Novel use of non-echo-planar diffusion weighted MRI in monitoring disease activity and treatment response in active Grave's orbitopathy: An initial observational cohort study

Orbit. 2018 Oct;37(5):325-330. doi: 10.1080/01676830.2017.1423343. Epub 2018 Jan 10.


Aim: To examine the novel use of non-echo-planar diffusion weighted MRI (DWI) in depicting activity and treatment response in active Grave's orbitopathy (GO) by assessing, with inter-observer agreement, for a correlation between its apparent diffusion coefficients (ADCs) and conventional Short tau Inversion Recovery (STIR) MRI signal-intensity ratios (SIRs).

Method and materials: A total of 23 actively inflamed muscles and 30 muscle response episodes were analysed in patients with active GO who underwent medical treatment. The MRI orbit scans included STIR sequences and non-echo-planar DWI were evaluated. Two observers independently assessed the images qualitatively for the presence of activity in the extraocular muscles (EOMs) and recorded the STIR signal-intensity (SI), SIR (SI ratio of EOM/temporalis muscle), and ADC values of any actively inflamed muscle on the pre-treatment scans and their corresponding values on the subsequent post-treatment scans. Inter-observer agreement was examined.

Results: There was a significant positive correlation (0.57, p < 0.001) between ADC and both SIR and STIR SI of the actively inflamed EOM. There was also a significant positive correlation (0.75, p < 0.001) between SIR and ADC values depicting change in muscle activity associated with treatment response. There was good inter-observer agreement.

Conclusion: Our preliminary results indicate that quantitative evaluation with non-echo-planar DWI ADC values correlates well with conventional STIR SIR in detecting active GO and monitoring its treatment response, with good inter-observer agreement.

Keywords: DWI; Grave’s orbitopathy; MRI; head and neck; orbit; thyroid eye disease.

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Glucocorticoids / therapeutic use
  • Graves Ophthalmopathy / diagnostic imaging*
  • Graves Ophthalmopathy / drug therapy
  • Graves Ophthalmopathy / physiopathology
  • Humans
  • Infusions, Intravenous
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Monitoring, Physiologic
  • Observer Variation
  • Oculomotor Muscles / diagnostic imaging*
  • Oculomotor Muscles / drug effects
  • Oculomotor Muscles / physiopathology
  • Orbit / diagnostic imaging
  • Retrospective Studies
  • Young Adult


  • Glucocorticoids
  • Methylprednisolone