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Assessment of disease activity in Graves' ophthalmopathy by orbital ultrasonography and clinical parameters
Author(s) -
Gerding Martin N.,
Prummel Mark F.,
Wiersinga Wilmar M.
Publication year - 2000
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1046/j.1365-2265.2000.00973.x
Subject(s) - medicine , graves' ophthalmopathy , predictive value , graves' disease , predictive value of tests , predictive marker , ultrasonography , eye disease , immunosuppression , receiver operating characteristic , gastroenterology , surgery , disease , cancer
OBJECTIVE To study if A‐mode ultrasonography (US) in combination with the Clinical Activity Score (CAS) and duration of Graves' ophthalmopathy (GO) could predict the response to immunosuppression in Graves' ophthalmopathy. DESIGN A prospective clinical study. PATIENTS AND METHODS Fifty‐six consecutive patients with moderately severe GO were treated with retrobulbar irradiation (10 fractions of 2 Gy). Before treatment the internal reflectivity in the extraocular eye muscles, the CAS, and the duration of Graves' ophthalmopathy were assessed and related to the therapeutic outcome 26 weeks after irradiation. RESULTS Twenty‐eight (50%) of the patients responded favourably to radiotherapy (four patients became worse, and 24 did not change), and the eye muscle echogenecity indeed tended to be lower in the responders than in the non‐responders ( P = 0.09). From a receiver operator characteristics curve, a cut‐off value of 30% yielded a good positive predictive value of 85%, but the negative predictive value was only 60%. The CAS (≥ 4/10) had a positive predictive value of 65%, and a negative predictive value of 56%. When combining the ultrasound with the CAS, the positive predictive value increased to 74% and the negative predictive value to 72%. Adding the duration of eye symptoms (cut‐off 18 months), the prediction of response further improved: positive predictive value 79%, and negative predictive value 89%. CONCLUSIONS A‐mode ultrasonography has a rather good positive predictive value, but its poor negative predictive value precludes its use as sole activity parameter. By adding the Clinical Activity Score and duration of Graves' ophthalmopathy, the negative predictive value increased considerably. By using this combination, inactive disease can be identified more precise, permitting rehabilitative surgery at an earlier stage in these patients.