Subjective Assessment of Eight CT Features in the Prediction of Dysthyroid Optic Neuropathy.

IF 1.3 4区 医学 Q3 OPHTHALMOLOGY
Isobel Landray, Kaveh Vahdani, James Carpenter, Katherine Miszkiel, Lakshmi A Ratnam, Geoffrey E Rose
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Abstract

Purpose: To evaluate the subjective assessment of 8 orbital CT features for predicting dysthyroid optic neuropathy (DON).

Methods: Scan montages from 137 orbits without DON and 121 with DON were each graded independently by 3 observers for 8 imaging features: namely, degree of apical crowding, extraocular muscle enlargement, expansion of orbital fat, clarity of the superior orbital fissure, fat prolapse through the superior orbital fissure, medial wall bowing, general orbital vascular congestion, and dilation of the superior ophthalmic vein. Gradings were analyzed individually and also averaged across observers. Associations with DON were assessed using univariate and multivariate logistic regression, and performance of the latter was assessed using area under the receiver-operating-characteristic curve, sensitivity, specificity, and calibration plots.

Results: Unadjusted models showed apical crowding (p < 0.001), extraocular muscle enlargement (p < 0.001), vascular congestion (p = 0.001), and medial wall bowing (p < 0.001) were each associated with DON, across all observers. Models for observers 1 and 3 included only apical crowding, with a 1-unit grading-increase giving, respectively, a 2.88-fold and 3.04-fold increase in DON odds (p < 0.001). The observer 2 model included extraocular muscle enlargement (odds ratio: 2.95; p < 0.001) and vascular congestion (odds ratio: 2.57; p = 0.023). The "averaged-score" model for all observers included only apical crowding, with a 3.76-fold increased odds per unit increase in grading (p < 0.001). The models showed borderline-acceptable discrimination (area under the receiver-operating-characteristic curve: 0.68-0.75) and good calibration, with the averaged-score model performing best.

Conclusions: Apical crowding, extraocular muscle enlargement, vascular congestion, and medial wall bowing are key predictors of DON, with apical crowding being the most influential.

预测甲状腺功能障碍视神经病变的8个CT特征的主观评价。
目的:探讨8项眶部CT主观评价对甲状腺功能障碍视神经病变(DON)的预测价值。方法:137例无DON和121例有DON的眼眶扫描蒙太奇,分别由3名观察员独立对8个影像学特征进行评分:眼尖拥挤程度、眼外肌肿大、眶脂肪扩张、眶上裂清晰、脂肪通过眶上裂脱垂、内侧壁弯曲、眶血管充血、眼上静脉扩张。分别对评分进行分析,并在观察者之间取平均值。采用单变量和多变量逻辑回归评估与DON的相关性,后者的表现通过接受者工作特征曲线下的面积、灵敏度、特异性和校准图来评估。结果:未经调整的模型显示,在所有观察者中,根尖拥挤(p < 0.001)、眼外肌肿大(p < 0.001)、血管充血(p = 0.001)和内侧壁弯曲(p < 0.001)均与DON相关。观察者1和观察者3的模型仅包括根尖拥挤,1个单位的评分增加分别使DON的几率增加2.88倍和3.04倍(p < 0.001)。观察者2模型包括眼外肌增大(优势比:2.95;P < 0.001)和血管充血(优势比:2.57;P = 0.023)。所有观察者的“平均得分”模型仅包括根尖拥挤,评分每单位增加3.76倍的几率(p < 0.001)。模型具有边界可接受判别(接受者-工作特征曲线下面积:0.68-0.75)和良好的校准,其中平均分模型表现最好。结论:眼尖拥挤、眼外肌增大、血管充血和内侧壁弯曲是DON的关键预测因素,其中眼尖拥挤影响最大。
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来源期刊
CiteScore
2.50
自引率
10.00%
发文量
322
审稿时长
3-8 weeks
期刊介绍: Ophthalmic Plastic and Reconstructive Surgery features original articles and reviews on topics such as ptosis, eyelid reconstruction, orbital diagnosis and surgery, lacrimal problems, and eyelid malposition. Update reports on diagnostic techniques, surgical equipment and instrumentation, and medical therapies are included, as well as detailed analyses of recent research findings and their clinical applications.
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