Introduction
Methodology
Search strategy
Search number | Search terms |
---|---|
1 | Graves Ophthalmopathy (MeSH Terms) |
2 | Graves' Ophthalmopathy (Title/Abstract) |
3 | Thyroid eye disease (Title/Abstract) |
4 | Thyroid Associated Ophthalmopathy (Title/Abstract) |
5 | Thyroid Associated Orbitopathy (Title/Abstract) |
6 | Graves’ orbitopathy (Title/Abstract) |
7 | Graves' eye disease (Title/Abstract) |
8 | #1 or #2 or #3 or #4 or #5 or #6 or #7 |
9 | Magnetic Resonance Imaging (MeSH Terms) |
10 | MRI (Title/Abstract) |
11 | Echo-Planar Imaging (Title/Abstract) |
12 | Magnetic Resonance (Title/Abstract) |
13 | Diffusion Tensor Imaging (Title/Abstract) |
14 | #9 or #10 or #11 or #12 or #13 |
15 | #8 and #14 |
Selection criteria
Data extraction
Risk of bias (quality) assessment
Statistical analysis
Results
Characteristics of included studies
No.
|
Author (year)
|
Country
|
Ethnicity
|
Definition
|
CAS (Mean ± SD) or (Median [IQR])
|
Age (Mean ± SD) or (Median [IQR])
|
Gender (M/F)
| Sample sizea (cases/controls) |
MRI parameters used
|
Purpose
| ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cases
|
Controls
|
Cases
|
Controls
|
Cases
|
Controls
|
Cases
|
Controls
| |||||||
1 | D. Huang (2014) | China | Chinese | TED (active + inactive) | HCs | Active: 4 (3–7) Inactive: 1 (0–2) | / | Active RE: 42.69 ± 11.593 Active LE: 42.71 ± 12.238 Inactive RE: 37.91 ± 10.406 Inactive LE: 37.40 ± 8.947 | 40.75 ± 11.947 | Active RE: 4/9^ Active LE: 5/9^ Inactive RE: 4/7^ Inactive LE: 3/7^ | 8/8 | 48/32 (27 active + 21 inactive)/32 | Dimensions (MAA, MCA, MAL, MCL, MAW, MCW) | Diagnostic |
2 | C. Gagliardo (2020) | Italy | Italians | TED (active) | TED (inactive) | Active: 4.2 ± 1.93 Inactive: 1 ± 0.91 | / | 52 [35—68]^ | 43 [30—64]^ | 5/11 | 5/11 | 32/32 | T2WI-FS—LGH | Diagnostic |
3 | L. Chen (2021) | China | Chinese | TED (active + inactive) | HCs | Active: 4.6 ± 0.8 Inactive: 1.3 ± 0.8 | / | 46.4 ± 13.4 Active: 47.8 ± 9.9 Inactive: 44.9 ± 16.4 | 46.5 ± 13.5 | 12/18 Active: 7/8 Inactive: 5/10 | 6/9 | 60/30 (30 active + 30 inactive)/30 | DTI – FA DTI—ADC | Diagnostic |
4 | D. Wu (2021) | China | Chinese | TED (active + inactive) | GD without TED | / | / | 46.98 ± 12.45 | 36.67 ± 11.16 | 39/60 | 4/8 | 198/24 (142 active + 56 inactive)/24 | Dimensions (MCA, MCL, MCW) DWI—ADC | Diagnostic |
5 | H. Hu (2016) | China | Chinese | TED (active + inactive) | HCs | Active: 4 ± 1 Inactive: 1 ± 1 | / | 48.4 ± 13.9 | 50.0 ± 12.9 | 12/21 | 8/16 | 66/48 (26 active + 40 inactive)/48 | Dimensions (MAA, MCA, MAL, MCL, MAW, MCW) T2WI-FS—SIR | Diagnostic |
6 | Y. Gao (2022) | China | Chinese | TED (active) | TED (inactive) | 4.21 ± 0.80 | 1.28 ± 0.69 | 54.1 ± 8.4 | 51.3 ± 14.0 | 13/16^ | 19/24^ | 29/43 | T2WI-FS—LGH | Diagnostic |
7 | A. A. Razek (2019) | Egypt | Africans | TED (active + inactive) | HCs | Active: 4.4 ± 0.4 Inactive: 1.42 ± 0.3 | / | 38 ± 12.6 | 33.5 ± 1.3 | 17/27 | 8/12 | 88/40 (48 active + 40 inactive)/80 | DWI—ADC | Diagnostic |
8 | H. Hu (2020) | China | Chinese | Acitve and moderate-severe TED responsive to GC therapy | Active and moderate-severe TED unresponsvie to GC therapy | 3.9 ± 0.8 | 3.8 ± 0.9 | 47.9 ± 13.1 | 44.2 ± 12.5 | 9/20 | 10/8 | 58/36 | T2WI-FS – LGH T2WI-FS—SIR | Therapeutic |
9 | L. Rui (2021) | China | Chinese | TED (mild + moderate-severe) | HCs | Mild: 2.00 (1.00, 2.00) Moderate-severe: 4.00 (3.00, 5.00) | / | Mild: 39.1 ± 12.3 Moderate-severe: 47.1 ± 14.5 | 35.4 ± 12.3 | Mild: 9/13 Moderate-severe: 15/20 | 7/10 | 114/34 (44 mild + 70 moderate-severe)/34 | DTI – FA DTI—MD | Grading |
Risks of bias in included studies
No.
|
Author (year)
| Selection (max 5) | Comparability (max 2) | Outcome (max 3) |
Total no. of
| ||||
---|---|---|---|---|---|---|---|---|---|
(1) Representativeness of the sample
|
(2) Sample size
|
(3) Non-respondents
|
(4) Ascertainment of the exposure (risk factor)
|
(1) The subjects in different outcome groups are comparable, based on the study design or analysis. Confounding factors are controlled
|
(1) Assessment of the outcome
|
(2) Statistical test
| |||
1 | D. Huang (2014) | - | - | 1 | 2 | 2 | - | 1 | 6 |
2 | C. Gagliardo (2020) | - | - | 1 | 2 | 2 | 1 | 1 | 7 |
3 | L. Chen (2021) | - | - | 1 | 2 | 2 | 2 | 1 | 8 |
4 | D. Wu (2021) | - | - | 1 | 2 | 2 | 2 | 1 | 8 |
5 | H. Hu (2016) | 1 | - | 1 | 2 | 2 | 1 | 1 | 8 |
6 | Y. Gao (2022) | - | - | 1 | 2 | 2 | 2 | 1 | 8 |
7 | A. A. Razek (2019) | - | - | 1 | 2 | 2 | 1 | 1 | 7 |
8 | H. Hu (2020) | - | - | 1 | 2 | 2 | 2 | 1 | 8 |
9 | L. Rui (2021) | - | - | 1 | 2 | 2 | 2 | 1 | 8 |
Outcome measures
Parameter | No. | Author (year) | Sample size (eye) | Outcome (Mean ± SD OR Median (IQR)) | |||
---|---|---|---|---|---|---|---|
Active
|
Inactive
|
Control
|
Active
|
Inactive
| |||
LG herniation (mm) | #2 | Gagliardo 2020 | 32 | 32 | / | RE: 10.1 (7.3–17) LE: 8.5 (6.6–13) | RE: 7 (0–13.4) LE: 5.8 (0–12) |
#6 | Gao 2022 | 29 | 43 | / | 15.5 ± 3.25 | 12.21 ± 2.09 | |
T2WI-FS—SIR | #5 | Hu 2016 | 26 | 40 | 48 | 2.72 ± 0.51 | 2.34 ± 0.36 |
Dimension | |||||||
Maximum axial area (mm2) | #1 | Huang 2014 | 27 | 21 | 32 | 94.29 ± 17.29 | 79.92 ± 14.86 |
#5 | Hu 2016 | 26 | 40 | 48 | 68.9 ± 31.49 | 68.63 ± 20.97 | |
Maximum coronal area (mm2) | #1 | Huang 2014 | 27 | 21 | 32 | 103.93 ± 20.44 | 89.32 ± 17.36 |
#4 | Wu 2021 | 142 | 56 | 24 | 75 (64, 92) | 66 (57, 86) | |
#5 | Hu 2016 | 26 | 40 | 48 | 70.36 ± 29.74 | 68.42 ± 17.6 | |
Maximum axial length (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 18.64 ± 3.09 | 18.28 ± 2.35 |
#5 | Hu 2016 | 26 | 40 | 48 | 16.7 ± 3.7 | 15.9 ± 3.4 | |
Maximum coronal length (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 21.67 ± 4.04 | 20.96 ± 3.35 |
#4 | Wu 2021 | 142 | 56 | 24 | 18.8 (17.4, 20.4) | 18.9 (16.1, 21.0) | |
#5 | Hu 2016 | 26 | 40 | 48 | 16.0 ± 4.5 | 16.3 ± 2.8 | |
Maximum axial width (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 7.21 ± 1.39 | 6.44 ± 1.41 |
#5 | Hu 2016 | 26 | 40 | 48 | 5.1 ± 1.1 | 6.1 ± 3.8 | |
Maximum coronal width (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 6.77 ± 1.48 | 6.61 ± 1.3 |
#4 | Wu 2021 | 142 | 56 | 24 | 5.8 (4.9, 6.5) | 5.6 (4.7, 5.9) | |
#5 | Hu 2016 | 26 | 40 | 48 | 5.4 ± 1.2 | 5.4 ± 0.9 | |
DTI-FA | #3 | Chen 2021 | 30 | 30 | 30 | 0.277 ± 0.04 | 0.349 ± 0.071 |
DTI-ADC (10–3 mm2/s) | 1.477 ± 0.342 | 1.329 ± 0.164 | |||||
DWI-ADC (10–3 mm2/s) | #4 | Wu 2021 | 142 | 56 | 24 | 1007.08 (939.71, 1074.83) | 955.89 (863.26, 1043.70) |
#7 | Razek 2019 | 48 | 40 | 40 | 1.83 ± 0.08 | 1.69 ± 0.04 |
Parameter | Pooled mean difference | 95% CI |
P-value | Significant difference? | I2
|
---|---|---|---|---|---|
LG herniation | 3.37 mm | [2.11, 4.64] | < 0.00001 | Yes | 0% |
Dimension | |||||
Maximum axial area | 8.3 mm2
| [-5.39, 21.98] | 0.23 | No | 64% |
Maximum coronal area | 8.1 mm2
| [2.97, 13.22] | 0.002 | Yes | 16% |
Maximum axial length | 0.55 mm | [-0.61, 1.71] | 0.35 | No | 0% |
Maximum coronal length | 0.19 mm | [-0.63, 1.01] | 0.65 | No | 0% |
Maximum axial width | -0.05 mm | [-1.78, 1.68] | 0.96 | No | 82% |
Maximum coronal width | 0.22 mm | [-0.03, 0.47] | 0.09 | No | 0% |
DWI-ADC | 0.1 × 10–3 mm2/s | [0.01, 0.18] | 0.02 | Yes | 93% |
Parameter | No. | Author (Year) | Sample size (eye) | Outcome (Mean ± SD OR Median (IQR)) | |||
---|---|---|---|---|---|---|---|
Active
|
Inactive
|
Control
|
TED
|
Control
| |||
T2WI-FS—SIR | #5 | Hu 2016 | 26 | 40 | 48 | 2.49 ± 0.46 | 2.17 ± 0.32 |
Dimension | |||||||
Maximum axial area (mm2) | #1 | Huang 2014 | 27 | 21 | 32 | 88 ± 17.64 | 65.8 ± 11.56 |
#5 | Hu 2016 | 26 | 40 | 48 | 68.74 ± 25.40 | 43.73 ± 18.57 | |
Maximum coronal area (mm2) | #1 | Huang 2014 | 27 | 21 | 32 | 97.54 ± 20.33 | 73.49 ± 12.61 |
#4 | Wu 2021 | 142 | 56 | 24 | 74 (60, 87) | 67 (58, 81) | |
#5 | Hu 2016 | 26 | 40 | 48 | 69.18 ± 22.97 | 54.96 ± 19.11 | |
Maximum axial length (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 18.48 ± 2.77 | 16.97 ± 2.12 |
#5 | Hu 2016 | 26 | 40 | 48 | 16.2 ± 3.5 | 14.0 ± 1.9 | |
Maximum coronal length (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 21.36 ± 3.74 | 20.06 ± 3.05 |
#4 | Wu 2021 | 142 | 56 | 24 | 18.8 (17.2, 20.7) | 19.7 (18.8, 20.5) | |
#5 | Hu 2016 | 26 | 40 | 48 | 16.2 ± 3.5 | 15.3 ± 2.7 | |
Maximum axial width (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 6.87 ± 1.44 | 5.65 ± 1.12 |
#5 | Hu 2016 | 26 | 40 | 48 | 5.7 ± 3.1 | 3.8 ± 0.8 | |
Maximum coronal width (mm) | #1 | Huang 2014 | 27 | 21 | 32 | 6.7 ± 1.39 | 5.39 ± 1.01 |
#4 | Wu 2021 | 142 | 56 | 24 | 5.7 (4.9, 6.3) | 4.9 (4.4, 5.8) | |
#5 | Hu 2016 | 26 | 40 | 48 | 5.4 ± 1.0 | 4.3 ± 0.7 | |
DTI-FA | #3 | Chen 2021 | 30 | 30 | 30 | 0.313 ± 0.067 | 0.375 ± 0.082 |
#9 | Rui 2021 | 56 | 58 | 34 | 0.376 ± 0.031 | 0.399 ± 0.049 | |
DTI-ADC (10–3 mm2/s) | #3 | Chen 2021 | 30 | 30 | 30 | 1.403 ± 0.276 | 1.289 ± 0.172 |
DTI-MD (10–3 mm2/s) | #9 | Rui 2021 | 56 | 58 | 34 | 1.39 ± 0.08 | 1.34 ± 0.04 |
DWI-ADC (10–3 mm2/s) | #4 | Wu 2021 | 142 | 56 | 24 | 989.81 (915.00, 1063.27) | 965.56 (881.40, 1014.81) |
#7 | Razek 2019 | 48 | 40 | 40 | 1.73 ± 0.08 | 1.52 ± 0.04 |
Parameter | Pooled mean difference | 95% CI |
P-value | Significant difference? | I2
|
---|---|---|---|---|---|
Dimension | |||||
Maximum axial area | 23.28 mm2
| [18.27, 28.30] | < 0.00001 | Yes | 0% |
Maximum coronal area | 14.44 mm2
| [3.44, 25.44] | 0.01 | Yes | 85% |
Maximum axial length | 1.88 mm | [1.15, 2.61] | < 0.00001 | Yes | 0% |
Maximum coronal length | 0.37 mm | [-1.04, 1.77] | 0.61 | No | 81% |
Maximum axial width | 1.45 mm | [1.00, 1.91] | < 0.00001 | Yes | 48% |
Maximum coronal width | 1.00 mm | [0.62, 1.38] | < 0.00001 | Yes | 59% |
DTI-FA | -0.04 | [0.00, 0.08] | 0.04 | Yes | 75% |
DTI-ADC/MD | 0.05 × 10–3 mm2/s | [0.03, 0.07] | < 0.00001 | Yes | 42% |
DWI-ADC | 0.12 × 10–3 mm2/s | [-0.05, 0.30] | 0.16 | No | 98% |
Sequence—Parameter | No. | Author (year) | Sample size (eye) | Purpose (diagnostic/ grading/ therapeutic) | Outcome (Mean ± SD) | ||
---|---|---|---|---|---|---|---|
Group 1
|
Group 2
|
Group 1
|
Group 2
| ||||
T2WI-FS—LG herniation (mm) | #8 | Hu 2020 | Responsive: 58 | Unresponsive: 36 | Therapeutic: responsive vs unresponsive to IV steroid after 6 months | 11.12 ± 2.15 | 9.89 ± 2.54 |
T2WI-FS—SIR | #8 | Hu 2020 | Responsive: 58 | Unresponsive: 36 | Therapeutic: responsive vs unresponsive to IV steroid after 6 months | SIR-max: 3.35 ± 0.88 | 3.44 ± 0.94 |
SIR-mean: 2.42 ± 0.55 | 2.42 ± 0.76 | ||||||
SIR-min: 1.43 ± 0.44 | 1.48 ± 0.53 | ||||||
DTI-FA | #9 | Rui 2021 | Moderate to Severe: 35 | Mild: 22 | Grading (EUGOGO): moderate to severe vs mild | 0.370 ± 0.03 | 0.386 ± 0.031 |
DTI-MD (10^-3 mm^2/s) | 1.41 ± 0.08 | 1.37 ± 0.08 |