Share this content in WeChat
Clinical Article
Comparative study on the application of Dixon and SPAIR in thyroid-associated ophthalmopathy
HUANG Kai  LIN Xiaoxin  LUO Yaosheng  HU Qiugen  GUO Baoliang  OUYANG Fusheng  OUYANG Yufeng  SONG Cheng  CHEN Haixiong 

HUANG K, LIN X X, LUO Y S, et al. Comparative study on the application of Dixon and SPAIR in thyroid-associated ophthalmopathy[J]. Chin J Magn Reson Imaging, 2023, 14(8): 51-57. DOI:10.12015/issn.1674-8034.2023.08.008.

[Abstract] Objective To compare the image quality and application value of water-fat separation (Dixon) and spectral attenuated inversion recovery (SPAIR) MRI fat suppression techniques in thyroid-associated ophthalmopathy (TAO).Materials and Methods This cross-sectional retrospective study included 73 TAO patients (146 eyes) who underwent orbital MRI including Dixon and SPAIR fat suppression sequences from 2020 to 2022. We compared the fat suppression effect, artifacts, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and diagnostic efficacy of TAO activity between T2WI-Dixon aqueous phase and T2WI-SPAIR images.Results In terms of the overall image quality of MRI, the proportion of T2WI-Dixon aqueous phase images superior to T2WI-SPAIR images was higher (67.1% vs. 13.7%). The fat suppression effect, artifact score and noise of T2WI-Dixon aqueous phase were significantly lower than those of T2WI-SPAIR images (Z: 6.632-10.473, P<0.001), SNR and CNR were significantly higher than those of T2WI-SPAIR images (Z: -8.792--10.482, P<0.001). The correlation between extraocular muscle/white matter signal intensity ratio (EOM-SIR), lacrimal gland/white matter signal intensity ratio (LG-SIR) and clinical activity score (CAS) in T2WI-Dixon water phase images was higher than that in T2WI-SPAIR image (0.613 vs. 0.520; 0.282 vs. 0.251). The AUC of EOM-SIR and LG-SIR of T2WI-Dixon water phase in evaluating TAO activity was higher than that of T2WI-SPAIR image (0.872 vs. 0.772; 0.673 vs. 0.604), the difference was statistically significant (Z=4.070, P<0.001; Z=2.174, P=0.030).Conclusions The image quality of T2WI-Dixon was better than that of T2WI-SPAIR. In addition, T2WI-Dixon water has a stronger ability to evaluate the inflammatory edema of TAO retrobulbar tissue than T2WI-SPAIR images, and has higher diagnostic efficiency for TAO diagnosis and activity staging. Dixon technique provides an excellent fat suppression technique for MRI examination of TAO patients.
[Keywords] thyroid-associated ophthalmopathy;fat-suppression;image quality;Dixon;spectral attenuated inversion recovery;magnetic resonance imaging

HUANG Kai1   LIN Xiaoxin1   LUO Yaosheng2   HU Qiugen1   GUO Baoliang1   OUYANG Fusheng1   OUYANG Yufeng1   SONG Cheng2   CHEN Haixiong1*  

1 Department of Radiology, Shunde Hospital, Southern Medical University, Foshan 528308, China

2 Department of Endocrinology, Shunde Hospital, Southern Medical University, Foshan 528308, China

Corresponding author: Chen HX, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS Medical Scientific and Technology Research Foundation of Guangdong Province of China (No. B2022185); Foshan Self-Raised Funds of Science and Technology Plan Projects (No. 2220001003987); Research Initiation Program of Shunde Hospital, Southern Medical University (Key Specialty-Cultivation Project) (No. SRSP2021037).
Received  2023-04-02
Accepted  2023-07-21
DOI: 10.12015/issn.1674-8034.2023.08.008
HUANG K, LIN X X, LUO Y S, et al. Comparative study on the application of Dixon and SPAIR in thyroid-associated ophthalmopathy[J]. Chin J Magn Reson Imaging, 2023, 14(8): 51-57. DOI:10.12015/issn.1674-8034.2023.08.008.

ŞAHLI E, GÜNDÜZ K. Thyroid-associated ophthalmopathy[J]. Turk J Ophthalmol, 2017, 47(2): 94-105. DOI: 10.4274/tjo.80688.
BARTALENA L, KAHALY G J, BALDESCHI L, et al. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy[J]. Eur J Endocrinol, 2021, 185(4): G43-G67. DOI: 10.1530/EJE-21-0479.
BARTALENA L, TANDA M L. Current concepts regarding Graves' orbitopathy[J]. J Intern Med, 2022, 292(5): 692-716. DOI: 10.1111/joim.13524.
MOURITS M P, PRUMMEL M F, WIERSINGA W M, et al. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy[J]. Clin Endocrinol, 1997, 47(1): 9-14. DOI: 10.1046/j.1365-2265.1997.2331047.x.
LI Z F, LUO Y S, FENG X T, et al. Application of multiparameter quantitative magnetic resonance imaging in the evaluation of Graves' ophthalmopathy[J/OL]. J Magn Reson Imaging, 2023 [2023-04-01]. DOI: 10.1002/jmri.28642.
SONG C, LUO Y S, YU G F, et al. Current insights of applying MRI in Graves' ophthalmopathy[J/OL]. Front Endocrinol, 2022, 13: 991588 [2023-04-01]. DOI: 10.3389/fendo.2022.991588.
LIU X T, SU Y, JIANG M D, et al. Application of magnetic resonance imaging in the evaluation of disease activity in Graves' ophthalmopathy[J]. Endocr Pract, 2021, 27(3): 198-205. DOI: 10.1016/j.eprac.2020.09.008.
TIAN Q C, XIAN J F, WANG Z C, et al. Application of fat suppression with GdDTPA enhancement in MRI of the orbit[J]. Chin J Radiol, 1999, 33(6): 395-399. DOI: 10.3760/j.issn:1005-1201.1999.06.011.
JENISTA E R, JENSEN C J, WENDELL D, et al. Double spectral attenuated inversion recovery (DSPAIR)-an efficient fat suppression technique for late gadolinium enhancement at 3 Tesla[J/OL]. [2023-04-01]. DOI: , 2021, 34(10): e4580. DOI: 10.1002/nbm.4580.
GE Q, ZHANG X H, WANG L, et al. Quantitative evaluation of activity of thyroid-associated Ophthalmopathy using short-tau inversion recovery (STIR) sequence[J/OL]. BMC Endocr Disord, 2021, 21(1): 226 [2023-04-01]. DOI: 10.1186/s12902-021-00895-3.
DALTO V F, ASSAD R L, LORENZATO M M, et al. Comparison between STIR and T2-weighted SPAIR sequences in the evaluation of inflammatory sacroiliitis: diagnostic performance and signal-to-noise ratio[J]. Radiol Bras, 2020, 53(4): 223-228. DOI: 10.1590/0100-3984.2019.0077.
DIXON W T. Simple proton spectroscopic imaging[J]. Radiology, 1984, 153(1): 189-194. DOI: 10.1148/radiology.153.1.6089263.
KIRCHGESNER T, STOENOIU M, MICHOUX N, et al. Comparison between 3-point Dixon- and CHESS-based OMERACT-recommended MRI protocols in hands of patients with suspicion of early rheumatoid arthritis[J/OL]. Eur J Radiol, 2021, 134: 109412 [2023-04-01]. DOI: 10.1016/j.ejrad.2020.109412.
LIU W Y, CHEN L, HU H, et al. Comparison of imaging quality for Dixon and Fat-Sat techniques in orbital T2-weighted imaging[J]. J Nanjing Med Univ Nat Sci, 2022, 42(12): 1741-1744.
CHEN L, HU H, CHEN H H, et al. Usefulness of two-point Dixon T2-weighted imaging in thyroid-associated ophthalmopathy: comparison with conventional fat saturation imaging in fat suppression quality and staging performance[J/OL]. Br J Radiol, 2021, 94(1118): 20200884 [2023-04-01]. DOI: 10.1259/bjr.20200884.
OLLITRAULT A, CHARBONNEAU F, HERDAN M L, et al. Dixon-T2WI magnetic resonance imaging at 3 Tesla outperforms conventional imaging for thyroid eye disease[J]. Eur Radiol, 2021, 31(7): 5198-5205. DOI: 10.1007/s00330-020-07540-y.
BARTLEY G B, GORMAN C A. Diagnostic criteria for Graves' ophthalmopathy[J]. Am J Ophthalmol, 1995, 119(6): 792-795. DOI: 10.1016/S0002-9394(14)72787-4.
GADDIKERI S, MOSSA-BASHA M, ANDRE J B, et al. Optimal fat suppression in head and neck MRI: comparison of multipoint Dixon with 2 different fat-suppression techniques, spectral presaturation and inversion recovery, and STIR[J]. AJNR Am J Neuroradiol, 2018, 39(2): 362-368. DOI: 10.3174/ajnr.A5483.
TAKAHASHI A, BABA S, SASAKI M. Assessment of collimators in radium-223 imaging with channelized Hotelling observer: a simulation study[J]. Ann Nucl Med, 2018, 32(10): 649-657. DOI: 10.1007/s12149-018-1286-4.
KIRSCH E C, KAIM A H, DE OLIVEIRA M G, et al. Correlation of signal intensity ratio on orbital MRI-TIRM and clinical activity score as a possible predictor of therapy response in Graves' orbitopathy: a pilot study at 1.5 T[J]. Neuroradiology, 2010, 52(2): 91-97. DOI: 10.1007/s00234-009-0590-z.
HU H, XU X Q, WU F Y, et al. Diagnosis and stage of Graves' ophthalmopathy: efficacy of quantitative measurements of the lacrimal gland based on 3-T magnetic resonance imaging[J]. Exp Ther Med, 2016, 12(2): 725-729. DOI: 10.3892/etm.2016.3389.
LEE S M, CHOI D S, SHIN H S, et al. FSE T2-weighted two-point Dixon technique for fat suppression in the lumbar spine: comparison with SPAIR technique[J]. Diagn Interv Radiol, 2018, 24(3): 175-180. DOI: 10.5152/dir.2018.17320.
SHI C L, FU H, GUO Y K, et al. Application value of T2WI-Dixon water fat separation sequence in the evaluation of muscle fat infiltration and edema in patient with Duchenne muscular dystrophy[J]. Chin J Magn Reson Imag, 2022, 13(7): 96-102. DOI: 10.12015/issn.1674-8034.2022.07.017.
LINS C F, SALMON C E G, NOGUEIRA-BARBOSA M H. Applications of the Dixon technique in the evaluation of the musculoskeletal system[J]. Radiol Bras, 2021, 54(1): 33-42. DOI: 10.1590/0100-3984.2019.0086.
YAO G, LIANG Z P, YANG Y F, et al. Comparison of fat suppression effects between Dixon and SPAIR techniques in the neck MRI[J]. Chin J Radiol, 2020, 54(7): 707-712. DOI: 10.3760/cma.j.cn112149-20200416-00563.
FENG F F, LI W J, SUN J, et al. A comparative study of the effect of SPAIR and Dixon techniques on fat suppression in spine magnetic resonance imaging[J]. China Mod Dr, 2022, 60(31): 57-59, 72.
WENDL C M, EIGLSPERGER J, DENDL L M, et al. Fat suppression in magnetic resonance imaging of the head and neck region: is the two-point DIXON technique superior to spectral fat suppression?[J/OL]. Br J Radiol, 2018, 91(1085): 20170078 [2023-04-01]. DOI: 10.1259/bjr.20170078.
ZAIKE T, KOTAKI S, TAKAHASHI S, et al. Evaluation of fat suppression effect and SNR using pixel shift method of fat suppression images with CHESS and IDEAL in head and neck MR imaging[J]. Nihon Hoshasen Gijutsu Gakkai Zasshi, 2021, 77(10): 1196-1202. DOI: 10.6009/jjrt.2021_JSRT_77.10.1196.
DENG W M, KANG W Y, WEN J, et al. Comparison of fat suppression effect of Dixon and frequency-selective saturation in head and neck contrast-enhanced MRI[J]. Chin J Med Imag Technol, 2018, 34(9): 1390-1394. DOI: 10.13929/j.1003-3289.201802038.
LI J, LI T, XIAN J F. Study of fat suppression effect and image quality of orbital MRI using IDEAL technique[J]. Radiol Pract, 2016, 31(8): 695-699. DOI: 10.13609/j.cnki.1000-0313.2016.08.005.
HUIJGEN W H F, VAN RIJSWIJK C S P, BLOEM J L. Is fat suppression in T1 and T2 FSE with mDixon superior to the frequency selection-based SPAIR technique in musculoskeletal tumor imaging?[J]. Skeletal Radiol, 2019, 48(12): 1905-1914. DOI: 10.1007/s00256-019-03227-8.
ZHAI L H, LUO B, WU H Y, et al. Prediction of treatment response to intravenous glucocorticoid in patients with thyroid-associated ophthalmopathy using T2 mapping and T2 IDEAL[J/OL]. Eur J Radiol, 2021, 142: 109839 [2023-04-01]. DOI: 10.1016/j.ejrad.2021.109839.
JIANG W H, HU H, CHEN H H, et al. The value of quantitative parameters on magnetization transfer imaging of lacrimal glands in distinguishing the clinical activity of thyroid-associated ophthalmopathy[J]. Chin J Magn Reson Imag, 2022, 13(11): 17-21. DOI: 10.12015/issn.1674-8034.2022.11.004.
JIANG M D, SONG X F, ZHANG H Y, et al. The combination of T2-mapping value of lacrimal gland and clinical indicators can improve the stage prediction of Graves' ophthalmopathy compared to clinical activity scores[J]. Endocrine, 2022, 78(2): 321-328. DOI: 10.1007/s12020-022-03167-9.
ZHAI L H, WANG Q X, LIU P, et al. T2 mapping with and without fat-suppression to predict treatment response to intravenous glucocorticoid therapy for thyroid-associated ophthalmopathy[J]. Korean J Radiol, 2022, 23(6): 664-673. DOI: 10.3348/kjr.2021.0627.

PREV Cerebral imaging characteristics of pruritus caused by eczema based on fALFF and FC analyses
NEXT Value of whole volume histogram features from Synthetic MRI in differentiating benign and malignant breast tumor

Tel & Fax: +8610-67113815    E-mail: