Evidence mapPaperPMID 40715745Full record

ArticleEndocrine2025

Orbital MRI and clinical activity score for predicting steroid treatment response in moderate-to-severe Graves' orbitopathy.

Betül Yiğit Yalçın, Görkem Durak, Gamze Bilik Oyman, Mehmet Barburoğlu, Ümmü Mutlu, Hülya Hacişahinoğulları, Nurdan Gül, Özlem Soyluk Selçukbiricik, Ayşe Kubat Üzüm, Gülşah Yenidünya Yalın

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Article in Endocrine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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10 authors.

Betül Yiğit YalçınDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey. byigit667@gmail.com.ORCID 0000-0002-5533-330X
Görkem DurakDepartment of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0002-1608-1955
Gamze Bilik OymanDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0001-8636-8700
Mehmet BarburoğluDepartment of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0002-8715-1893
Ümmü MutluDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0002-5259-7326
Hülya HacişahinoğullarıDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0001-9989-6473
Nurdan GülDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0002-1187-944X
Özlem Soyluk SelçukbiricikDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0003-0732-4764
Ayşe Kubat ÜzümDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0003-0478-1193
Gülşah Yenidünya YalınDepartment of Endocrinology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID 0000-0002-9013-5237

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo evaluate the potential role of pre-treatment clinical activity score (CAS) and extraocular muscle (EOM) signal intensity ratio (SIR) values on orbital MRI in predicting the steroid response in patients with moderate-to-severe active Graves' orbitopathy (GO).

methodsThe data of 51 patients with moderate to severe GO (CAS ≥ 3) were retrospectively evaluated. The patients were categorized into two groups: steroid-resistant (n = 25) and steroid-responsive (n = 26). Demographic and clinical characteristics, CAS, VISA (vision, inflammation, strabismus, appearance), laboratory data and orbital MRI measurements were compared. Two standardized MRI sequences were utilized for analysis: T2-weighted short-tau inversion-recovery (T2w-STIR) and contrast-enhanced T1-weighted fat-suppressed (T1w-CE) imaging. Predictors of steroid resistance were identified through multivariate logistic regression analysis, and ROC curve was performed to determine predictive performance and optimal cut-off values.

resultsPre-treatment CAS (5.05 ± 1.07 vs 4.00 ± 0.93, p = 0.002) and T2w-STIR SIR (4.77 ± 0.93 vs 3.95 ± 1.32, p = 0.031) were both significantly higher in the steroid-resistant group. Higher pretreatment CAS (OR 2.380, p = 0.001) and T2w-STIR SIR (OR 1.862, p = 0.040) predicted steroid resistance. ROC analysis demonstrated good discriminative performance for CAS (AUC = 0.786); with a cut-off value > 4 yielding 71.4% sensitivity and 68.2% specificity. T2w-STIR SIR with a threshold value > 3.6 provided high sensitivity (94.4%) but limited specificity (37.5%), indicating moderate overall accuracy (AUC = 0.673).

conclusionPre-treatment CAS and T2w-STIR SIR values may serve as potential predictors of steroid resistance in moderate-to-severe active GO. Early identification of high-risk patients may facilitate consideration of alternative treatments such as immunosuppressive agents or radiotherapy. Larger scale prospective studies are required to validate optimal T2w-STIR SIR cut-off values and the role of imaging biomarkers in risk stratification.

Indexed as

Graves OphthalmopathyMagnetic Resonance ImagingOrbitSteroidsAdultAgedDrug ResistanceFemaleHumansMaleMiddle AgedOculomotor MusclesRetrospective StudiesSeverity of Illness IndexTreatment OutcomeSteroidsClinical activity scoreExtraocular muscleGraves’ orbitopathyOrbital Magnetic Resonance ImagingSteroid response

Identifiers

PMID40715745

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.