甲状腺相关性眼病的影像学诊断技术及应用研究进展
Research Progress on Imaging Diagnostic Techniques and Their Applications for Thyroid-Associated Ophthalmopathy
摘要: 甲状腺相关性眼病(TAO)是一种与甲状腺功能障碍密切相关的自身免疫性疾病，其临床表现多样，包括眼睑退缩、眼球突出、复视、视力下降等，严重影响患者的生活质量。近年来，随着影像学技术的飞速发展，多种成像方法在TAO的诊断、活动性评估及疗效监测中发挥着越来越重要的作用。本文综述了近年来关于TAO影像学诊断技术的最新研究进展，包括光学相干断层扫描、光学相干断层扫描血流成像、放射性核素显像、彩色多普勒成像、电子计算机断层扫描、磁共振成像等，旨在为TAO的临床诊治提供影像学参考。
Abstract: Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease closely related to thyroid dysfunction, with diverse clinical manifestations, including eyelid retraction, exophthalmos, diplopia, and decreased vision, which seriously affect the quality of life of patients. In recent years, with the rapid development of imaging technology, various imaging methods have played an increasingly important role in the diagnosis, activity assessment, and therapeutic monitoring of TAO. This article reviews the latest research progress in imaging diagnostic techniques for TAO in recent years, including optical coherence tomography, optical coherence tomography angiography, radionuclide imaging, color Doppler imaging, computed tomography, and magnetic resonance imaging, aiming to provide imaging references for the clinical diagnosis and treatment of TAO.
文章引用：王冰玉, 贺舒靖, 肖泊杉, 吴乃君. 甲状腺相关性眼病的影像学诊断技术及应用研究进展[J]. 亚洲急诊医学病例研究, 2026, 14(1): 1-12. https://doi.org/10.12677/acrem.2026.141001

参考文献

[1] Huang, J., Chen, M., Liang, Y., Hu, Y., Xia, W., Zhang, Y., et al. (2022) Integrative Metabolic Analysis of Orbital Adipose/Connective Tissue in Patients with Thyroid-Associated Ophthalmopathy. Frontiers in Endocrinology, 13, Article ID: 1001349. [Google Scholar] [CrossRef] [PubMed]
[2] Lai, K.K.H., Aljufairi, F.M.A.A., Li, C.L., Ngai, A.K.Y., Yeung, C.S.K., Fong, R.H.Y., et al. (2023) Efficacy and Safety of 6-Weekly versus 12-Weekly Intravenous Methylprednisolone in Moderate-to-Severe Active Thyroid-Associated Ophthalmopathy. Journal of Clinical Medicine, 12, Article No. 3244. [Google Scholar] [CrossRef] [PubMed]
[3] Barrio-Barrio, J., Sabater, A.L., Bonet-Farriol, E., Velázquez-Villoria, Á. and Galofré, J.C. (2015) Graves’ Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management. Journal of Ophthalmology, 2015, Article ID: 249125. [Google Scholar] [CrossRef] [PubMed]
[4] Mourits, M.P., Koornneef, L., Wiersinga, W.M., Prummel, M.F., Berghout, A. and van der Gaag, R. (1989) Clinical Criteria for the Assessment of Disease Activity in Graves’ Ophthalmopathy: A Novel Approach. British Journal of Ophthalmology, 73, 639-644. [Google Scholar] [CrossRef] [PubMed]
[5] Kvetny, J., Puhakka, K.B. and Røhl, L. (2006) Magnetic Resonance Imaging Determination of Extraocular Eye Muscle Volume in Patients with Thyroid‐Associated Ophthalmopathy and Proptosis. Acta Ophthalmologica Scandinavica, 84, 419-423. [Google Scholar] [CrossRef] [PubMed]
[6] Muralidhar, A., Singh, S., Das, S., Mondal, K., Kumar, B., Agarwal, M., et al. (2023) Choroidal Thickness in Thyroid Eye Disease and Its Correlation with Disease Activity. Indian Journal of Ophthalmology, 72, 281-286. [Google Scholar] [CrossRef] [PubMed]
[7] Chien, L., Go, C.C., Lahaie Luna, G.M. and Briceño, C.A. (2022) Changes in Choroidal Thickness and Choroidal Vascularity Index in Thyroid Eye Disease: A Systematic Review. Orbit, 43, 399-407. [Google Scholar] [CrossRef] [PubMed]
[8] Ioana, A.M., Andrei, D., Iacob, D. and Bolintineanu, S.L. (2025) Retinal and Choroidal Alterations in Thyroid-Associated Ophthalmopathy: A Systematic Review. Life, 15, Article No. 293. [Google Scholar] [CrossRef] [PubMed]
[9] Chien, L., Go, C.C., Luna, G.M.L. and Briceño, C.A. (2023) Changes in Retinal Nerve Fiber Layer, Ganglion Cell Complex, and Ganglion Cell Layer Thickness in Thyroid Eye Disease: A Systematic Review. 14, 217-224.[CrossRef] 
[10] Jamshidian Tehrani, M., Niktinat, H., Ebrahimiadib, N., Jafari, B., Rafizadeh, S.M. and Kasaee, A. (2023) Assessment of Retinal and Choroidal Vessel Density and Nerve Fibre Layer Thickness Changes after Orbitotomy in Patients with Severe Non-Active Thyroid Orbitopathy: A Prospective Study. International Ophthalmology, 43, 4427-4433. [Google Scholar] [CrossRef] [PubMed]
[11] Wu, H., Song, Q., Zhang, Y., Cheng, R., Li, Y., Su, M., et al. (2025) Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) for Assessing Thyroid-Associated Ophthalmopathy Activity. Photodiagnosis and Photodynamic Therapy, 53, Article ID: 104578. [Google Scholar] [CrossRef] [PubMed]
[12] Zhong, S., He, F., Fang, S., Sun, J., Li, Y., Shuo, Z., et al. (2023) Choroidal Thickness in Patients with Thyroid-Associated Ophthalmopathy, as Determined by Swept-Source Optical Coherence Tomography. British Journal of Ophthalmology, 108, 1081-1087. [Google Scholar] [CrossRef] [PubMed]
[13] Yu, L., Jiao, Q., Cheng, Y., Zhu, Y., Lin, Z. and Shen, X. (2020) Evaluation of Retinal and Choroidal Variations in Thyroid-Associated Ophthalmopathy Using Optical Coherence Tomography Angiography. BMC Ophthalmology, 20, Article No. 421. [Google Scholar] [CrossRef] [PubMed]
[14] Wu, J.H., Luo, L.Y., Zhou, H., Wu, Y., Zhang, J. and Cheng, J.W. (2022) Reduced Choroidal Peripapillary Capillaries in Thyroid-Associated Ophthalmopathy with Early Stage of Dysthyroid Optic Neuropathy. International Journal of Ophthalmology, 15, 1135-1141.
[15] Wu, Y., Yang, Q., Ding, L., Tu, Y., Deng, X., Yang, Y., et al. (2022) Peripapillary Structural and Microvascular Alterations in Early Dysthyroid Optic Neuropathy. Eye and Vision, 9, Article No. 30. [Google Scholar] [CrossRef] [PubMed]
[16] Geng, X., Liang, X., Liu, Y., Chen, Y., Xue, B., Wei, X., et al. (2024) Natural Fat Nanoemulsions for Enhanced Optical Coherence Tomography Neuroimaging and Tumor Imaging in the Second Near-Infrared Window. ACS Nano, 18, 9187-9198. [Google Scholar] [CrossRef] [PubMed]
[17] Fernando, R., Caldera, O. and Smith, T.J. (2021) Therapeutic IGF-I Receptor Inhibition Alters Fibrocyte Immune Phenotype in Thyroid-Associated Ophthalmopathy. Proceedings of the National Academy of Sciences, 118, e2114244118. [Google Scholar] [CrossRef] [PubMed]
[18] Kang, S., Hamed Azzam, S., Minakaran, N. and Ezra, D.G. (2022) Rituximab for Thyroid-Associated Ophthalmopathy. Cochrane Database of Systematic Reviews, 2022, CD009226. [Google Scholar] [CrossRef] [PubMed]
[19] Gürez, C. and Ergül, N. (2024) Does Radioactive Iodine Treatment Damage the Lacrimal System? Clinical Nuclear Medicine, 49, 513-515. [Google Scholar] [CrossRef] [PubMed]
[20] Ariamanesh, S., Ayati, N., Mazloum Khorasani, Z., Mousavi, Z., Kiavash, V., Kiamanesh, Z., et al. (2020) Effect of Different 131I Dose Strategies for Treatment of Hyperthyroidism on Graves’ Ophthalmopathy. Clinical Nuclear Medicine, 45, 514-518. [Google Scholar] [CrossRef] [PubMed]
[21] Oeverhaus, M., Koenen, J., Bechrakis, N., Stöhr, M., Herrmann, K., Fendler, W.P., et al. (2022) Radioiodine Ablation of Thyroid Remnants in Patients with Graves’ Orbitopathy. Journal of Nuclear Medicine, 64, 561-566. [Google Scholar] [CrossRef] [PubMed]
[22] Shin, K., Choung, H., Lee, M.J., Kim, J., Lee, G.M., Kim, S., et al. (2024) A Preliminary Evaluation of the Diagnostic Performance of a Smartphone-Based Machine Learning-Assisted System for Evaluation of Clinical Activity Score in Digital Images of Thyroid-Associated Orbitopathy. Thyroid®, 34, 744-752. [Google Scholar] [CrossRef] [PubMed]
[23] Yao, N., Li, L., Gao, Z., Zhao, C., Li, Y., Han, C., et al. (2023) Deep Learning-Based Diagnosis of Disease Activity in Patients with Graves’ Orbitopathy Using Orbital SPECT/CT. European Journal of Nuclear Medicine and Molecular Imaging, 50, 3666-3674. [Google Scholar] [CrossRef] [PubMed]
[24] Li, H., Wang, Y., Zhou, J., You, D., Song, L., Wang, M., et al. (2024) Evaluation of Fibroinflammatory Activity in Thyroid Eye Disease Using [18F]AlF-NOTA-FAPI-04 PET/CT: A Prospective Study. European Journal of Nuclear Medicine and Molecular Imaging, 52, 1890-1900. [Google Scholar] [CrossRef] [PubMed]
[25] Chen, Y., Tang, R., Xiong, W., Zhang, F., Wang, N., Xie, B., et al. (2023) RNA Aptamers with Specific Binding Affinity to CD40 (CD40Apt) Represents a Promising Antagonist of the CD40-CD40L Signaling for Thyroid-Associated Ophthalmopathy (TAO) Treatment in Mouse. Journal of Translational Medicine, 21, Article No. 396. [Google Scholar] [CrossRef] [PubMed]
[26] Cao, J., Zhang, F., Chen, H., Wu, B., Yin, J., Chenzhao, C., et al. (2024) A TSHR-Targeting Aptamer in Monocytes Correlating with Clinical Activity in Tao. International Journal of Nanomedicine, 19, 3577-3588. [Google Scholar] [CrossRef] [PubMed]
[27] Goel, R., Shah, S., Sundar, G., Arora, R., Gupta, S. and Khullar, T. (2023) Orbital and Ocular Perfusion in Thyroid Eye Disease. Survey of Ophthalmology, 68, 481-506. [Google Scholar] [CrossRef] [PubMed]
[28] Tang, J., Kilic, K., Szabo, T.L. and Boas, D.A. (2021) Improved Color Doppler for Cerebral Blood Flow Axial Velocity Imaging. IEEE Transactions on Medical Imaging, 40, 758-764. [Google Scholar] [CrossRef] [PubMed]
[29] Sun, X., Su, M., Zhang, X., Shen, H., Xie, Z., Kong, W., et al. (2024) Correlation between Choroidal Vascularity and Retrobulbar Ocular Blood Flow Changes and Thyroid-Associated Ophthalmopathy Activity: A Cross-Sectional Study. BMC Ophthalmology, 24, Article No. 64. [Google Scholar] [CrossRef] [PubMed]
[30] Srisombut, T., Arjkongharn, N., Vongsa, N., Kanacharoen, A. and Kemchoknatee, P. (2024) Orbital CT Scan Parameters in Dysthyroid Optic Neuropathy: A Systematic Review and Meta-Analysis. Eye, 38, 1734-1741. [Google Scholar] [CrossRef] [PubMed]
[31] Berger, M., Matlach, J., Pitz, S., Berres, M., Axmacher, F., Kahaly, G.J., et al. (2022) Imaging of the Medial Rectus Muscle Predicts the Development of Optic Neuropathy in Thyroid Eye Disease. Scientific Reports, 12, Article No. 6259. [Google Scholar] [CrossRef] [PubMed]
[32] Rana, K., Garg, D., Yong, L.S.S., Macri, C., Tong, J.Y., Patel, S., et al. (2024) Extraocular Muscle Enlargement in Dysthyroid Optic Neuropathy. Canadian Journal of Ophthalmology, 59, e542-e546. [Google Scholar] [CrossRef] [PubMed]
[33] Osias, E., Cale, M., Saffari, P., Barbosa Diniz, S., Singh, P. and Rootman, D.B. (2023) Clinical and Demographic Predictors of Buccal Fat Pad Volume in Thyroid Eye Disease. Orbit, 43, 58-63. [Google Scholar] [CrossRef] [PubMed]
[34] Starčević, A., Radojičić, Z., Djurić Stefanović, A., Trivić, A., Milić, I., Milić, M., et al. (2023) Morphometric and Volumetric Analysis of Lacrimal Glands in Patients with Thyroid Eye Disease. Scientific Reports, 13, Article No. 16345. [Google Scholar] [CrossRef] [PubMed]
[35] Ma, L., Jiang, X., Yang, X., Wang, M., Hou, Z., Zhang, J. and Li, D. (2025) CT-Based Machine Learning Radiomics Analysis to Diagnose Dysthyroid Optic Neuropathy. Seminars in Ophthalmology, 40, 419-425.
[36] Liu, Z., Tan, K., Zhang, H., Sun, J., Li, Y., Fang, S., et al. (2024) CT-Based Artificial Intelligence Prediction Model for Ocular Motility Score of Thyroid Eye Disease. Endocrine, 86, 1055-1064. [Google Scholar] [CrossRef] [PubMed]
[37] Wu, C., Li, S., Liu, X., Jiang, F. and Shi, B. (2022) DMs-MAFM+ Efficientnet: A Hybrid Model for Predicting Dysthyroid Optic Neuropathy. Medical & Biological Engineering & Computing, 60, 3217-3230. [Google Scholar] [CrossRef] [PubMed]
[38] Ye, Y., Hu, F., Ji, Y., Wang, R., Zhu, K. and Kong, Q. (2023) The Outcomes of Endoscopic Orbital Decompression Combined with Fat Decompression for Thyroid-Associated Ophthalmopathy. BMC Ophthalmology, 23, Article No. 217. [Google Scholar] [CrossRef] [PubMed]
[39] Sun, R., Yin, Z., Li, L., Zhou, H., Song, X. and Li, Y. (2023) A Novel Method of Measuring Proptosis with Computed Tomography. Acta Radiologica, 64, 2603-2610. [Google Scholar] [CrossRef] [PubMed]
[40] Kuo, P.C., Kuo, S.C., Teng, Y.S. and Lai, C.C. (2025) Association of Obesity with Orbital Fat Expansion in Thyroid Eye Disease. BMC Ophthalmology, 25, Article No. 2. [Google Scholar] [CrossRef] [PubMed]
[41] Moledina, M., Lee, V., Bhatia, K., Madani, G., Feeney, C., George, N., et al. (2025) Radiological Activity Score (RAS)—MRI Characteristics in Dysthyroid Optic Neuropathy in a Multi‐Ethnic Thyroid Eye Disease Population. Clinical Endocrinology, 103, 385-395. [Google Scholar] [CrossRef] [PubMed]
[42] Karhanová, M., Kalitová, J., Kovář, R., Schovánek, J., Karásek, D., Čivrný, J., et al. (2022) Ocular Hypertension in Patients with Active Thyroid-Associated Orbitopathy: A Predictor of Disease Severity, Particularly of Extraocular Muscle Enlargement. Graefe’s Archive for Clinical and Experimental Ophthalmology, 260, 3977-3984. [Google Scholar] [CrossRef] [PubMed]
[43] Nakano, M., Konishi, H. and Koshiba, M. (2022) Thyroid-Stimulating Antibody/Thyroid-Stimulating Hormone Receptor Antibody Ratio as a Sensitive Screening Test for Active Graves’ Orbitopathy. Endocrine Practice, 28, 1050-1054. [Google Scholar] [CrossRef] [PubMed]
[44] Ueki, S., Hasegawa, Y., Hatase, T., Kiyokawa, M. and Fukuchi, T. (2022) One-Year Recurrence Rate of Graves Ophthalmopathy Presenting as Diplopia in the Primary Position after Varied Doses of Intravenous Methylprednisolone Followed by Oral Prednisolone with Dosing Based on the Magnetic Resonance Imaging Findings. Japanese Journal of Ophthalmology, 67, 91-96. [Google Scholar] [CrossRef] [PubMed]
[45] Liu, H., Zhong, Y. and Huang, X. (2024) Specific Static and Dynamic Functional Network Connectivity Changes in Thyroid-Associated Ophthalmopathy and It Predictive Values Using Machine Learning. Frontiers in Neuroscience, 18, Article ID: 1429084. [Google Scholar] [CrossRef] [PubMed]
[46] Qi, C., Wen, Z. and Huang, X. (2024) Altered Functional Connectivity Strength of Primary Visual Cortex in Subjects with Thyroid-Associated Ophthalmopathy. NeuroReport, 35, 568-576. [Google Scholar] [CrossRef] [PubMed]
[47] Tian, H., Wang, Y., Li, J. and Li, H. (2023) Prognostic Value of Extraocular Muscles for Intraocular Pressure in Thyroid-Associated Ophthalmopathy Patients. Quantitative Imaging in Medicine and Surgery, 13, 5727-5736. [Google Scholar] [CrossRef] [PubMed]
[48] Gao, Y., Chang, Q., Li, Y., Zhang, H., Hou, Z., Zhang, Z., et al. (2022) Correlation between Extent of Lacrimal Gland Prolapse and Clinical Features of Thyroid-Associated Ophthalmopathy: A Retrospective Observational Study. BMC Ophthalmology, 22, Article No. 66. [Google Scholar] [CrossRef] [PubMed]
[49] Wong, N.T.Y., Yuen, K.F.K., Aljufairi, F.M.A.A., Lai, K.K.H., Hu, Z., Chan, K.K.W., et al. (2023) Magnetic Resonance Imaging Parameters on Lacrimal Gland in Thyroid Eye Disease: A Systematic Review and Meta-Analysis. BMC Ophthalmology, 23, Article No. 347. [Google Scholar] [CrossRef] [PubMed]
[50] Li, Y., Ma, J., Xiao, J., Wang, Y. and He, W. (2023) Use of Extreme Gradient Boosting, Light Gradient Boosting Machine, and Deep Neural Networks to Evaluate the Activity Stage of Extraocular Muscles in Thyroid-Associated Ophthalmopathy. Graefe’s Archive for Clinical and Experimental Ophthalmology, 262, 203-210. [Google Scholar] [CrossRef] [PubMed]
[51] Ma, Z., Lin, J., Li, S., Liu, H. and Zhang, Y. (2024) Deep Learning Methods for Diagnosis of Graves’ Ophthalmopathy Using Magnetic Resonance Imaging. Quantitative Imaging in Medicine and Surgery, 14, 5099-5108. [Google Scholar] [CrossRef] [PubMed]
[52] Zhou, W., Song, Y., Shi, J. and Li, T. (2025) The Value of MRI and Radiomics for the Diagnostic Evaluation of Thyroid-Associated Ophthalmopathy. Diagnostics, 15, Article No. 388. [Google Scholar] [CrossRef] [PubMed]
[53] Hu, H., Pu, X., Zhou, J., Jiang, W., Wu, Q., Lu, J., et al. (2024) Determining Disease Activity and Glucocorticoid Response in Thyroid-Associated Ophthalmopathy: Preliminary Study Using Dynamic Contrast-Enhanced MRI. Korean Journal of Radiology, 25, 1070-1082. [Google Scholar] [CrossRef] [PubMed]
[54] Ma, R., Geng, Y., Gan, L., Peng, Z., Cheng, J., Guo, J., et al. (2021) Quantitative T1 Mapping MRI for the Assessment of Extraocular Muscle Fibrosis in Thyroid-Associated Ophthalmopathy. Endocrine, 75, 456-464. [Google Scholar] [CrossRef] [PubMed]
[55] Wu, Q., Zhou, J., Fang, W., Jiang, W., Pu, X., Chen, H., et al. (2023) Structural and Functional Brain Changes after Glucocorticoid Therapy in Thyroid-Associated Ophthalmopathy. The Journal of Clinical Endocrinology & Metabolism, 109, 649-658. [Google Scholar] [CrossRef] [PubMed]
[56] Hu, H., Chen, L., Zhang, J., Chen, W., Chen, H., Liu, H., et al. (2022) T2‐Weighted MR Imaging‐Derived Radiomics for Pretreatment Determination of Therapeutic Response to Glucocorticoid in Patients with Thyroid‐Associated Ophthalmopathy: Comparison with Semiquantitative Evaluation. Journal of Magnetic Resonance Imaging, 56, 862-872. [Google Scholar] [CrossRef] [PubMed]
[57] Li, Z., Luo, Y., Feng, X., Zhang, Q., Zhong, Q., Weng, C., et al. (2023) Application of Multiparameter Quantitative Magnetic Resonance Imaging in the Evaluation of Graves’ Ophthalmopathy. Journal of Magnetic Resonance Imaging, 58, 1279-1289. [Google Scholar] [CrossRef] [PubMed]

为你推荐