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Title: Graves ophthalmopathy: The bony orbit in optic neuropathy, its apical angular capacity, and impact on prediction of risk
Authors: Chan, L.-L 
Tan, H.-E
Fook-Chong, S
Teo, T.-H 
Lim, L.-H 
Seah, L.-L 
Keywords: adult
clinical article
computer assisted tomography
endocrine ophthalmopathy
optic nerve disease
risk assessment
sensitivity and specificity
Graves Ophthalmopathy
Logistic Models
Middle Aged
Multivariate Analysis
Oculomotor Muscles
Optic Nerve
Optic Nerve Diseases
Predictive Value of Tests
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Tomography, X-Ray Computed
Issue Date: 2009
Publisher: American Society of Neuroradiology
Citation: Chan, L.-L, Tan, H.-E, Fook-Chong, S, Teo, T.-H, Lim, L.-H, Seah, L.-L (2009). Graves ophthalmopathy: The bony orbit in optic neuropathy, its apical angular capacity, and impact on prediction of risk. American Journal of Neuroradiology 30 (3) : 597-602. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Optic neuropathy (ON), a serious complication of Graves ophthalmopathy, is often subclinical and masked by symptoms of orbitopathy. We examined herein bony and soft-tissue CT features associated with ON, including an angular assessment of orbital apex capacity, and their usefulness in the risk prediction of ON. MATERIALS AND METHODS: The CT scans of 41 patients with Graves ophthalmopathy (17 men, 24 women; mean age, 49.1 years) clinically diagnosed with (19 patients, 32 orbits) or without ON were evaluated by 2 independent raters. Quantitative linear and angular measurements of the orbital structures and bony walls and categoric scores of apical crowding and intracranial fat prolapse were assessed on a clinical workstation. Inter- and intrarater variability of these features was determined. The CT features of the 2 patient groups were compared, and multivariate logistic regression analysis was performed to evaluate the predictive features of ON. RESULTS: Bony orbital angles (P < .005), length of the lateral orbital wall (P< .05), muscular diameters (P < .0005), muscular bulk of the medial rectus muscle relative to the bony orbit (P < .05), and apical crowding (P < .0005) were associated with clinical ON. Stepwise multivariate logistic regression analysis revealed the muscle diameter index and medial and lateral wall angles to be independent predictors. Combining these in a single multivariate equation yielded sensitivity, specificity, and positive and negative predictive values of 73%, 90%, 82%, and 85%, respectively. CONCLUSIONS: Orbital wall angles, especially the medial wall, and muscular enlargement are independent risk predictors.
Source Title: American Journal of Neuroradiology
ISSN: 0195-6108
DOI: 10.3174/ajnr.A1413
Rights: Attribution 4.0 International
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