{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:55:49Z","timestamp":1791932149075,"version":"4.3.4"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Dysthyroid Optic Neuropathy (DON) is a sight threatening and diagnostically challenging complication of Thyroid Eye Disease (TED). We provide a comparative analysis of the MRI features associated between patietnts with and without DON.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Anonymised retrospective cohort study of patients with TED over eleven years. All patients had Axial T1\u2010weighted and coronal 3\u2009mm MRI STIR images. In a subset, a 3\u2010mm\u2010thick non\u2010echoplanar HASTE DWI sequence was acquired in the coronal plane, and an ADC map was calculated using the diffusion scan raw data. Assessment of apical crowding (AC), extraocular muscle (EOM) enlargement (E), peri\u2010muscular fat (PMF)\/muscle signal intensity (SI) and Apparent Diffusion Coefficient (ADC) were analysed on coronal images.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010six consecutive DON and 516 non\u2010DON cases. In the DON group, elevated EOMSI, PMFSI, EOME and AC were present in 54.6%, 25.9%, 72.7% and 64.6%, respectively, compared to 24.1%, 6.2%, 42.1% and 5.9% in the non\u2010DON (<jats:italic>p<\/jats:italic>\u2009=\u20090.001, <jats:italic>p<\/jats:italic>\u2009=\u20090.000, <jats:italic>p<\/jats:italic>\u2009=\u20090.001 and <jats:italic>p<\/jats:italic>\u2009=\u20090.000). The average ADC value in the DON cohort was 1373\u2009\u00b1\u2009319 versus 973\u2009\u00b1\u2009237 in the non\u2010DON (<jats:italic>p<\/jats:italic>\u2009=\u20090.000). Likelihood of DON on Univariable Regression Analysis (Odds Ratios): Apical Crowding (29.1\u2009x <jats:italic>p<\/jats:italic>\u2009=\u20090.000) and ADC Value\u2009\u2265\u20091200 (7.3 x <jats:italic>p<\/jats:italic>\u2009=\u20090.000). On Multivariable Regression Analysis (Odds Ratios): Apical Crowding 22.1 x (<jats:italic>p<\/jats:italic>\u2009=\u20090.000) and ADC Value\u2009\u2265\u20091200 3.7 x (<jats:italic>p<\/jats:italic>\u2009=\u20090.027).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>MRI features associated with a higher diagnostic likelihood of DON include significant AC and elevated ADC values. ADC may show reasonable promise in diagnosing and predicting DON.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15272","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T08:30:13Z","timestamp":1747729813000},"page":"385-395","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Radiological Activity Score (RAS)\u2014MRI Characteristics in Dysthyroid Optic Neuropathy in a Multi\u2010Ethnic Thyroid Eye Disease Population"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3554-7797","authenticated-orcid":false,"given":"Malik","family":"Moledina","sequence":"first","affiliation":[{"name":"Oculoplastics and Adnexal Service, Western Eye Hospital Imperial College Healthcare NHS Trust London UK"},{"name":"Imperial College Ophthalmology Research Group (ICORG) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vickie","family":"Lee","sequence":"additional","affiliation":[{"name":"Oculoplastics and Adnexal Service, Western Eye Hospital Imperial College Healthcare NHS Trust London UK"},{"name":"Imperial College Ophthalmology Research Group (ICORG) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunwar","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Radiology Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitta","family":"Madani","sequence":"additional","affiliation":[{"name":"Department of Radiology Imperial College Healthcare NHS Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Feeney","sequence":"additional","affiliation":[{"name":"Department of Metabolic Medicine St Mary's Hospital, Imperial College Healthcare NHS Foundation Trust London UK"},{"name":"Department of Metabolism, Faculty of Medicine, Digestion and Reproduction Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"George","sequence":"additional","affiliation":[{"name":"National Institute of Health Research Imperial Clinical Research Facility London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nour","family":"Houbby","sequence":"additional","affiliation":[{"name":"National Institute of Health Research Imperial Clinical Research Facility London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy","family":"Metcalf","sequence":"additional","affiliation":[{"name":"National Institute of Health Research Imperial Clinical Research Facility London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Man","sequence":"additional","affiliation":[{"name":"National Institute of Health Research Imperial Clinical Research Facility London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajni","family":"Jain","sequence":"additional","affiliation":[{"name":"Oculoplastics and Adnexal Service, Western Eye Hospital Imperial College Healthcare NHS Trust London UK"},{"name":"Imperial College Ophthalmology Research Group (ICORG) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Aziz","sequence":"additional","affiliation":[{"name":"Oculoplastics and Adnexal Service, Western Eye Hospital Imperial College Healthcare NHS Trust London UK"},{"name":"Imperial College Ophthalmology Research Group (ICORG) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi Kumar","family":"Lingam","sequence":"additional","affiliation":[{"name":"Department of Radiology London North West University Healthcare NHS Trust Harrow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"477","article-title":"The Epidemiologic Characteristics and Clinical Course of Ophthalmopathy Associated With Autoimmune Thyroid Disease in Olmsted County, Minnesota","volume":"92","author":"Bartley G. 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