility, since fibrosis, and not inflammation, is mainly responsible for restricted motility. In conclusion, 18 F-FDG-PET/MRI can be used for assessment of GO inflammation.
ISSN:0721-832X
1435-702X
DOI:10.1007/s00417-021-05339-1