ULTRASOUND EXAMINATION OF THE ORBIT IN PATIENTS WITH THYROIDASSOCIATED ORBITOPATHY - EXAMINATION GUIDE AND RECOMMENDATIONS FOR EVERYDAY PRACTICE. A REVIEW.

The purpose of this study is to present the possibilities and benefits of ultrasonography (US) of the orbit in the diagnosis and treatment of thyroidassociated orbitopathy (TAO). Methods: US examination of the orbit is an essential addition to clinical and laboratory examination in TAO patients. Nevertheless, it is often neglected in clinical practice or indicated with delay. Based on previously published studies and our experience with the diagnosis and treatment of TAO patients, we aim to highlight the clear benefit of US examination of the orbit and oculomotor muscles, not only for correct TAO diagnosis but also in the monitoring of the disease over time. However, knowledge of the drawbacks and limitations of this method is also essential, as we shall point out. It is always necessary to remember that US examination must be evaluated in connection with the clinical findings. A detailed recommendation for US examination of the extraocular muscles and the orbit based on our experiences with diagnosing and treating TAO patients in daily practice is also included. Conclusion: According to our experience, US examination of the orbit is an excellent and irreplaceable tool for timely TAO diagnosis and further disease monitoring. However, considerable examiner experience and detailed knowledge of the clinical and ultrasound manifestations of TAO are essential.

Computed tomography and magnetic resonance imaging of the orbit in the diagnosis and treatment of thyroid-associated orbitopathy - experience from practice. A Review.

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computed tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included.  Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

Comparison of semi-quantitative and visual assessment of early MRI signal evolution in acute ischaemic stroke.

Background: The evaluation of DWI/FLAIR mismatch in ischaemic stroke patients with unknown, time from onset can determine the treatment strategy. This approach is based on, visual assessment and may be subject to insufficient inter-rater agreement. Objective: To compare the inter-rater agreement of visual evaluation of FLAIR MRI and proposed region of interest (ROI) semiquantitative method in large vessel occlusion (LVO) strokes. Methods: Five readers have analysed MRIs of 104 patients obtained within six hours of the onset of stroke symptoms resulting from LVO visually and semi-quantitatively. For the semiquantitative analysis, a ROI method was used to obtain relative signal intensity compared to the unaffected side. Cut-off values of 1.15 and 1.10 were tested. The analysis yielded FLAIR-positive (abnormal) and negative (normal) findings. Percentage agreement and Fleiss kappa coefficients were calculated. Results: The visual agreement of 5/5 readers and ≥ 4/5 readers occurred in 31% and 59% of cases respectively. Semi-quantitative evaluation using a cut-off value of 1.15 increased the agreements to 67% and 88% respectively. The agreement of visual evaluation was fair. The semi-quantitative method utilising the cut-off of 1.15 had moderate agreement although it increased the number of FLAIR-negative results compared to the visual evaluation. A low cut-off value of 1.10 didn't improve the agreement significantly. Conclusion: The inter-rater agreement of visual evaluation of FLAIR in patients with short-duration large vessel occlusion stroke was fair. The high cut-off value of semiquantitative evaluation increased the agreement although it changed the proportion of FLAIR positive and negative results.

COMPUTER TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING OF THE ORBIT IN THE DIAGNOSIS AND TREATMENT OF THYROID-ASSOCIATED ORBITOPATHY - EXPERIENCE FROM PRACTICE. A REVIEW.

The purpose is to acquaint readers with the contribution of imaging methods (IMs) of the orbit, specifically computer tomography (CT) and magnetic resonance imaging (MRI), in the diagnosis of thyroid-associated orbitopathy (TAO). Methods: IMs of the orbit are an indispensable accessory in the clinical and laboratory examination of TAO patients. The most frequently used and probably most accessible method is an ultrasound examination of the orbit (US), which, however, has a number of limitations. Other methods are CT and MRI. Based on the published knowledge implemented in our practice and several years of experience with the diagnosis and treatment of TAO patients, we would like to point out the benefits of CT and MRI in the given indications: visualisation of the extraocular muscles, assessment of disease activity, diagnosis of dysthyroid optic neuropathy and differential diagnosis of other pathologies in the orbit. Our recommendation for an ideal MRI protocol for disease activity evaluation is also included. Conclusion: IMs play an irreplaceable role not only in the early diagnosis of TAO, but also in the monitoring of the disease and the response to the applied treatment. When choosing a suitable IM for this diagnosis, a number of factors must always be taken into account; not only availability, cost and burden for the patient, but especially the sensitivity and specificity of the given method for the diagnosis of TAO.

MRI in the assessment of thyroid-associated orbitopathy activity.

Management of patients with thyroid-associated orbitopathy (also called Graves' disease) is dependent on the assessment of the disease activity. Evaluation of disease activity is based on ophthalmological examination. Magnetic resonance imaging (MRI) is an auxiliary method that may help quantify the activity and is also helpful in obtaining anatomical information concerning muscle thickness, exophthalmos, or optic neuropathy. We present a review of MRI techniques of the orbits with emphasis on the evaluation of disease activity. The most convincing seems to be the group of T2-weighted techniques such as conventional T2 weighting, T2 relaxometry, and T2 mapping. Dynamic contrast-enhanced MRI is another promising method.

Open mitral commissurotomy. A new plea for an old operation.

From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair. This analysis is concerned exclusively with a subset of 127 patients, in whom open mitral commissurotomy was carried out (104 females and 23 males with a mean age at the time of operation of 45.5 years). There were 2 postoperative deaths, both due to intractable arrhythmias: one on the 4th postoperative day and one 6 years after surgery, giving a cardiac-related mortality of 1.5%. Thromboembolic complications were observed in 5 patients, none of whom developed permanent neurological deficits. There were 2 non-cardiac-related deaths: one of cancer and one of viral pneumonia. Mitral valve replacement was subsequently required in 2 patients at 2 and 7 years, respectively, after commissurotomy. Surgical intervention is pending for 2 further patients who appear likely to require valve replacement. Based on actuarial curves, the analysis of these results shows that, provided valvular morphology is suitable, open mitral commissurotomy is superior to valve replacement with respect to mortality rate and long-term survival.